/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/cpg/,/clinical/cckm-tools/content/cpg/infection-and-isolation/,/clinical/cckm-tools/content/cpg/infection-and-isolation/related/,

/clinical/cckm-tools/content/cpg/infection-and-isolation/related/name-111074-en.cckm

201612354

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Clinical Practice Guidelines,Infection and Isolation,Related

Coordinating an Outpatient Parenteral Antimicrobial Therapy Discharge

Coordinating an Outpatient Parenteral Antimicrobial Therapy Discharge - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Infection and Isolation, Related


Copyright ©2016 University of Wisconsin Hospitals and Clinics Authority
Contact: CCKM@uwhealth.org Last Revised: 11/2016
Clinical Monitoring of Outpatient Parenteral Antimicrobial Therapy
(OPAT) and Selected Oral Antimicrobial Agents – Adult –
Inpatient/Ambulatory – Clinical Practice Guideline
Appendix A. Coordinating an OPAT Discharge
From: Clinical Monitoring of Outpatient Parenteral Antimicrobial Therapy (OPAT) and Selected
Oral Antimicrobial Agents – Adult – Inpatient/Ambulatory – Clinical Practice Guideline
CPG Contact for Content: Lucas Schulz, PharmD, BCPS (AQ-ID); 608-890-8617;
lschulz2@uwhealth.org
OPAT discharge navigator and laboratory monitoring
ξ Select OPAT button for ALL patients that discharge on intravenous antimicrobials
ξ Confirm team has ordered appropriate labs
o Labs should appear in the OPAT monitoring navigator if they are ordered through UWHealth. If
ordered outside of UWHealth, labs will not appear in this section and confirmation of ordering will
need to be made by discussion with primary team.
ξ Compare ordered labs to OPAT Guideline and ID consult note (if available)
ξ Ask team to order any missing labs (lab ordering is the responsibility of the provider)
ξ Confirm date for first outpatient drug level (if necessary) by communicating with infusion agency
o Some Home Health nurses can only draw labs on certain days; discuss with infusion agency to
confirm most appropriate time for first outpatient drug level
ξ Select “laboratory monitoring has been reviewed” button in HealthLink
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org


Copyright ©2016 University of Wisconsin Hospitals and Clinics Authority
Contact: CCKM@uwhealth.org Last Revised: 11/2016

Preparing OPAT prescriptions
ξ Ensure team orders drug for injection on discharge
o Discharge Navigator  Order Reconciliation  New Med Orders for Discharge tab  Database
lookup




o Do NOT order the drug in a base fluid. The infusion agency will put the drug in the most
appropriate fluid and concentration for home stability when the infusion agency pharmacists
receive the prescription.
ξ Round dose to nearest 10 mg for daptomycin
ξ Change dispense quantity to “1 each”
ξ Change refills to “PRN” even if duration is known
o This allows the infusion agency to re-dispense drug if patients have storage issues or
malfunctions while dispensing at home
ξ If duration is known, add anticipated stop date as a note in Discharge Medication List and discharge
hand-off note
ξ Print prescription for fax; fax to infusion agency
ξ Include the name of the provider who will follow the patient after discharge in the discharge hand-off
note

Contacting Home Infusion Agency
ξ Look at social work or Chartwell note in HealthLink for fax numbers, contact information, or planning
information
ξ Chartwell nurses are available during business hours at UW University Hospital
ξ Chartwell main office: 608-831-8555
o Can speak to pharmacist during business hours for drug or dosing questions
o Can ask to speak with on-call pharmacist after-hours or on weekends
ξ Paging (2-2122 or 262-2122) can assist in contacting a home infusion agency

Clinical considerations for home infusions
(All recommendations: UW Health Strong Recommendation, Moderate Quality of Evidence)

ξ Try to avoid checking inpatient drug troughs on the day of discharge if possible
o Infusion agencies process orders and prepare the first home dose the morning of discharge;
pending troughs will delay care
ξ It is preferred to administer drugs at home over short infusions or IV push to significantly decrease
amount of time patient is connected to pump
o Improves ability to fit into work/life/sleep schedule
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org


Copyright ©2016 University of Wisconsin Hospitals and Clinics Authority
Contact: CCKM@uwhealth.org Last Revised: 11/2016

o Enhances adherence
o All antimicrobials can be administered via Rateflow short infusion (small-volume admixture
connected to IV pole) EXCEPT nafcillin/oxacillin and penicillin G
o The following antimicrobials can be administered via IV push or Freedom 60 pump by Chartwell
(other home infusion agencies may have different practices), avoiding the need to be connected
to an IV pole:
Amikacin** Ceftazidime Meropenem*
Aztreonam Ceftriaxone Nafcillin *
Cefazolin* Cefuroxime Oxacillin *
Cefepime* Clindamycin** Piperacillin-tazobactam *
Cefotaxime Daptomycin Tobramycin**
Cefotetan Gentamicin** Vancomycin***
Cefoxitin
* IV push available, however, prolonged infusion is the preferred method of administration
** 30-60 minute infusion on Freedom 60 pump, no IV push available
*** 60-90 minute infusion on Freedom 60 pump, no IV push available

