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The Going Home project: implementing a frontline pharmacist-led team approach towards appropriate IV to oral antibiotic switch for patients with antibiotic resistant infections and subsequent discharge to outpatient management

Abstract number: P1284

Bamford K., Desai M., Lawson W., Jacklin A., Sanderson F., Holmes A., Brown M., Dean Franklin B.

Objectives: A previous study showed that 29% of patient on IV glycopeptides, predominantly used to treat proven or suspected MRSA, fulfilled clinical criteria for switch to oral antibiotics and discharge to completer treatment as an outpatient with a median reduction in stay of 5 days. Prior to this study there was no IV-oral switch program for glycopeptide use with patients usually remaining in hospital until the end of treatment. The objectives of this work were to assess whether the predicted benefit of earlier appropriate discharge to home treatment could be implemented by targeting this group of patients, and if so, whether this was an effective management strategy.

Methods used: We implemented a study using the same approach. All patients on IV glycopeptides were screened against pre-determined IV-oral switch and discharge on oral antibiotics criteria. The study team identified patients suitable for IV-oral switch and discharge. Advice was provided to prescribers on the most appropriate oral antibiotic for switch and treatment at home. Follow up was arranged as appropriate to clinical need.

Switch from IV glycopeptides to oral suitable antibiotics, reduction in length of stay, IV line use, and estimated cost savings were measured. In addition pharmacist time and interventions profile was assessed.

Results: 81 (52%) of patients on IV glycopeptides were switched to an oral antibiotic. 64 (41%) were discharged home early on oral antibiotics. 22 different combinations of oral antibiotic that were either consistent with trust policy or specifically approved by senior microbiology/infectious diseases specialists were used. Overall this intervention resulted in a reduction of 1215 bed days and a further 511 in-patient IV line days. The study ran in parallel and was complimentary to the introduction of an OPAT service.

Conclusion: A targeted approach by a dedicated team results in a significant reduction in hospital length of stay for patients being treated for resistant Gram-positive infections with IV glycopeptides. This intervention improves the quality of infection management and resource utilisation. This has resulted in a successful business case for an enhanced antibiotic pharmacist team.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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