Iv To Po Pp[1]


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  • Iv To Po Pp[1]

    1. 1. RYAN MILLS, PHARM.D CANDIDATE Pharmacist role in MTM at Charleston Area Medical Center Switching patients Intravenous to oral
    2. 2. Quick Overview <ul><li>Goals </li></ul><ul><li>Background Information </li></ul><ul><li>Drug Utilization Evaluation </li></ul><ul><li>Policy and Procedures </li></ul><ul><li>Follow-up Evaluation </li></ul><ul><li>Conclusions </li></ul><ul><li>Questions </li></ul>
    3. 3. Goals <ul><li>Maintain or improve patient outcomes </li></ul><ul><li>Decrease overall cost of target IV drugs </li></ul><ul><li>Decrease overall cost of patient care </li></ul>
    4. 4. Background Information <ul><li>Potential Benefits </li></ul><ul><ul><li>Decrease indirect costs </li></ul></ul><ul><ul><li>Decrease direct costs </li></ul></ul><ul><ul><li>Increase patient satisfaction </li></ul></ul><ul><ul><li>Decrease risk iatrogenic disease </li></ul></ul><ul><ul><li>Decreased risk adverse reactions to IV therapy </li></ul></ul><ul><ul><li>Patients ambulate sooner </li></ul></ul><ul><li>Previous Programs </li></ul><ul><ul><li>Cure rates of 98-100% </li></ul></ul><ul><ul><li>Decreased length of stay by 1.5-2 days </li></ul></ul><ul><ul><li>Approximately 50% of patients on IV antibiotics may be eligible for early switch </li></ul></ul><ul><ul><li>Direct and Indirect cost savings </li></ul></ul>
    5. 5. Drug Utilization Evaluation <ul><li>25 patients evaluated </li></ul><ul><ul><li>1 month </li></ul></ul><ul><ul><li>CAP </li></ul></ul><ul><li>13 of the patients met criteria for early switch </li></ul><ul><ul><li>9 would have been switched with the program </li></ul></ul><ul><ul><ul><li>Estimated $463.58 in direct cost savings </li></ul></ul></ul><ul><ul><ul><li>Estimated $6700 per year for CAP </li></ul></ul></ul><ul><ul><li>4 were converted early by physician </li></ul></ul><ul><li>Average length of stay 6.5 days </li></ul><ul><li>Average length of IV therapy 4.5 days </li></ul>
    6. 6. Criteria for Switch <ul><li>Inclusion </li></ul><ul><ul><li>Adequate oral intake and absorption </li></ul></ul><ul><ul><li>Afebrile for at least 24 hours </li></ul></ul><ul><ul><li>Documented improvement in signs and symptoms </li></ul></ul><ul><ul><li>White blood cells normalizing and <15/mm 3 </li></ul></ul><ul><ul><li>Has Received 48 hours of IV antibiotics </li></ul></ul><ul><li>Exclusion </li></ul><ul><ul><li>Neutropenia or Immunocompromised </li></ul></ul><ul><ul><li>Infections requiring prolong treatment with IV antibiotics </li></ul></ul><ul><ul><li>Nausea/Vomiting </li></ul></ul><ul><ul><li>Ileus or Bowel obstructions </li></ul></ul><ul><ul><li>NPO orders </li></ul></ul><ul><ul><li>ICU Admission </li></ul></ul>
    7. 7. Switch Therapy <ul><li>IV antibiotics </li></ul><ul><ul><li>Ampicillin </li></ul></ul><ul><ul><li>Amp/Sulbactam </li></ul></ul><ul><ul><li>Cefazolin </li></ul></ul><ul><ul><li>Cefuroxime </li></ul></ul><ul><ul><li>Ceftazidime </li></ul></ul><ul><ul><li>Ceftriaxone </li></ul></ul><ul><ul><li>Ciprofloxacin </li></ul></ul><ul><ul><li>Gatifloxacin </li></ul></ul><ul><ul><li>Metronidazole </li></ul></ul><ul><ul><li>Clindamycin </li></ul></ul><ul><ul><li>Gentamicin </li></ul></ul><ul><ul><li>Fluconazole </li></ul></ul><ul><li>PO antibiotics </li></ul><ul><ul><li>Amoxicillin </li></ul></ul><ul><ul><li>Amoxicillin/Clav. </li></ul></ul><ul><ul><li>Cephalexin </li></ul></ul><ul><ul><li>Cefuroxime </li></ul></ul><ul><ul><li>Ciprofloxacin </li></ul></ul><ul><ul><li>Gatifloxacin </li></ul></ul><ul><ul><li>Ciprofloxacin </li></ul></ul><ul><ul><li>Gatifloxacin </li></ul></ul><ul><ul><li>Metronidazole </li></ul></ul><ul><ul><li>Clindamycin </li></ul></ul><ul><ul><li>Ciprofloxacin </li></ul></ul><ul><ul><li>Fluconazole </li></ul></ul>
    8. 8. Policy and Procedures <ul><li>Proposal to P&T committee </li></ul><ul><li>Medical Center Memorandum </li></ul><ul><li>Medical Staff Council </li></ul><ul><ul><li>Scope of Practice </li></ul></ul><ul><li>Presentation at medical noon conference </li></ul><ul><li>Physician Acceptance </li></ul>
    9. 9. Methods
    10. 10. Follow-up Evaluation <ul><li>30% of 63 evaluated patients were switched </li></ul><ul><li>100% cure rates </li></ul><ul><li>Average cost to treat CAP during DUE $130.60 </li></ul><ul><li>Average cost to treat CAP with switch program $86.40 </li></ul><ul><li>Average length of stay 6.4 days </li></ul><ul><li>Average length of IV therapy 2.6 days </li></ul><ul><li>Adverse outcomes </li></ul>
    11. 11. Limitations <ul><li>Limited duration of evaluation </li></ul><ul><li>Confounding factors involved with length of stay </li></ul><ul><li>Changes in formulary antibiotics potentially inflating cost savings </li></ul><ul><li>Difficult to estimate indirect cost savings </li></ul>
    12. 12. Conclusion <ul><li>Maintenance of this program should result in direct cost savings for this institution </li></ul><ul><li>Patient safety initially appears to be maintained </li></ul><ul><li>Further evaluation over a year would be useful </li></ul>
    13. 13. References <ul><li>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 </li></ul><ul><li>Elbe Dean, et al. Use of cefixime in an IV to oral stepdwn program to reduce antimicrobial costs. Formulary. 1998;3354-63. </li></ul><ul><li>Fraser Giles L., et al. Antibiotic Optimization: An Evaluation of Patient Safety and Economic Outcomes. Arch Intern Med. 1997;157:1689-1694. </li></ul><ul><li>Przybylski Kevin G., et al. A Pharmacist-Initiated Program of Intravenous to Oral Antibiotic Convesion. Pharmacotherapy. 1997;17(2):271-276 </li></ul><ul><li>Ramirez Julio A. Managing Antiinfective Therapy of Community-Acquired Pneumonia in the Hospital Setting: Focus on Switch Therapy. Pharmacotherapy. 2001;27(7Pt2):79S-82S </li></ul>
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