Category: Professional Posters
Purpose: Exacerbation of chronic obstructive pulmonary disease (COPD) is a common reason for hospital admission. Guidelines recommend systemic corticosteroids during acute exacerbations to reduce the risk of treatment failure and relapse as well as improve lung function and breathlessness. Although guidelines recommend use of oral (PO) prednisone, many patients at Methodist Medical Center of Oak Ridge receive intravenous (IV) methylprednisolone. Investigators sought to assess the impact of an IV to PO substitution program on IV methylprednisolone use and length of stay for patients with COPD.
Methods: This was a single center, pre-post retrospective study evaluating the impact of a pharmacist-driven, automatic IV to PO corticosteroid substitution program on average IV methylprednisolone days of therapy (DOT) and average patient length of stay (LOS). All patients in a COPD diagnosis-related group (DRGs 191-193) were included in the study. Data were collected prior to substitution program implementation (May 2016-April 2017) and compared to data collected after implementation (May 2018-April 2019). Pharmacists screened all patients receiving IV methylprednisolone to determine eligibility for conversion to oral prednisone. Patients met criteria for conversion if they were receiving IV methylprednisolone doses of ≤40 mg for at least 24 hours, tolerating an oral solid diet, and taking other medications by mouth. Independent samples t-tests were used to compare pre-post data.
Results: There were a total of 387 patients in the three COPD DRGs (191-193) in the post-implementation group and 467 in the pre-implementation group. The hospital experienced a significant reduction in the average IV methylprednisolone DOT after implementation [(4.2 ± 2.2 days) vs. (3.8 ± 2.3 days); p<0.001]. Additionally, there was a significant reduction in LOS [(5.5 ± 3.2 days) vs. (5.1 ± 3.3 days); p=0.003].
Conclusion: Implementation of a pharmacist-driven, automatic IV to PO corticosteroid conversion program in patients with COPD resulted in a significant reduction in the use of IV methylprednisolone and may have contributed to a significant decrease in length of stay.