Outpatient parenteral therapy is when a patient receives intravenous medications while commuting. They don’t require an admission unless their condition worsens. Outpatient parenteral treatment is becoming a standard of care in many regions globally, but many health care providers and patients may misuse it. It requires constant evaluation and stewardship. Benefits of such therapy include avoiding inpatient admission and shortening inpatient stay. It reduces exposure to nosocomial infections, costs, as well as enhancing patient comfort.
Before you prescribe any intravenous medications to any patient, check out if they are suitable for outpatient parenteral therapy. First, does the patient need antibiotics? Is their clinical state sufficiently stable to allow discharge to an outpatient setting? Does the patient require antibiotics via intravenous routes or, will oral drugs suffice? Is there a suitable and effective antibiotic for outpatient administration? Is the patient or caregiver capable of maintaining outpatient parenteral therapy? Is outpatient parenteral therapy financially feasible for the patient?
When the patient suits outpatient parenteral therapy, in collaboration with a consultant physician or a stewardship program:
- To determine an appropriate vascular access device. It will depend on the length of the therapy.
- To assess an appropriate antibiotic, dose, and infusion duration.
- To predict and avoid drug-drug interactions.
- Plan for the duration of therapy.
In a few cases, physicians should avoid outpatient parenteral therapy. It is imperative that the clinician screens such patients appropriately. If a patient isn’t a candidate for oral antibiotic administration, consider an antibiotic agent with an extraordinarily long serum half-life.
It’s prudent to monitor this type of treatment. Antimicrobial stewards require that clinicians perform face-to-face visits and virtual visits. Evaluate therapeutic response. To evaluate opportunities to convert from parenteral to oral administration. To ascertain the safety, recognise secondary infections, and discontinue therapy when the patient has achieved a maximum benefit. Besides, weekly laboratory evaluations are paramount. The antibiotics being used, determine the tests requested. Stewardship programs must carefully track the process to monitor response to therapy, recognise toxicity and therapeutic drugs.
Unfortunately, there are few stewardship programs in our local hospitals, if any. So, outpatient parenteral treatment has gained traction in Uganda, but the systems that monitor this new wave of treatment still lag.
Today’s article is an excerpt from an online course – antimicrobial stewardship: improving clinical outcomes by optimising antibiotics practices from Stanford Online.