Reactions and COVID-19 disease progression following SARS-CoV-2 monoclonal antibody infusion.

SARS-CoV-2 monoclonal antibodies (mAbs) have been proposed as a treatment for mild to moderate COVID-19, with favorable outcomes reported in clinical trials and an emergency use authorization granted by the Food and Drug Administration. Real-world data remain limited, however, and thus this analysis presents findings from over 6,500 outpatient administrations of mAb at facilities affiliated with a large healthcare organization in the United States. Within 48 hours of mAb infusion, 15.6% (1,043) of patients received a drug that was indicative of a possible reaction to the infusion; the majority of these were mild (e.g., acetaminophen). Approximately 5.2% of patients who received mAb (n=347) had a post-infusion emergency department visit or admission for COVID-19 disease progression. The results of this analysis indicate that patients who receive mAb have a low likelihood of both an immediate negative reaction to the treatment as well as future inpatient admission related to COVID-19 disease progression.

Process analysis of procalcitonin monitoring within community hospitals.

PURPOSE: Monitoring of procalcitonin (PCT) levels may support appropriate antibiotic discontinuation. The purpose of this study was to determine the current state of PCT monitoring at community hospitals across the United States. METHODS: Data from adult patients who were admitted to community hospitals affiliated with a large healthcare system between August 1, 2016, and July 31, 2017, and who received antibiotics were evaluated for the number of PCT levels drawn and the timing between multiple levels. Data from eligible patients were evaluated for the discontinuation of antibiotics after meeting prespecified PCT thresholds for discontinuation of therapy, namely, a PCT measurement of <0.5 µg/L or a decrease of ≥80% from a previous peak value. RESULTS: PCT levels were evaluated for 103,913 patient data sets collected from 136 hospitals. Of these, 70% of the data sets showed a single PCT level drawn, and approximately 30% (30,887) of the data sets showed multiple levels drawn. The first PCT measurement was drawn within 36 hours of antibiotic initiation in 96% of the patients. Of those with multiple levels, 23% (7,089) had levels drawn 24 to 72 hours apart. A small proportion (20% [6,127]) of the patients with multiple levels were eligible for evaluation of appropriate antibiotic discontinuation. Of these, 1,973 (32.2%) patients had antibiotics discontinued within 36 hours of meeting the prespecified PCT thresholds; these patients had a mean duration of antibiotic therapy of 6.1 days with a median of 4.7. CONCLUSION: Additional standardization of ongoing PCT monitoring and education regarding the appropriate discontinuation of antibiotics when thresholds are reached could aid in the use of this biomarker in support of antibiotic and laboratory stewardship.

Use of clinical decision support to identify i.v.-to-oral conversion opportunities and cost savings.

PURPOSE: The use of a clinical decision support (CDS) tool to determine patients' eligibility for oral medication therapy and the opportunity cost of i.v.-to-oral conversion practices in a large health system was evaluated. METHODS: This multicenter, retrospective, process improvement study comprised CDS data generated by 149 hospitals from May 1 through October 31, 2015. Data related to i.v.-to-oral conversions were identified and compiled for evaluation. For each patient with an opportunity for i.v.-to-oral therapy conversion, corresponding barcode-assisted medication administration data were evaluated to determine the number of doses that were administered within prespecified time periods. RESULTS: A total of 121,685 i.v.-to-oral conversion opportunities, corresponding to 71,342 unique patients and encompassing 31 different medications, were evaluated. The top 13 medications representing 94% of the total number of alerts and over 1.4 million doses were included for analysis. Current i.v.-to-oral conversion practices saved the hospitals 9% on medication costs. Upon further evaluation, additional cost savings of 29-78% for those 13 medications could be achieved with more timely conversion from i.v. to oral therapy. CONCLUSION: Hospital pharmacists' i.v.-to-oral conversion practices with the CDS tool resulted in medication cost savings of 9%, or $1.48 million, for 13 medications evaluated over a 6-month period.