196.  Benefits of a Self-Administered Outpatient Antimicrobial Therapy (OPAT) Clinic in a Resource Limited Setting
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Background:  Outpatient parenteral antimicrobial therapy (OPAT) services are commonly administered in one of three settings – infusion clinics, visiting nurse model, and self-administration.

Parkland Hospital is a 758-bed teaching hospital serving an indigent patient population in Dallas, Texas. The OPAT clinic at Parkland Hospital consists of an infectious Disease (ID) physician, 2 ID clinical pharmacists, and nursing staff.  Patients discharged on OPAT are educated regarding self-administration of antibiotics and monitored in OPAT clinic weekly until completion of their therapy.  During OPAT visits, PICC line dressing changes are made, necessary labs are drawn, modifications to therapy are made as needed, and patients are evaluated for resolution of infection. 

Prior to the existence of this clinic patients discharged on OPAT were followed in various settings, and had frequent emergency room (ER) visits and readmissions related to their therapy. The objective of this study is to determine the impact of a dedicated OPAT Clinic on unwanted ER visits and hospital readmissions.

Methods: Numerous inconsistencies and lack of standardization were identified via a process flow map. We standardized the discharge and follow-up process, and developed patient/nursing education tools. We prospectively collected data for patients discharged on OPAT from 11/2009 – present to calculate rates of unwanted ER visits and readmissions.

Results:   The mean duration of therapy (N – 442) was 25 days. The leading diagnosis for OPAT was osteomyelitis (60%) followed by bacteremia (19%) and genitourinary infections (8%). Commonly prescribed antimicrobials were Ceftriaxone, Vancomycin, and Ertapenem. From 4/2009 – 11/2009 the revisit/readmission rate was 53%. The main causes of readmissions were PICC line dysfunction, acute renal failure, and treatment failure.  After the establishment of the OPAT clinic the revisit/readmission rate decreased to 29%.

Conclusion:  OPAT has several pharmacoeconomic advantages associated with cost benefit, cost avoidance, and reduction in nosocomial infections. A dedicated clinic is necessary for the safe, effective and timely monitoring of patients self-administering OPAT.

  


Subject Category: J. Clinical practice issues

Kavita Bhavan, MD, Infectious Disease, UT Southwestern Medical Center, Dallas, TX, Florence Short, Patient Safety & Quality Improvement, Parkland Hospital, Dallas, TX, Nikita Patel, PharmD, Pharmacy Administration, Parkland Hospital, Dallas, TX, Mark Swancutt, UT Southwestern Medical Center, Dallas, TX and Travis Cooper, PharmD, Children's Med. Ctr. Dallas, Dallas, TX

Disclosures:

K. Bhavan, None

F. Short, None

N. Patel, None

M. Swancutt, None

T. Cooper, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.