Outpatient Parenteral Antibiotic Therapy (OPAT) Safety

Outpatient parenteral antibiotic therapy (OPAT) is a common approach to complete therapy for serious infections after hospitalization. It is generally safe, effective, and less costly than prolonged inpatient therapy, although it has well described complications. For some conditions, there is uncertainty around the superiority of OPAT over oral therapy. Several recent studies suggest that OPAT is overused and antimicrobial stewardship activities at hospital discharge can improve care, either by recommending earlier conversion to oral therapy, or by ensuring follow-up plans for patients discharged with OPAT.

The frequency with which OPAT is used has prompted increased concern about the safety of OPAT, with an estimated 3-10% of antimicrobial courses stopped prematurely because of an adverse reaction. A previous EIN survey in 2004 found that 65% of respondents had encountered serious infectious and noninfectious complications in the year before the survey. Involvement of infectious diseases consultants in this process has been shown to improve safety and efficacy and reduce the volume of antibiotic use. The current level of involvement of ID consultants in OPAT is unknown.

The purpose of this survey is to assess basic OPAT practice patterns, the involvement of ID consultants in this process, and ascertain member experiences with adverse events associated with OPAT.
References:
1. Chary A, Tice AD, Martinelli LP, et al. Experience of infectious diseases consultants with outpatient parenteral
    antimicrobial therapy: results of an Emerging Infections Network survey. Clin Infect Dis 2006;43:1290-5.
2. Dryden M, Saeed K, Townsend R, et al. Antibiotic stewardship and early discharge from hospital: impact of a structured
    approach to antimicrobial management. J Antimicrob Chemother 2012 Sept; 67:2289-96.
3. Heintz BH, Halilovic J, Christensen C L. Impact of a multidisciplinary team review of potential outpatient parenteral
    antimicrobial therapy prior to discharge from an academic medical center. Ann Pharmacother 2011 Nov;45:1329-37.
4. Seaton RA, Sharp E, Bezlyak V, et al. Factors associated with outcome and duration of therapy in OPAT patients with
    skin and soft-tissue infections. Int J Antimicrob Agents 2011 Sept;38:243-8.
5. Tice AD, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. Clin Infect Dis 2004;38:1651-72.

If you see patients at more than one institution, please respond based on your experience with your primary hospital (the institution at which you spend the most time).

Name:                                                                       EIN ID: Characteristics of OPAT Practice How many patients do you discharge from your primary hospital on IV antibiotics during an average 30-day period seeing inpatients?    None          1-5         6-15         16-25          26-50          >50 [If you answered ‘None’, please stop here and click Submit below. Thank you for completing this survey.] a. At your primary hospital, is an infectious diseases (ID) consultation required for any     patient to be discharged on IV antibiotics?     No      Yes b. If yes, is ID consultation required prior to placement of vascular access for OPAT?     No      Yes When patients are discharged from your primary hospital on IV antibiotics, who is usually responsible for monitoring and acting upon laboratory results?   [Please select all that apply]  Inpatient ID physician        Discharging physician  Outpatient ID physician           Surgeon  OPAT service  Primary care physician  Pharmacist  No one  Do not know  Other, specify: Does your hospital or clinic have a specified provider or team of providers whose primary purpose is to monitor patients on OPAT?    No      Yes Where do your patients receive OPAT? [Rank in order from 1 (the most frequent) to 5 (the least frequent)] 1 2 3 4 5  Home 1 2 3 4 5  Emergency room 1 2 3 4 5  Infusion center (office, clinic, or hospital-based) 1 2 3 4 5  Dialysis center 1 2 3 4 5  Other, specify: OPAT Safety Issues Do you have a system to track the frequency of errors, adverse events or "near-misses" associated with OPAT?    No      Yes In your experience, how frequently do your patients experience the following OPAT-related complications?   Rare     (0-5%)     Infrequent   (6-15%)   Frequent   (16-25%)   Very Frequent   (>25%) Nephrotoxicity Cytopenias Rash Line occlusion or clotting Line-associated DVT Line exit site or tunnel infection Dislodged line C. difficile infection Bloodstream infection Other, specify: Due to a complication, what percentage of your OPAT patients require... a. ...a change in therapy? <=1%     2-10%    11-20%    21-50%    >50% b. ...hospitalization? <=1%     2-10%    11-20%    21-50%    >50% c. ...line removal or change? <=1%     2-10%    11-20%    21-50%    >50% How do you think that the frequency of OPAT-related complications has changed over the past 5 years? Less frequent         About the same        More frequent        Do not know What factors present the most difficulty in providing safe OPAT services to your patients? [Rank in order from 1 (the most challenging) to 7 (the least challenging)] 1 2 3 4 5 6 7  Lack of dedicated personnel to proactively find and review lab results 1 2 3 4 5 6 7  Volume of lab results 1 2 3 4 5 6 7  Diversity in locations at which patients receive OPAT 1 2 3 4 5 6 7  Too many home health/infusion companies 1 2 3 4 5 6 7  Not enough home health/infusion companies 1 2 3 4 5 6 7  Difficulty communicating with home health/infusion companies 1 2 3 4 5 6 7  Other, specify: Assuming lab values are within normal limits at the time of hospital discharge, indicate how frequently you typically order monitoring labs for the antibiotics below:   <1x/week     1x/week     2x/week     3x/week     >3x/week   Aminoglycosides Amphotericin (any formulation) Carbapenems Cephalosporins Oxacillin/nafcillin Vancomycin Daptomycin Additional comments about OPAT and related safety issues: