Beth Israel Deaconess Medical Center
Catherine Li, a PGY2 in infectious diseases at Beth Israel Deaconess Medical Center, was scheduled to begin her 4-week outpatient parenteral antimicrobial therapy (OPAT) rotation on March 30. On March 16, the institution shifted all the clinic and ambulatory pharmacists to work remotely in an effort to support social distancing endeavors. This resulted in a completely remote experience, in an otherwise heavy patient-contact rotation. Dr. Li embraced the challenges.
In collaboration with her preceptor, the rotation was re-imagined with the goal of providing the same level of patient care in a safe and telehealth format. One of the unique aspects of the pre-COVID rotation was meeting with patients enrolled in OPAT one to two days prior to hospital discharge. The pharmacist would perform a medication reconciliation and counsel the patient on what to expect with home antibiotic administration. Since this was not possible, the task was shifted to calling the patient at home, one to two days after discharge.
The change was profound. Performing patient outreach after discharge allowed the pharmacist to assess the real-world situation. The pharmacist was able to reinforce teaching points the patient forgot, answer administration questions, assess home infusion supplies, and truly aid in transitions of care. One patient on cefazolin noticed a new rash forming. Dr. Li was able to ask follow-up questions about the rash and reach out to the provider. The provider subsequently changed the patient to an alternative regimen. When asked about home supplies, another patient mentioned they only had enough supplies on hand to last through the following day. Dr. Li was able to email the home infusion company, which had been having difficulty reaching the patient. Based on Dr. Li's information, the home infusion company was able to set up a delivery prior to the patient using up their supplies.
After completion of the rotation, both Dr. Li and her preceptor reflected on the changes and challenges of a remote rotation. They realized the benefit of contacting the patient at home post-discharge, and this will now be incorporated into future in-person OPAT rotations as well.
Catherine Li, PharmD, is a PGY2 resident in infectious diseases at Beth Israel Deaconess Medical Center.