620. Identifying the Role for a Pharmacist on an Outpatient Parenteral Antimicrobial Therapy (OPAT) Team in an Academic Teaching Hospital

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is currently an emerging practice to continue effective treatment after hospital discharge for patients requiring parenteral (IV) treatment. Pharmacists can collaborate with outpatient services like home infusion services to allow for safe administration and monitoring of IV antibiotics. The role of pharmacists in an OPAT team has been shown to improve patient outcomes such as optimizing antimicrobial therapy and reducing hospital length of stay and readmissions. We sought to define the utility of an OPAT pharmacist at an academic teaching hospital that currently does not have an OPAT service. Methods Patients receiving IV therapy via home infusion from 1/4/21 to 3/4/21 were screened for inclusion and excluded if antimicrobials were not prescribed. Infection characteristics and antimicrobial therapy were recorded. Interventions on day of and after discharge were noted. Duration of therapy (DOT) was calculated by the difference between start and stop dates of appropriate antibiotics. Discharge delays due to OPAT-related reasons were recorded. Continuous data are expressed as median (IQR). Categorical data are expressed as frequencies (%). Results Of the patients screened, 77 of 123 patients met inclusion criteria. Most patients were treated for a bone/joint infection (29/77, 38%). Ceftriaxone (18/82, 22%) and vancomycin (13/82, 16%) were the most frequently prescribed agents. The median DOT was 30 days (IQR 15, 42). On day of discharge, 52 opportunities for a pharmacist initiated intervention were identified with majority being clarifying DOT (19/52, 37%), streamlining or escalating antibiotic (8/52, 15%), and optimizing drug dose (8/52, 15%). OPAT-related discharge delays resulted in an excess of 58 hospital days and over 25% of patients (20/77) were readmitted 30 days after discharge. The most common post-discharge issues (n=56) were worsening infection (11/56, 20%), PICC line issues (9/56, 16%), and drug related adverse events (8/56, 14%). Conclusion A pharmacist on a dedicated OPAT service can assist with antimicrobial selection, treatment duration, and drug monitoring to promote patient safety in patients discharged on antimicrobials. Disclosures All Authors: No reported disclosures


