2025 Southeastern Residency Conference

Title: Evaluation of Outpatient Parenteral Antimicrobial Therapy (OPAT) in a Community Healthcare System
 
Authors: Giovanna Brannon, Chris Whitman, Rachel L. Foster, Kelly Huff, Nichole Moore, Charles Hartley
 
Objective: Describe the pharmacist's role in OPAT management, such as review of antimicrobial selection and adverse event monitoring, to optimize patient safety and reduce hospital readmissions
 
Self Assessment Question: What are potential risk factors associated with unplanned healthcare events that pharmacists can identify in patients receiving OPAT?
 
Background: Outpatient parenteral antimicrobial therapy (OPAT) enables patients to complete extended courses of antimicrobial treatment for serious infections at home or in a step-down facility following hospital discharge. OPAT discharges require a multidisciplinary and well-coordinated approach. The Infectious Diseases Society of America OPAT guidelines recommend all patients should have infectious diseases (ID) experts review prior to initiation of OPAT. Prior studies have shown improved patient safety, improved patient outcomes, and reduction in healthcare costs when ID-trained pharmacists are involved. No formal OPAT program exists at this hospital system. The purpose of this study is to evaluate the OPAT prescribing and management practices across the Infirmary Health system (IHS) in order to understand factors associated with hospital readmissions and improve patient safety and efficiency through streamlining and standardizing the OPAT discharge process.

Methods: In this retrospective epidemiological cohort study, data was collected on patients at least 19 years of age who were discharged with orders to receive parenteral antimicrobials between May 1, 2023 and April 30, 2024. Patients meeting any of these three criteria were screened for inclusion: 1) Discharge order for an intravenous antimicrobial, 2) Order for vascular access for intention of OPAT, or 3) Case management order containing specific OPAT orders. Patients were excluded if they completed the entire planned OPAT course prior to hospital discharge. The primary outcome is the rate of unplanned healthcare events within 30 days of completing OPAT therapy. The secondary outcomes include qualitatively describing the OPAT patient population, hospital length of stay, and 30-day mortality. A sub-group analysis was conducted to evaluate risk factors associated with unplanned healthcare events.

Results: There were 1244 patients who received OPAT during the study period; 101 patients were included in the final analysis after randomization. The median age of patients included was approximately 63 years old (IQR 52-73). The most common infectious diagnoses were osteoarticular (30%), skin and skin structure (18%), endovascular (16%), urologic (16%), and complicated intra-abdominal (14%). Ceftriaxone and vancomycin were the most commonly prescribed antimicrobials. Of the 101 patients evaluated, 42 experienced a 30-day unplanned healthcare event. Of these 42 patients, 25 (60%) of the unplanned healthcare events were OPAT or infection related.  

Conclusion: OPAT patients experienced a high rate of 30-day unplanned healthcare events. Opportunities exist within our healthcare system to improve the OPAT workflow and to enhance safety and efficiency. The results of this study demonstrate the opportunity for our healthcare system to implement a formal multidisciplinary OPAT inpatient review program. This would include ID-trained pharmacists who will review OPAT orders and provide treatment recommendations regarding OPAT modality, antimicrobial selection, outpatient safety and efficacy monitoring, and patient counseling.