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746. Improving Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) for Solid Tumor Patients at a Comprehensive Cancer Center

BACKGROUND: Increasing rates of antimicrobial resistance require more frequent parenteral antimicrobial therapy. OPAT improves patient quality of life and is cost-effective. Although IDSA OPAT guidelines are applied to cancer patients, few studies have addressed implementation in this unique populat...

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Autores principales: Dishner, Emma L, McDaneld, Patrick, Rowan, Meagan, Robins, Alison, Bartek, Jalen, Dailey Garnes, Natalie J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811171/
http://dx.doi.org/10.1093/ofid/ofz360.814
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author Dishner, Emma L
McDaneld, Patrick
Rowan, Meagan
Robins, Alison
Bartek, Jalen
Dailey Garnes, Natalie J
author_facet Dishner, Emma L
McDaneld, Patrick
Rowan, Meagan
Robins, Alison
Bartek, Jalen
Dailey Garnes, Natalie J
author_sort Dishner, Emma L
collection PubMed
description BACKGROUND: Increasing rates of antimicrobial resistance require more frequent parenteral antimicrobial therapy. OPAT improves patient quality of life and is cost-effective. Although IDSA OPAT guidelines are applied to cancer patients, few studies have addressed implementation in this unique population. Through our quality improvement project, we aimed to improve monitoring of solid tumor patients recommended for OPAT by infectious diseases (ID) consultation as measured by an increased percentage of patients with physician follow-up and laboratory monitoring. METHODS: We used the plan-do-study-act methodology to guide our quality improvement project. To establish baseline frequencies, we retrospectively reviewed a subset of solid tumor patients seen for ID consultation and recommended for OPAT. We used brainstorming, fishbone analysis, and process mapping to analyze our current process. We standardized a sign-off note for inclusion with OPAT recommendations within our electronic medical record. We reminded ID providers of the new process weekly and to notify the OPAT team and outpatient clinical nursing staff of OPAT-enrolled patients. RESULTS: We found that clarifying recommendations addressed several identified obstacles to monitoring. After instituting our intervention, the percentage of patients who completed follow-up increased from 44% to 78% during the 6-week intervention period. Although the frequency of laboratory monitoring recommendations increased from 43% to 86%, the percentage of patients completing such monitoring did not improve. Our results were sustainable during the 3-month post-intervention observation period. CONCLUSION: By standardizing ID recommendations, we increased outpatient follow-up frequency. Our inability to increase the frequency of laboratory monitoring likely reflects the increased complexity of the process, which requires action from external stakeholders. We learned that a simple intervention can have a meaningful impact and that gains can be limited without involvement of all stakeholders. We plan to expand to a comprehensive OPAT clinic for all patients at our facility and further characterize challenges and opportunities for utilizing OPAT in cancer patients. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68111712019-10-29 746. Improving Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) for Solid Tumor Patients at a Comprehensive Cancer Center Dishner, Emma L McDaneld, Patrick Rowan, Meagan Robins, Alison Bartek, Jalen Dailey Garnes, Natalie J Open Forum Infect Dis Abstracts BACKGROUND: Increasing rates of antimicrobial resistance require more frequent parenteral antimicrobial therapy. OPAT improves patient quality of life and is cost-effective. Although IDSA OPAT guidelines are applied to cancer patients, few studies have addressed implementation in this unique population. Through our quality improvement project, we aimed to improve monitoring of solid tumor patients recommended for OPAT by infectious diseases (ID) consultation as measured by an increased percentage of patients with physician follow-up and laboratory monitoring. METHODS: We used the plan-do-study-act methodology to guide our quality improvement project. To establish baseline frequencies, we retrospectively reviewed a subset of solid tumor patients seen for ID consultation and recommended for OPAT. We used brainstorming, fishbone analysis, and process mapping to analyze our current process. We standardized a sign-off note for inclusion with OPAT recommendations within our electronic medical record. We reminded ID providers of the new process weekly and to notify the OPAT team and outpatient clinical nursing staff of OPAT-enrolled patients. RESULTS: We found that clarifying recommendations addressed several identified obstacles to monitoring. After instituting our intervention, the percentage of patients who completed follow-up increased from 44% to 78% during the 6-week intervention period. Although the frequency of laboratory monitoring recommendations increased from 43% to 86%, the percentage of patients completing such monitoring did not improve. Our results were sustainable during the 3-month post-intervention observation period. CONCLUSION: By standardizing ID recommendations, we increased outpatient follow-up frequency. Our inability to increase the frequency of laboratory monitoring likely reflects the increased complexity of the process, which requires action from external stakeholders. We learned that a simple intervention can have a meaningful impact and that gains can be limited without involvement of all stakeholders. We plan to expand to a comprehensive OPAT clinic for all patients at our facility and further characterize challenges and opportunities for utilizing OPAT in cancer patients. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6811171/ http://dx.doi.org/10.1093/ofid/ofz360.814 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Dishner, Emma L
McDaneld, Patrick
Rowan, Meagan
Robins, Alison
Bartek, Jalen
Dailey Garnes, Natalie J
746. Improving Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) for Solid Tumor Patients at a Comprehensive Cancer Center
title 746. Improving Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) for Solid Tumor Patients at a Comprehensive Cancer Center
title_full 746. Improving Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) for Solid Tumor Patients at a Comprehensive Cancer Center
title_fullStr 746. Improving Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) for Solid Tumor Patients at a Comprehensive Cancer Center
title_full_unstemmed 746. Improving Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) for Solid Tumor Patients at a Comprehensive Cancer Center
title_short 746. Improving Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) for Solid Tumor Patients at a Comprehensive Cancer Center
title_sort 746. improving monitoring of outpatient parenteral antimicrobial therapy (opat) for solid tumor patients at a comprehensive cancer center
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811171/
http://dx.doi.org/10.1093/ofid/ofz360.814
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