Discharge Considerations for patients requiring Outpatient Parenteral Antimicrobial
Therapy (OPAT)
Not all patients being discharged will need to be followed formally through our OPAT
program; some may be safely followed by their primary care provider or other specialist.
When making discharge plans, we suggest you consider these factors in determining
where patients will be optimally served. Any patient who will be discharged with less
than two weeks remaining of IV therapy remaining needs approval from Sandy Nelson to
be included in the OPAT program. For any questions on how patients may best be
monitored after discharge, please feel free to contact Sandy Nelson. Please also refer to
the guidelines published by the IDSA regarding suggestions for laboratory monitoring for
patients on home IV therapy
Factors favoring traditional monitoring through the ID OPAT program:
Longer courses of antimicrobial therapy (e.g. > 2 weeks) after hospital discharge
Greater potential for toxicity based on comorbidities, immunosuppression, or multiple
parenteral agents
More toxic medications (e.g. aminoglycosides, amphotericin products)
Greater risk of antibiotic failure if inappropriate dosing adjustments made (e.g.
vancomycin dosing of endocarditis or other serious infections)
Factors supporting the safety of monitoring by PCP or referring provider:
Shorter courses of antimicrobial therapy (e.g. < 2 weeks) after hospital discharge
Less toxic medications being administered
Fewer comorbidities
Self-limited infectious illnesses (e.g. cellulitis, meningitis)
Actively involved PCP or referring provider, especially if at MGH
No Infectious Disease followup is required.
When OPAT monitoring is deemed appropriate:
 Schedule an ID clinic followup visit prior to discharge, via Karen Manning (and
include appt time/date/location in ID discharge note)
 Complete ID discharge note (templates on ID intranet) and post in LMR
o Avoid cutting and pasting, be succinct but complete
 Communicate the ID discharge plan to the inpatient referring service and
outpatient ID teams, along with the patient/family and Karen Manning
 Ensure necessary followup tests are scheduled
2/12/2016