Category: Professional Posters
Purpose: The main aim of this study was to explore the pharmacist role in improving the utilization of -intravenous medications and respective conversion to oral within 24-48 hours of initiated order. The main objective was to evaluate the rate of conversion from IV to PO enhanced by pharmacist interventions in adult patients who have been on intravenous medications in the selected clinical units at Tawam hospital. The selected medications were chosen to be converted from IV to PO because of availability in injection and oral form, have comparable bioavailability, have different cost price between injection and oral form and highly prescribed.
Methods: Adults patients who were receiving intravenous medications during hospitalization and have met the inclusion criteria for conversion from intravenous to oral therapy.
The pharmacist generated a daily report from health information system (Malaffi) of patients who were on selected intravenous medications (Esomeprazole, Ranitidine, Metronidazole and fluconazole) which have been started for more than 24-48 hours. The pharmacist screened patients for opportunity of intravenous conversion to oral and has contacted prescriber/attending physician to obtain verbal approval for conversion.
The conversion was documented as an accepted clinical intervention in the patient’s electronic medical record.
The pharmacist continued monitoring patients receiving oral medications by getting clinical feedback from attending physician progress notes.
Patients eligibility for conversion were screened based on patient’s age, gender, comorbidities, IV medication, medication converted to PO, reason for IV, reason for conversion, patient’s clinically improvement. Inclusive criteria were all adult patients on intravenous therapy within 24-48 hours of drug initiation.
Criteria to be considered in the conversion from IV to PO therapy, patients should satisfy the following characteristics that documented oral intake, oral diet, tube feeding with ≤100 mL residuals over 24 hour. Also patient with no documented nausea/vomiting, no use of “as needed” anti-emetics in the previous 24 hour.
Paediatric patients and adult ICU, patients with chemotherapy-related neutropenia and/or bone marrow transplant patients and patients admitted to emergency department were excluded.
Results: The pharmacists has conducted 120 interventions for conversion of intravenous medications to oral therapy as per the policy of conversion. However,120 interventions (59%) has been accepted by the treating physician and consequently the orders has been replaced with oral in accordance with the protocol.
The main finding was a number of patient’s medications converted from intravenous to oral in which patients were eligible for switch within 24/48 hr and total cost saving 28,720AED.
Usually medications are prescribed with automatic stop order (ASO) Esomeprazole and Ranitidine 30days, Metronidazole 7 days, Fluconazole 14 days all converted to PO after 24-48 hr*
Conclusion: The rate of acceptance to convert IV medication to orally was increased by pharmacist role played in communication with physicians for possibility of intervening the switch of IV to PO. The impact on the cost minimization enhanced by pharmacist efforts is evidence based . The important role of the pharmacist in conversion of intravenous to oral therapy and the substantial reduction in excessive use of intravenous medications will change the unnecessary prolonged use of intravenous medication. This approach can be used to reduce excess use of intravenous medications, with potential benefits in patient comfort, safety and cost saving.