Since its introduction in the 1970s in the United States, outpatient parenteral antibiotic/antimicrobial therapy (OPAT) has been adopted internationally for long-term intravenous (IV) treatment of stable infectious diseases. The aim is to provide a safe and successful completion of IV antimicrobial treatment at the ambulatory care center or at home without complications and costs associated with hospitalization. OPAT implementation has been accelerated by progress in vascular access devices, newly available antibiotics, the emphasis on cost-savings, as well as an improved patient comfort and a reduced incidence of health care associated infections with a similar outcome. OPAT utilization is supported by an extensive published experience and guidelines of the British Society of Antimicrobial Chemotherapy and the Infectious Diseases Society of America for adults as well as for children. Despite these recommendations and its widespread adoption, in Belgium OPAT is only fully reimbursed and established for cystic fibrosis patients. Possible explanations for this unpopularity include physician unfamiliarity and a lack of uniform funding arrangements with higher costs for the patient. This article aims to briefly review benefits, risks, indications, financial impact for supporting OPAT in a non-university hospital as standard of care. Our experience with OPAT at the ambulatory care center of our hospital and its subsequent recent introduction in the home setting is discussed.

BackgroundDischarge of patients from the intensive care unit (ICU) to a hospital ward is one of the most high risk transitions of care. Discrepancies in medication regimens at transfer may lead to medication errors and consequently adverse drug events.PurposeTo examine the prevalence and types of medication discrepancies during ICU to ward transfer.Material and methodsWe conducted a 6 week prospective baseline evaluation of medication discrepancies on transfer. All adult ICU patients to be discharged from our 18 bed mixed surgical-medical ICU were eligible for inclusion. Medication discrepancies were defined as changes in drug therapy not documented on the transfer notes. Discrepancies were identified through assessment and comparison of the actual transfer notes with medication history and medication administration records during ICU stay. A classification system was adapted to systematically characterise the identified discrepancies.1 ResultsTransfer notes of 30 patients (mean age 65.5 years, mean length of stay on ICU 4.1 days) were analysed. More than half of the chronic drug therapy of patients was not mentioned on the transfer notes (61.3% omitted drugs). For the 275 other drugs prescribed on the transfer notes, 129 medication discrepancies were identified (39 concerning chronic medication, 90 concerning ICU drugs). In comparison with the drug history, altered active substance or posology occurred most frequently (32/39, 82.1%). Concerning new drugs initiated in the ICU, the most common types of medication discrepancies were lack of information regarding indication for new drugs (14.4%), regarding intended duration of drug therapy (18.9%) and regarding suspended drugs (16.7%). Antisecretory drugs, insulin therapy and antimicrobial agents were most commonly involved. Of the prescribed ICU drugs at transfer,15% of intravenous drugs were eligible for intravenous to oral switch.ConclusionICU to ward transfer is associated with a great burden of medication discrepancies. Transfer notes specifying reasons for alterations of drug therapy could improve the quality of available drug information at hand-off.References and/or AcknowledgementsLee, et al. Ann Pharmacother 2010;44:1887-95No conflict of interest.

Background49% of adverse drug events are due to ordering and prescribing errors. Pharmacists play a key role in providing drug information to other caregivers to reduce adverse events and improve patient safety.PurposeAnalysis of pharmacists’ interventions during drug order validation after implementation of standardised drug information in a computerised physician order entry system (CPOE). To evaluate its added value and further information needs.Material and methodsIntegration of structured and standardised drug information in a CPOE system and on the hospital’s intranet was performed in a 500 bed regional hospital. Implementation of systematic drug order validation prior to dispensing by trained hospital pharmacists was studied in a retrospective analysis of pharmacists’ interventions.ResultsTo guide prescribing, we translated existing predefined drug orders in our CPOE as part of a preliminary clinical decision support system. These schemes comprised multiple drugs in relation to specific procedures or diagnosis (eg, postoperative pain protocols) and schemes for intravenous (IV) drug administration (including correct infusion bag and duration of administration). In addition, drug specific information concerning crushing of oral dosage forms, schemes for IV drugs, antibiotic monographs and leaflets for new formulary drugs were made available on the hospital’s intranet. Prior to drug dispensing, the pharmacist performs a systematic drug order validation, with the aid of the integrated drug information. The pharmacist checks, among other items, correct drug dosing and administration modalities, drug therapy in relation to known drug allergies and contraindicated drug interactions (eg, meropenem–valproate, low molecular weight heparin (LMWH) at the same time as novel anticoagulants (NOAC)).Over a 4 month period, 119 pharmacists’ interventions were registered. Most common reasons for intervention were adjustment of drug dose or frequency (31%), drug prescribed for which an allergy was documented in the medical record (21%), adjustment of IV drug administration (16%), duplicate therapy (16%) and LMWH–NOAC interaction (8%). Overall acceptance rate of pharmacist advice was 88%.ConclusionIntegration of standardised drug information in existing computerised systems in combination with patient tailored advice by the hospital pharmacist improves the quality and safety of drug orders and administrations for hospitalised patients. Analysis of pharmacists’ interventions provides valuable information to continuously improve our drug information service.References and/or acknowledgementsKaushal R. Arch Int Med2003;163:1409–16.No conflict of interest

BackgroundOutpatient parenteral antimicrobial therapy(OPAT) has been demonstrated to be safe and effective. Therefore, it has widespread application outside our country.PurposeTo set up a framework to establish and expand qualitative and safe OPAT care in a regional hospital.Material and methodsWe conducted a literature analysis and a retrospective analysis (including pharmacoeconomics) of OPAT patients discharged from our hospital. In addition, we conducted a survey questioning healthcare providers’ points of view regarding OPAT. We questioned members of the antimicrobial management teams of 94 hospitals, physicians of our hospital and primary care providers in the hospital’s region. Based on the results, we developed a structured OPAT service supported by validated tools and information leaflets.ResultsIn 2015, we treated 77 OPAT patients in our 500 bed hospital, mostly for urinary tract, bone and joint, and genital tract infections, most commonly with ceftriaxone or temocilline. The majority of OPAT patients (74%) were treated in the day care hospital. The overall average duration of OPAT therapy was 11 days. 822 hospitalisation bed days were saved. The surveys revealed that despite acknowledgment of the benefits and potential of OPAT, there was only small scale application in hospitals. Lack of procedures, high costs for the patient and restrictive legislation regarding drug delivery were mentioned as the main drawbacks. Key features of our OPAT service were a multidisciplinary approach, criteria based patient selection, delivery of antibiotics and intravenous fluids via community pharmacy, provision of intravenous administration sets and trained nurses via external home care providers and use of validated tools and information leaflets for patients and home care nurses. The hospital pharmacist has a central role in informing patients and caregivers, delivery of hospital restricted antibiotics and as the contact person after discharge. After implementation of this structured OPAT service, more than twice as many patients could be discharged on OPAT at home compared with 2015.ConclusionBased on the international literature and local experience, a structured OPAT programme was implemented at our hospital. Next steps are raising awareness and training health care providers, conducting patient satisfaction surveys and intensifying follow-up and audit of our OPAT service.No conflict of interest