Unit IV: Coordination Reflex Arc Chapter 11 – pp 363-371 Chapter 12 – pp 413-421.
Iv To Po Pp[1]
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RYAN MILLS, PHARM.D CANDIDATE
Pharmacist role in MTM at Charleston Area Medical Center Switching
patients Intravenous to oral
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Quick Overview
GoalsBackground InformationDrug Utilization EvaluationPolicy and ProceduresFollow-up EvaluationConclusionsQuestions
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Goals
Maintain or improve patient outcomes Decrease overall cost of target IV drugsDecrease overall cost of patient care
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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
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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
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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
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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
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Policy and Procedures
Proposal to P&T committeeMedical Center MemorandumMedical Staff Council
Scope of Practice
Presentation at medical noon conference
Physician Acceptance
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Methods
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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
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Limitations
Limited duration of evaluationConfounding factors involved with
length of stayChanges in formulary antibiotics
potentially inflating cost savingsDifficult to estimate indirect cost
savings
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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
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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