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Home IV Antibiotic Program: A Two Year Update

Amy Wai, B.Sc. (Pharm)
VHHSC Home IV Antibiotic Program
December 1997 Drug & Therapeutics Newsletter
(C) 1997, CSU-Pharmaceutical Sceinces
Vancouver Hospital & Health Sciences Centre

 

The Home Intravenous (IV) Antibiotic Program at VHHSC was successfully launched on June 1, 1995 as part of the "Closer to Home - Vancouver Regional Home IV Program". Over the past 24 months, this program has permitted medically stable patients to initiate or continue parenteral antibiotic therapy in the comfort of their own homes.

How many patients were screened and enrolled into the program over the two year period?

From June 1, 1995 to June 30, 1997, 245 patients were screened and 140 patients (57%) were successfully discharged on home IV antibiotics. Of these 140 patients, 80 were enrolled into the VHHSC program and the balance were transferred to a non-Vancouver region program. One hundred and five patients (43%) were found to be inappropriate candidates for home IV therapy. Of these 105 patients, 51 remained as inpatients, 29 were discharged on oral antibiotics, 16 were referred to medical daycare, 7 had their antibiotics discontinued, and 2 patients left the hospital against medical advice.

Patient referrals increased by 85% during the second year of the program while home IV enrollment doubled for the same period. The incidence of inappropriate candidates remained stable at 45%. The overall duration of treatment at home increased by 92% to 3421 days. Figures 5 and 6 illustrate the incidence of referrals and the number of treatment days at home per quarter respectively.

Figure 1. Incidence of referrals per quarter

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Figure 6. Total number of planned or completed antibiotic days per quarter

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What types of infections were treated?

Infections treated include bone and joint infections (45%), endocarditis (15%), skin and soft tissue infections (12%), respiratory infections (9%), cytomegalovirus (CMV) infections (6%), and others (13%).

What were the general characteristics of those patients enrolled?

The mean age was 53 years (range 19-83) and 61% were male. Inpatients were discharged after a mean hospital stay of 13 days (range 1-56) and received a mean of 12 days (range 1-50) of antibiotic therapy prior to discharge.

What types of antibiotics were used?

Several different antibiotic treatment regimens were administered at home. The 5 most common home IV antibiotics were vancomycin (27%), cloxacillin (23%), cefazolin (23%), ceftriaxone (11%) and penicillin (9%). The median duration of home parenteral therapy administered was 20 days (range 1-247).

What were the treatment course characteristics?

Of the 80 patients enrolled into the VHHSC program, 68 (85%) patients successfully completed their treatment course while 4 (5%) clinically deteriorated during therapy. The remaining 8 (10%) patients were discontinued from the program due to catheter-related complications (3), noncompliance (2), adverse drug reaction (1), an inappropriate home environment (1) and death due to an unrelated cause (1).

Were there any adverse drug reactions during therapy?

Thirteen (16%) of the 80 patients experienced an adverse drug reaction during their treatment course. The most common reactions were dizziness and loss of balance (4), nausea (2), and rash (2). The remaining 5 reactions included thrush, fever, vancomycin-induced redman’s syndrome, diarrhea and interstitial nephritis. Two patients were unable to complete their antibiotic course due to vancomycin-induced drug fever, and cloxacillin-induced interstitial nephritis.

What types of IV access devices were used?

There were 77 (55%) peripherally inserted catheters (PIC), 29 (21%) peripheral lines, 15 (11%) port-a-caths, and 19 (13%) central lines.

What were the patients’ perceptions of our program?

Since June 1, 1996, patients were asked to complete a patient satisfaction survey anonymously after completion of their antibiotic therapy. Seventy-one percent of the 42 mailed surveys were returned. Ninety-three percent of patients felt that the amount of time spent teaching them about their antibiotic treatment regimens was appropriate while 7% of the patients believed additional time was required. Patients typically claimed to be comfortable administering IV medications at home and felt it was more convenient than remaining in the hospital. While on the program, 80% of the patients were able to return to the majority of their normal activities. Patients were very satisfied with the quality of care they received and with the medication and supply delivery process. Over 95% of patients stated they would consider home IV antibiotic treatment again in the future should they require it.

How do I enroll a patient into the program?

A physician must request a Home IV Antibiotic Program assessment (on a standard physician order form) and notify the program pharmacist (pager 601-7899 at VGH site, 822-7249 at UBC site). Please contact Amy Wai, Home IV Antibiotic Program Pharmacist, if you have any questions or concerns regarding this program.