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CHAPTER AIMS
The aims of this chapter are to:
Describe common medication-related problems encountered in Outpatient Parenteral Antimicrobial Therapy (OPAT) patients during the transition of care process.
Discuss the roles of critical thinking, clinical reasoning and the Pharmacists’ Patient Care Process (PPCP) in assessing and resolving medication-related problems as a part of collaborative care for patients receiving OPAT.
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KEY WORDS
• OPAT • infectious diseases • transitions of care • clinical reasoning • clinical problem solving • medication-related problems • Pharmacists’ Patient Care Process • critical thinking
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Infectious diseases (IDs) are encountered commonly across the healthcare system and affect all patient populations. These conditions range from nonsevere infections that may be treated in the self-care setting (eg, minor skin infections) and outpatient setting (eg, uncomplicated urinary tract infections) to critical illnesses requiring intensive hospital resources for management. In addition, patients with deep-seated infections may initiate therapy in the hospital and transition to the outpatient setting to complete a treatment course. Pharmacists fulfill vital roles in the prevention and management of IDs across various practice settings, including serving as members of antimicrobial stewardship teams, helping to manage transitions of care, and providing care in outpatient parenteral antimicrobial therapy (OPAT) programs.
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Antimicrobial stewardship is defined as “coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents by promoting the selection of the optimal drug regimen including dosing, duration of therapy, and route of administration.”1 One of the benefits of antimicrobial stewardship is a reduction in the incidence of antimicrobial-resistant microorganisms.2 Antimicrobial resistance is recognized as a significant healthcare threat worldwide, and the Centers for Disease Control and Prevention report an annual incidence of 2.8 million antibiotic-resistant infections in the United States, with greater than 35,000 deaths as a result of these infections.3 Additional goals of antimicrobial stewardship programs include improving patient outcomes and reducing the rate of secondary infections, such as Clostridioides difficile infection.2 Several healthcare accreditation organizations require the presence of antimicrobial stewardship programs in the inpatient setting. Outpatient antimicrobial stewardship is an emerging area within the field of ID.
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OPAT involves administration of intravenous antimicrobials outside of the hospital setting. As part of OPAT, patients may self-administer parenteral antimicrobials or receive these therapies with the assistance of a caregiver or healthcare provider at home. Patients may also receive treatment in an infusion center or institutional setting, such as a skilled nursing facility or long-term care facility. Benefits of OPAT include decreased hospital length of stay or avoidance of hospital admission, reduction in the risk of nosocomial-acquired infections, cost savings, and improved quality of life as compared to a prolonged inpatient stay.4 It is important to ensure that patients receiving OPAT have a finalized treatment and monitoring plan in place prior to discharge from the hospital, including routine ...