Iv To Po Pp[1]
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Iv To Po Pp[1]

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Iv To Po Pp[1] Iv To Po Pp[1] Presentation Transcript

  • RYAN MILLS, PHARM.D CANDIDATE Pharmacist role in MTM at Charleston Area Medical Center Switching patients Intravenous to oral
  • Quick Overview
    • Goals
    • Background Information
    • Drug Utilization Evaluation
    • Policy and Procedures
    • Follow-up Evaluation
    • Conclusions
    • Questions
  • Goals
    • Maintain or improve patient outcomes
    • Decrease overall cost of target IV drugs
    • Decrease 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 physician
    • Average length of stay 6.5 days
    • Average 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/mm 3
      • 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 committee
    • Medical Center Memorandum
    • Medical 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 rates
    • Average cost to treat CAP during DUE $130.60
    • Average cost to treat CAP with switch program $86.40
    • Average length of stay 6.4 days
    • Average length of IV therapy 2.6 days
    • Adverse outcomes
  • Limitations
    • Limited duration of evaluation
    • Confounding factors involved with length of stay
    • Changes in formulary antibiotics potentially inflating cost savings
    • Difficult 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