Iv To Po Pp[1]

RYAN MILLS, PHARM.D CANDIDATE

Pharmacist role in MTM at Charleston Area Medical Center Switching

patients Intravenous to oral

Quick Overview

GoalsBackground InformationDrug Utilization EvaluationPolicy and ProceduresFollow-up EvaluationConclusionsQuestions

Goals

Maintain or improve patient outcomes Decrease overall cost of target IV drugsDecrease overall cost of patient care

Background Information

Potential Benefits Decrease indirect

costs Decrease direct

costs Increase patient

satisfaction Decrease risk

iatrogenic disease Decreased risk

adverse reactions to IV therapy

Patients ambulate sooner

Previous Programs Cure rates of 98-

100% Decreased length of

stay by 1.5-2 days Approximately 50%

of patients on IV antibiotics may be eligible for early switch

Direct and Indirect cost savings

Drug Utilization Evaluation

25 patients evaluated 1 month CAP

13 of the patients met criteria for early switch 9 would have been switched with the program

Estimated $463.58 in direct cost savings Estimated $6700 per year for CAP

4 were converted early by physicianAverage length of stay 6.5 daysAverage length of IV therapy 4.5 days

Criteria for Switch

Inclusion Adequate oral intake

and absorption Afebrile for at least

24 hours Documented

improvement in signs and symptoms

White blood cells normalizing and <15/mm3

Has Received 48 hours of IV antibiotics

Exclusion Neutropenia or

Immunocompromised

Infections requiring prolong treatment with IV antibiotics

Nausea/Vomiting Ileus or Bowel

obstructions NPO orders ICU Admission

Switch Therapy

IV antibiotics Ampicillin Amp/Sulbactam Cefazolin Cefuroxime Ceftazidime Ceftriaxone Ciprofloxacin Gatifloxacin Metronidazole Clindamycin Gentamicin Fluconazole

PO antibiotics Amoxicillin Amoxicillin/Clav. Cephalexin Cefuroxime Ciprofloxacin Gatifloxacin Ciprofloxacin Gatifloxacin Metronidazole Clindamycin Ciprofloxacin Fluconazole

Policy and Procedures

Proposal to P&T committeeMedical Center MemorandumMedical Staff Council

Scope of Practice

Presentation at medical noon conference

Physician Acceptance

Methods

Follow-up Evaluation

30% of 63 evaluated patients were switched

100% cure ratesAverage cost to treat CAP during DUE

$130.60 Average cost to treat CAP with switch

program $86.40Average length of stay 6.4 days Average length of IV therapy 2.6 daysAdverse outcomes

Limitations

Limited duration of evaluationConfounding factors involved with

length of stayChanges in formulary antibiotics

potentially inflating cost savingsDifficult to estimate indirect cost

savings

Conclusion

Maintenance of this program should result in direct cost savings for this institution

Patient safety initially appears to be maintained

Further evaluation over a year would be useful

References

Ahkee Sunket. Early Switch from Intravenous to Oral Antibiotics in Hospitalized Patients with Infections: A 6-Month Prospective Study. Pharmacotherapy. 1997;17(3):569-575

Elbe Dean, et al. Use of cefixime in an IV to oral stepdwn program to reduce antimicrobial costs. Formulary. 1998;3354-63.

Fraser Giles L., et al. Antibiotic Optimization: An Evaluation of Patient Safety and Economic Outcomes. Arch Intern Med. 1997;157:1689-1694.

Przybylski Kevin G., et al. A Pharmacist-Initiated Program of Intravenous to Oral Antibiotic Convesion. Pharmacotherapy. 1997;17(2):271-276

Ramirez Julio A. Managing Antiinfective Therapy of Community-Acquired Pneumonia in the Hospital Setting: Focus on Switch Therapy. Pharmacotherapy. 2001;27(7Pt2):79S-82S