Mandatory Antimicrobial Stewardship Program Review of Pediatric OPAT: Program Implementation and Results of Pilot Phase
Background: Mandatory infectious disease (ID) consultation or review by an ASP is required at many adult hospitals for patients receiving outpatient parenteral antimicrobial therapy (OPAT), thus reducing OPAT overuse, lowering costs and optimizing therapy. Similar initiatives have not been reported in pediatrics. A retrospective review of OPAT at our children's hospital showed substantial opportunities to improve OPAT use. As a result, our hospital initiated mandatory ASP review prior to hospital discharge for OPAT. We present an overview of the program implementation and pilot phase results.
Methods: Our hospital executive board selected OPAT as a priority area for quality improvement and formed a multidisciplinary implementation team. We analyzed the care process for patients receiving OPAT to identify critical time points and opportunities to notify the ASP about potential OPAT discharges. We modified several care processes to enhance detection of potential discharges. Before hospital-wide implementation, we performed a pilot intervention in two high-volume services: hospital medicine and oncology/ICS.
Results: We implemented 5 distinct care process interventions to enhance detection and recognition of plans for OPAT. These included (1) education of providers; (2) daily prospective ASP review of patients receiving IV antimicrobials via central catheter; (3) modification of the PICC order set to include notification to ASP or ID for PICCs placed for OPAT; (4) verification that OPAT was reviewed by case managers; (5) reminder system to physicians in electronic discharge software. Before program implementation, baseline ID/ASP involvement in OPAT discharges was approximately 50%. During the pilot phase, we successfully identified and reviewed 85% of OPAT cases before discharge (Figure 1). The intervention was implemented hospital-wide on May 1, 2014.
Conclusion: A thorough understanding of care processes associated with OPAT is necessary to identify candidates for ASP review. The pilot phase showed marked improvement but continuous process improvement is needed to identify missed opportunities. Expanding ASP efforts to include mandatory review of OPAT can improve the appropriateness and safety of antimicrobial use in children.
C. Stockmann, None
J. Olson, None
E. A. Thorell, None
A. Pavia, None
A. L. Hersh, None