Outpatient IV Antibiotics Home/SNF Infusion Orders (PICC, Midline, peripheral IV)
Outpatient Parenteral Antimicrobial Therapy (OPAT)
Drug name, dosing, frequency, and duration: _
Anticipated last day of treatment: _
Intravenous line care plan: Biopatch dressing, change on first day of care, qweek and as needed. Alteplase prn for clot.
Weekly lab orders: _
Additional Supplies for IV Antimicrobials: (PICC supplies, Infusion Pump / Eclipse Ball Infusion) _
Clinical Information and Follow Up:
Ordering Physician (Discharging Inpatient Attending): _
Discharge Inpatient Resident: _
Outpatient Physician Continuing Care and following weekly labs (requires verbal confirmation): _
Diagnosis (reason for antimicrobial agent) including microorganism: _
Common complications: (Vancomycin – renal failure / Nafcillin – renal failure, serum sickness, allergic reactions / Daptomycin – elevated CK with myalgias / Cephalosporins – renal failure / Quinolones – prolonged QT, altered mental status, dysglycemia, C. dif)
Intravenous line type and date of insertion: _
Home nursing agency name/contact #: ****
Pharmacy name/contact #: ****
Scheduled outpatient appointments: ****
Scheduled appointment of outpatient physician continuing care and monitoring weekly labs if not PCP if not listed above: _
Office and Fax # for outpatient physician continuing care and monitoring weekly labs: _
**Home health agency must notify outpatient physician continuing care immediately if the above orders cannot be fulfilled during the course of treatment.
Sample PICC line note
Diagnosis: Infective endocarditis with streptococcus viridans.
Line Type: PICC
Line Care Plan: Biopatch dressing, change on first day of care then q week and prn soilage or loss of integrity.
Medication: Ceftriaxone 2 gram IVP daily x total of 28 days, then reassess.
Lab orders: qWeek CBCd, CMP, ESR, quantitative CRP. Fax lab results to _
Home nursing agency: _
Start date: _
Date/time of drug delivery: _
Contact physician for abnormal labs or problems with line: _
FYI: NOT FOR INCLUSION IN NOTE - HELPFUL HINTS FROM DR. SIMPSON
First dose of any IV antibiotic is usually given in the hospital to avoid possible anaphylaxis at home. Anaphylaxis kits are available.
Time medications so that at least 2 teaching sessions with the home health nurse are possible before the patient has to self-administer an IV dose (overnight dosing is generally not supervised).
Obtain time of home nurse availability and work around it, as this is often the biggest barrier to discharge.
Nursing will typically teach the patient or family member how to administer and then go out weekly to draw labs and change PICC dressing.
ID consult can assist with organizing doses and drugs given in the hospital prior to discharge to accommodate the transition to home care and avoid as much time without adequate drug in patient and still be able to coordinate with home care.
Home nursing and home pharmacies need to coordinate with each other and the patient/family for delivery of drug to the home or hospital. Also verify that the address where the patient plans to go and the contact phone numbers match those on the face sheet/in Cerner.
Consider PO or a hep-locked IV in place of PICC lines. The choice of delivery method should be confirmed prior to PICC placement.
In general, do not change the drug or dosing schedule for the benefit of the home nursing agency. Call ID consultant with questions about what is feasible at home.
Avoid PICC lines in patients with IVDU histories. Midline catheters may be more appropriate.
PICC lines are discouraged as methods for access in sick hospitalized patients. Midline would be preferred.
Midlines can be left in for up to 6 weeks, with a dressing change qWeek and a daily flush with heparin or saline.