ANTIBIOTICS> Outpatient Antimicrobial Treatment

For patients at VA West Los Angeles, OPAT services are available to otherwise stable patients requiring IV antibiotics for 2 days or more. Cases are evaluated by the ID Pharmacist, Thuong Tran, PharmD (x49813 or pager 5-5092) in conjunction with an ID attending, and if deemed suitable, an appropriate antimicrobial regimen is instituted and home services are arranged. If necessary, followup with infectious diseases on an outpatient basis will be arranged.

For inpatients, all outpatient IV antimicrobial therapy must be approved by the Infectious Diseases Pharmacist and by the Infectious Diseases Attending at least one day prior to the proposed day of hospital discharge.  For outpatients, all IV outpatient antimicrobial requires the approval of an Infectious Diseases Attending Physician.

Instructions
  • For all patients requiring home IV antibiotics, primary team providers must send 2 consults under the following titles:
                 1. ID OUTPATIENT PARENTERAL ANTIBIOTIC (under ID consult)
                 2. HOME CARE SERVICES
  • If approval is granted, the ID fellow will put in an “ID OUTPATIENT PARENTERAL ANTIBIOTICS CONSULT APPROVAL” note, which should include name of approved antibiotic(s), dosage, duration, labs and clinic follow up. If labs will be drawn by home health, reports should be faxed to ID central office (310-268-4928).
  • All patients who will be discharged on antimicrobials that require laboratory monitoring, such as aminoglycosides or vancomycin, need to have drug levels and kidney function checked within 3 days prior to discharge.
  • Patients who have peripheral lines must be evaluated (by primary team) for ease of line replacement to ensure that they can be replaced by home health nurse for treatment duration longer than 3 days (maximum 7 days duration)
  • A PICC line is required for vancomycin treatment
  • Patients must have received 1st dose of discharged antimicrobial agent prior to discharge
  • Prior to patient discharge, the ID pharmacist should counsel patients on catheter care, hand hygiene, laboratory monitoring, common /severe adverse drug reactions, and plan of follow up (via PCP or ID clinic)