Figure 2. E-consult Topics by Referring Specialty
Conclusion. Implementation of an outpatient ID e-consult program at a large safety-net healthcare system was an effective means of providing timely input on common ID topics, such as latent TB and interpretation of syphilis serologies, without formal clinic visits. E-consults were able to service a range of providers including PCPs and a variety of specialties, and most e-consults were completed without a clinic visit.
Disclosures. Background. Outpatient parenteral antimicrobial therapy (OPAT) is the process of administering intravenous (IV) antimicrobials outside the acute inpatient setting. Oral antimicrobials for complex infections are referred to as complex outpatient antimicrobial therapy (COpAT). OPAT/COpAT programs are expanding, as are the opportunities for clinical Infectious Diseases (ID) pharmacists (RPHs) involvement. The current state of clinical (non-dispensing) role and the functions being performed by RPHs in OPAT/COpAT is unknown.
Methods. To define the current state of OPAT/COpAT pharmacy practice across the United States (US), specifically the clinical functions performed by RPHs, design of RPH involved OPAT/COpAT clinics, and compare training of RPHs who practice in OPAT/COpAT to ID RPHs who do not, a survey of a possible 31 questions was emailed to the American College of Clinical Pharmacists (ACCP) Infectious Diseases Practice and Research Network (PRN) email list. Results were focused on US-based respondents.
Results. Eighty-seven RPHs responded with 27 practicing in OPAT/COpAT. Training background did not differ between groups. Programs with an OPAT/ COpAT RPH were more likely to have a formal OPAT team compared to those without an OPAT/COpAT RPH (p < 0.001). OPAT/COpAT RPHs were early in their careers, with roughly half practicing < 5 years in ID, and 66.7% practicing < 5 years in OPAT/COpAT. Most OPAT/COpAT RPHs (66.7%) practiced at an academic medical center with a median full time equivalent (FTE) of 1 RPH. Most (63%) utilized a collaborative practice agreement and 81.5% shared job functions with other ID RPH roles, most commonly antimicrobial stewardship. Few (28%) OPAT/ COpAT programs involved a dispensing component. The average daily census was 42 patients followed by an OPAT/COpAT RPH. There was wide variability in the types of tasks ID RPH performed in OPAT/COpAT, the three most important tasks are listed in Figure 1.
OPAT Pharmacists Task Ranking by Importance There was wide variability in the types of tasks ID pharmacist performed in OPAT/ COpAT. The most OPAT/COpAT pharmacists responded that adjusting medications based on lab values was in their top 3 most important clinical tasks. When ranking the top three most important tasks, selecting the initial OPAT/COpAT regimen was ranked first most often, followed by review of review of OPAT appropriateness for discharge, then adjusting medications based on lab values.
Conclusion. This is the largest known survey of OPAT/COpAT RPHs. RPH involvement in OPAT/COpAT in the US is an emerging trend with wide variability in program structure. Tasks performed by OPAT/COpAT RPHs varied significantly; however, OPAT/COpAT RPH respondents' functions are largely clinical in nature.
Disclosures. Background. Outpatient parenteral antimicrobial therapy (OPAT) is currently an emerging practice to continue effective treatment after hospital discharge for patients requiring parenteral (IV) treatment. Pharmacists can collaborate with outpatient services like home infusion services to allow for safe administration and monitoring of IV antibiotics. The role of pharmacists in an OPAT team has been shown to improve patient outcomes such as optimizing antimicrobial therapy and reducing hospital length of stay and readmissions. We sought to define the utility of an OPAT pharmacist at an academic teaching hospital that currently does not have an OPAT service.
Methods. Patients receiving IV therapy via home infusion from 1/4/21 to 3/4/21 were screened for inclusion and excluded if antimicrobials were not prescribed. Infection characteristics and antimicrobial therapy were recorded. Interventions on day of and after discharge were noted. Duration of therapy (DOT) was calculated by the difference between start and stop dates of appropriate antibiotics. Discharge delays due to OPAT-related reasons were recorded. Continuous data are expressed as median (IQR). Categorical data are expressed as frequencies (%).

Conclusion.
A pharmacist on a dedicated OPAT service can assist with antimicrobial selection, treatment duration, and drug monitoring to promote patient safety in patients discharged on antimicrobials.
Disclosures. All Authors: No reported disclosures

Identifying Quality-Improvement Interventions to Improve Inpatient Intravenous Vancomycin Safety at an Academic Medical Center
Sean Christensen, PharmD; Russell J. Benefield, PharmD; University of Utah Health, Salt Lake City, Utah

Session: P-27. Clinical Practice Issues
Background. The reported incidence of intravenous (IV) vancomycin-associated acute kidney injury (AKI) is highly variable. The primary purpose of this study was to determine the baseline rate of IV vancomycin-associated AKI at the University of Utah Hospital (UUH) and Huntsman Cancer Institute (HCI) with the goal of identifying areas of focus for future quality improvement (QI) initiatives.
Methods. This was a retrospective descriptive study of patients ≥ 18 years old, hospitalized at UUH or HCI, who received at least daily scheduled doses of IV vancomycin for ≥ 72 hours between November 1, 2018 and October 31, 2019. AKI was defined using the serum creatinine (SCr) aspect of the AKIN criteria. Variables assessed for association with AKI included demographic characteristics, hospital and unit where vancomycin was initiated, duration of therapy, administration method, and concomitant nephrotoxic medications. Multivariable logistic regression was used to identify variables independently associated with AKI as potential QI interventions.
Results. One thousand eighty-six patients were included. Baseline patient characteristics are listed in Table 1 , and administration in specific units (see Table 1). Administration of vancomycin by continuous infusion showed a protective effect (HR 0.13, 95% CI [0.02-1.12]) as did baseline SCr and total daily dose of vancomycin (HR 0.76, 95% CI [0.61-0.94] and HR 0.63, 95% CI [0.51-0.78] respectively); the latter two are likely a reflection of the study design. The median hospital length of stay in days was longer in individuals experiencing an AKI (19 vs 10, p < 0.0001).