ξ Factors that prohibit short infusions or IV push antibiotics with OPAT may include (but are not limited
to):
o Accepting facility or patient family unable to perform multiple administrations daily
o Patient inability to complete short infusion or IV push independently
o Therapeutic inferiority with short infusion (i.e. therapeutic superiority with prolonged infusion or
continuous infusion)
ξ The following antimicrobials have frequent dosing intervals and can therefore be made in a 24-hour
bag by Chartwell (other home infusion agencies may have different practices), which can be given as
continuous infusion or programmed on a pump that fires intermittent doses from the same bag:
Acyclovir Cefotetan Ceftolozane-tazobactam *
Ampicillin Cefoxitin Meropenem **
Aztreonam Ceftazidime Nafcillin *
Cefazolin Cefuroxime Oxacillin *
Cefepime Clindamycin Penicillin G potassium *
Cefotaxime Doripenem Piperacillin-tazobactam *
Vancomycin
* Continuous infusion is the preferred method of administration
** Must change bag after 12 hours instead of 24 hours

ξ Ampicillin-sulbactam does not have good home stability and cannot be given as a 24-hour bag
o Patients or caregivers have to be willing and able to administer this medication multiple times a
day
ξ Some SNFs or Home Health agencies cannot run extended infusions, cannot administer medications
every 6 hours, and/or cannot hook patients up to 24-hour pumps
o This is rare, but can create difficulty if it occurs. Attempt to confirm this before discharge day.
o The dosing for extended beta-lactam infusions and intermittent/short infusions may be different.
See the Renal Function-Based Dose Adjustments Clinical Practice Guideline and the
Pharmacokinetic/Pharmacodynamic Dose Optimization of Antibiotics for the Treatment of Gram-
negative Infections Clinical Practice Guidelines
ξ If antimicrobial infusion cost is preventing discharge to home or to other facility, work with attending
team and/or Infectious Disease service to identify if other antimicrobial choices may facilitate discharge

Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org


Copyright ©2016 University of Wisconsin Hospitals and Clinics Authority
Contact: CCKM@uwhealth.org Last Revised: 11/2016

Antimicrobial Drug for Injection Medication Record Numbers (ERx)
Antimicrobial ERx for OPAT Injection Database Lookup (F7) Concentrations or Strengths
Liposomal amphotericin 58058 50 mg
Acyclovir 44030 500 mg
Amikacin 760007 250 mg/mL
Ampicillin 34543 1 g
34546 2 g
Ampicillin-sulbactam 50601 1.5 g
50599 3 g
Azithromycin 57146 500 mg
Aztreonam 44264 1 g
44265 2 g
Caspofungin 66233 50 mg
66234 70 mg
Cefazolin 35636 1 g
Cefepime 52161 1 g
52163 2 g
Cefoxitin 44555 1 g
44557 2 g
Ceftazidime
44571 500 mg
44568 1 g
44570 2 g
Ceftriaxone 44581 1 g
44582 2 g
Cefuroxime 35657 750 mg
35655 1.5 g
Ciprofloxacin 144939 200 mg/ 20 mL
144940 400 mg/ 40 mL
Clindamycin
119041 300 mg/ 2 mL
119039 600 mg/ 4 mL
119040 900 mg/ 6 mL
Daptomycin 73977 500 mg
Doripenem 143475 250 mg
126526 500 mg
Ertapenem 68678 1 g
Ganciclovir 45226 500 mg
Gentamicin 37859 10 mg/mL
37860 40 mg/mL
Levofloxacin 54892 25 mg/mL
Linezolid
170913 200 mg/ 100 mL
170914 600 mg/ 300 mL
Meropenem 53238 500 mg
53239 1 g
Micafungin 107268 50 mg
115014 100 mg
Nafcillin
39988 1 g
39990 2 g
39989 10 g
Oxacillin
40651 1 g
40653 2 g
40652 10 g
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org


Copyright ©2016 University of Wisconsin Hospitals and Clinics Authority
Contact: CCKM@uwhealth.org Last Revised: 11/2016

Antimicrobial ERx for OPAT Injection Database Lookup (F7) Concentrations or Strengths
Penicillin G Potassium 40825 5,000,000 units
40824 20,000,000 units
Penicillin G Sodium 40826 5,000,000 units
Piperacillin-tazobactam
54253 2.25 g
54252 3.375 g
54251 4.5 g
Rifampin 46481 600 mg
Sulfamethoxazole-
trimethoprim 42456 400-80 mg/ 5 mL
Tigecycline 107987 50 mg
Tobramycin 760239 40 mg/mL
104635 80 mg/ 2 mL
Vancomycin
43437 500 mg
135474 750 mg
43436 1000 mg
Voriconazole 69968 200 mg

Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org