P15 - Maintaining good antimicrobial stewardship on the virtual ward

Sep 29, 2026

Evaluation of a UK tertiary hospital’s virtual ward model for administering IV antibiotics at home assessed antimicrobial stewardship oversight without a formal OPAT service. From April to September 2025, 162 virtual-ward referrals were prospectively reviewed by AMS pharmacists, recording acceptance, rejection reasons, requested agents, and indications. Overall, 60% (98) were accepted and 40% (64) declined. Rejections mainly reflected availability of suitable oral alternatives and patients’ medical unfitness for discharge. Results support early AMS involvement and commissioning a formal OPAT service for complex cases.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Background

Objectives

Methods

Results

Conclusions

Posters Abstract citation ID: dlaf239.019 P15 Maintaining good antimicrobial stewardship on the virtual ward Yasmin Elmasry1, Austin Trotman1, Katie Heard1 1Pharmacy Department, University Hospitals Plymouth NHS Trust, Plymouth, UK Background: A tertiary hospital in South West England has implemented a virtual ward service allowing patients to complete courses of IV antibiotics at home, in lieu of a commissioned outpatient parenteral antimicrobial therapy (OPAT) service. This model facilitates admission avoidance, earlier discharge and continuity of care while maintaining patient safety. In the absence of a formal OPAT service, robust antimicrobial stewardship oversight is crucial to ensure the appropriate use of antimicrobials. As such, only patients with an antimicrobial plan approved by an infection specialist are accepted for virtual ward treatment. Objectives: Between April and September 2025, data were collected to evaluate the number and outcomes of virtual ward referrals to the AMS team for IV antimicrobial therapy. The primary aim was to assess acceptance rates and identify common reasons for rejection to inform service improvement and support prudent antimicrobial prescribing. Methods: All virtual ward referrals for IV antimicrobials during the study period were prospectively reviewed by the AMS pharmacists. Data were recorded on referral volumes, acceptance and rejection rates, reasons for rejection, antimicrobial agents requested, and clinical indications. Rejections were categorized by decision-maker (AMS pharmacist, microbiology consultant, or virtual ward team) and underlying rationale, including suitability for oral switch, patient ﬁtness for discharge, or inappropriate referral. Results: Over the 6 month period, 162 referrals were made for IV antimicrobials. Of these, 98 (60%) were accepted and 64 (40%) declined. AMS pharmacists declined the majority of referrals (23), most commonly due to the availability of suitable oral alternatives (15), patients not being medically ﬁt for discharge (3), antibiotics stopped (4) . Microbiology declined 10 referrals, due to availability of appropriate oral options (5) and pending ongoing investigations (5) . The virtual ward team declined 31 referrals, mainly due to medical unﬁtness for discharge (20), inappropriate referrals (4) or home environment deemed inappropriate (2) . The most frequent indications among declined referrals were cellulitis (19) due to oral options being available. Bacteraemia referrals (15) were declined due to no conﬁrmed source or pending investigations which were similar reasons as endocarditis (4), intra-abdominal abscess (6) and bacterial meningitis (4) . Conclusions: This evaluation highlights the essential role of AMS and infection specialist oversight in ensuring safe and appropriate antimicrobial use within a virtual ward model. Asigniﬁcant40%of referrals were declined, most often duetothe availability of suitable oral therapy or patient unﬁtness for discharge, underscoring the need for early AMS input during inpatient care. However, complex patients remain outside theremitofvirtual ward and make a case fora formalized and commissioned OPAT service which adheres to BSAC good practice recommendations.

FAQs

Why is antimicrobial stewardship oversight essential in the virtual ward model?

In the absence of a formal OPAT service, robust stewardship oversight ensures antimicrobials are used appropriately and safely. Only patients with an antimicrobial plan approved by an infection specialist are accepted for virtual ward treatment.

What were the primary findings about referral acceptance and rejection?

Across six months, 162 IV antimicrobial referrals were made: 98 (60%) were accepted and 64 (40%) were declined. The most common rejection drivers included suitable oral alternatives and patients being medically unfit for discharge.

How were rejection reasons categorized in the study?

Rejections were categorized by decision-maker—AMS pharmacist, microbiology consultant, or the virtual ward team—and by underlying rationale. Reasons included suitability for oral switch, fitness for discharge, antibiotic stoppage, inappropriate referral, or pending investigations.

Sep 29, 2026

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