Evaluation of Pharmacy Student Interventions on Outpatient Parenteral Antimicrobial Therapy (OPAT) in a Veteran (VA) Healthcare System


The purpose of this study was to identify and categorize drug-related problems documented by 4th-year pharmacy students that required intervention in an OPAT clinic associated with the Salt Lake City VA. This enabled investigators to describe common drug-related problems found by students to serve as a basis for curricula development.


Charts were reviewed from January 1, 2016, to December 31, 2016, in order to analyze notes written by pharmacy students regarding medication interventions. Each note was reviewed, classifying problems into several categories of drug therapy problems (DTPs).

A DTP is where medication therapy has or may cause an event which could interfere with positive patient outcomes. Classification of the intervention required to resolve the DTP was also recorded. In addition to the identification of DTPs and the interventions which were made to resolve them, this study also characterized any interventions that were not made, when it should have been, according to the Infectious Diseases Society of America (IDSA) guidelines and VA Health System protocols.

Patients were identified according to whether they did or did not require intervention as noted by pharmacy student documentation in the patient medical chart. Patients who were identified as having an intervention were further classified into specific categories. Classification of each intervention, ultimately, was determined by the chart reviewers, based on the Pharmacy Quality Alliance’s Medication Therapy Problem Categories Framework that was published in 2012.


According to student-initiated pharmacy notes, a total of 102 medical chart notes were reviewed. These notes required intervention by the patient’s infectious diseases clinic team. The most common drug-related problems were found to be related to vancomycin where 57.4% of patients treated within the OPAT program were being treated for osteomyelitis or prosthetic joint infections. Vancomycin was associated with an increased number of interventions, likely due to the extensive monitoring parameters required to maintain therapeutic efficacy and safety.


Antimicrobial regimens used in patients on OPAT are associated with drug-related problems involving many antimicrobial agents. It is clear that students are highly involved in monitoring patients on vancomycin for safety and effectiveness. These results highlight important parts of OPAT management for students to be able to identify common problems in order to make appropriate recommendations. 

Published in College of Pharmacy, Virtual Poster Session Spring 2020


  1. Sam, this is a great poster, and suggests training that should be emphasized for our students. In that regard, I’m curious whether the problems identified and acted upon by the students parallel those identified by the preceptor and/or other members of the ID team. That is, are our students already, based on the knowledge and training acquired in our curriculum, accurately identifying and intervening for the major issues, or where there issues that they were not as good at identifying, suggesting areas for improvement in the curriculum? for example, there are few interventions for “Needs additional drug therapy.” Is that because few needed additional therapy, or our students weren’t as in tune to that need?

    1. Dr. Keefe, thank you for your comments and question. I think you bring up an excellent point, and I think it would best be answered with future studies including surveys by students and preceptors regarding therapeutic knowledge expectations and reality. However, having just finished the program and having a small taste of practice through APPE rotations, I think that our curriculum highlights and prepares students well for common problems they might encounter while on rotation (i.e. vancomycin monitoring for safety and efficacy). I think through our chart review, there were few “needs additional drug therapy” interventions because there were few available to intervene with. That being said, the student may or may not have felt entirely comfortable making that recommendation and may have needed to seek out additional help and support through various resources (preceptors, team members, literature), and is difficult to delineate their level of competency through their note. In short, I do think our curriculum highlights common clinical practice scenarios and appears to prepare students well for clerkship opportunities.

      1. Great study Sam! For the sake of elucidating potential areas to reinforce in the curriculum do you think it would be beneficial to add a section into the student note asking how confident they felt monitoring the therapy or would this add unnecessary strain to the student without adding any benefit?

        1. Yes, I do think that further studies will be needed and useful in identifying confidence and competence. Great question! It could be something that we do as a survey sent out to students who have completed the rotation in recent years… Just my thought! I like the idea of adding that section to the note, though!

  2. Great work Sam! From the information you gathered, do you think this would provide training areas for other medications or would it be best to reinforce education for vancomycin?

    1. Excellent question. I do think that reinforcement of education for vancomycin is important. However, given data collected throughout this study, it may be important to try and tackle other common medication therapy problems, especially regarding specific disease states such as osteomyelitis, PJI, and bacteremia.

  3. Awesome, Sam! This could be a cool position for a fourth-year pharmacy intern. Interns are always looking for ways to be more clinical and learn while working outside of school – this would be an interesting opportunity that makes a difference too!

    1. Agreed! I definitely know I would love to have that kind of opportunity as an intern – I like it!

  4. Hi Sam! Now that the data have been collected, reviewed, assessed and analyzed, what would you recommend from an education/curricula standpoint to help future pharmacy students who come for an acute care clerkship to provide efficient and holistic monitoring of infected patients? (From the “Why is it important?” section of the poster. Nice work! Thank you again!

    1. Thank you, Dr. Orlando! To answer your question, I think it would be beneficial to run through more scenarios in therapeutics involving vancomycin and the common disease states that were seen here in this study (osteo, PJI, bacteremia, etc.). This would help students become more confident working with vancomycin and could hit the ground running faster at the beginning of the rotation. Additionally, I think that it would be useful to even help students become familiar with the intervention category tool that I used to assess these patients. I had never seen anything like that until my clerkships. Could potentially help students start thinking about things sooner. Anyways, these are kind of my thoughts involving recommendations for curriculum development/improvement. Thank you for your help and support throughout this project 🙂

  5. Nice work Sam. This highlights the value of students in this area and the opportunities to collaborate with the medical team.

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