Antibiotic adverse events during OPAT

[jonnylambourne]

Adverse events related to antibiotics need to be recorded including

• Intolerance
• Rash
• Anaphylaxis
• Diarrhoea (C diff positive)
• Diarrhoea (C diff negative)
• Blood dyscrasia
• Other

Logical place seems to be in the antimicrobial therapy section e.g. 'Any adverse events associated with this antibiotic' = Y/N, if Y, drop down menu of above options

tricky bit will come for patients on >1 antibiotic, choosing which abx to assign the adverse event to…..

[michaeledwardmarks]

@davidmiller and @jonnylambourne What about an extra subfield specific to OPAT for Antimicrobials? After End Date we could have a "Reason for Stopping" subfield which would be the list above plus: Completed Course Antimicrobial Resistance

[jonnylambourne]

Have tried to capture these in #190 tricky as same info could be gathered at multiple points 'end of iv abx' and 'end of and' both end-points could just as well go into 'abx section', I guess as this is where changes will be made e.g. altering the 'stop date'

[davidmiller]

Natural way to maintain the link between adverse event && antibiotic would be to add these as a subfield as @michaeledwardmarks suggests.

Only appearing when end date <= today is a nice touch.

[GabPoll]

Unnecessary layer of complexity warning:

• what about when adverse event = rash or anaphylaxis, then this autofills the drug allergy field?

I know, fanciful and over-complicated, but sprung to mind as I was reading this thread.

[michaeledwardmarks]

not all rashes post drug are allergies so I would be against this.

[davidmiller]

This has now been added as an OPAT only field!

[michaeledwardmarks]

Works well on list view. If patient is tagged OPAT and you go to single patient view then this subfield doesn't appear.

[davidmiller]

What's the desired behaviour here?

If we are viewing an OPAT episode, and you open the antimicrobial modal from either list or detail view, then this field appears ?

[michaeledwardmarks]

Yes I think so.

[jonnylambourne]

yes please

[davidmiller]

This is no longer showing - likely due to team / tag changes.

[michaeledwardmarks]

Still would be very inclined to rename this field: "Reason for Stopping" and add Completed Course Antimicrobial Resistance

to the drop down list That way you get more information for no extra fields @davidmiller @jonnylambourne @GabPoll thoughts on this?

[GabPoll]

sorry to be obtuse, but where is this? I can't seem to find it anymore.

[davidmiller]

It's in the antimicrobials modal if you're on an OPAT list - deployed to the OPAT instance

[GabPoll]

Agree with @michaeledwardmarks . add Adverse event to your list

Therefore, drop down to include:

• completed course
• antimicrobial resistance
• adverse event

Anyway to bring up a free text box next to only "Adverse Event" option?

[GabPoll]

ps. thx @davidmiller for pointing it out

[davidmiller]

All - is there a clear consensus course of action here?

Particular thoughts welcome from @jonnylambourne !

[davidmiller]

Pings @michaeledwardmarks && @jonnylambourne re. forming a consensus on how to proceed?

[michaeledwardmarks]

I would proceed as above:

• [ ] Rename field: Reason for Stopping
• [ ] Amend lookup list to contain
• Completed course
• Antimicrobial resistance
• Intolerance
• Rash
• Anaphylaxis
• Diarrhoea (C diff infection)
• Diarrhoea (NOT C diff infection)
• Blood dyscrasia
• Other adverse event

[GabPoll]

Agree - have amended C diff nomenclature to be more in line with audit / study outcomes in this area

[michaeledwardmarks]

Closing this and opening a clearer issue following discussion with Jon.