Date of Graduation

Spring 5-18-2023

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Executive Leader DNP

First Advisor

Elena Capella EdD, MSN/MPA, CNL, CPHQ, LNCC

Second Advisor

Sara Horton-Deutsch, Ph.D., RN, FAAN, ANEF, Caritas Coach

Abstract

Background: Outpatient parenteral antimicrobial therapy is the standard of care for patients who require long-term antimicrobial therapy but is not considered a safe discharge option for persons who inject drugs (PWID). Many PWID leave against medical advice before completing therapy, resulting in high emergency department utilization and frequent readmissions.

Local Problem: A 646-bed academic and Level I trauma center where opioid overdoses are 6.5 times higher than the state average experiences disproportionately high PWID admissions. Prolonged hospitalization for the duration of antimicrobial therapy increases costs and reduces access for other acute care patients.

Methods: A prospective cohort of PWID discharged to a hospital-based clinic for supervised OPAT was compared to a similar cohort of patients admitted during the intervention period. The primary outcome was the completion of antimicrobial therapy. A two-way t-test, chi-square, and Fisher’s exact test were used to determine statistical significance (p < 0.05) between the two groups.

Interventions: A multidisciplinary team developed tools and processes to aid in the early identification and referral of PWID for treatment supported by infectious disease, addiction medicine, and other wrap-around services. Eleven patients received supervised OPAT in a hospital-based clinic.

Results: Twenty-seven non-intervention and 11 intervention patients were evaluated. Nine of 11 (82%) intervention patients completed therapy. PICC lines were present in four (40%) of the intervention group. A total of 233 inpatient days were saved, with an estimated cost savings of nearly $1M.

Conclusions: Supervised OPAT, supported by wrap-around services, is a safe, cost-effective alternative to prolonged hospitalizations in PWID.

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