Appropriate conversions from intravenous (IV) to oral (PO) therapy early in the hospital stay can promote patient comfort and satisfaction while decreasing unnecessary costs and adverse events related to IV catheters. Although IV to PO conversion as a stewardship intervention is considered low hanging fruit, the time spent on review can be extensive and reporting can be challenging. Utilization of an automated decision support system allows for easy monitoring of IV to PO switches as well as identification of ways to enhance the efficiency and effectiveness of the program. The primary objective was improving IV to PO conversions through an automated system and measuring outcomes electronically without manual chart review. Desired metrics were percentage of eligible antimicrobials ordered as PO, number of conversions, and cost avoidance.
A protocol was approved by the Pharmacy and Therapeutics committee allowing pharmacists to auto-convert medications from IV to PO when meeting pre-specified criteria. These identification criteria were implemented electronically using a traffic light decision support system to prioritize eligible patients (Fig 1). Education was provided both in person and as pocket cards with guidance on eligible antimicrobials for IV to PO conversions. Metrics were based on monthly antimicrobial utilization data and displayed as a dashboard (Fig 2).
Monthly metrics provided the stewardship team feedback on the effectiveness of the IV to PO program and identified areas for improvement. From January 2017 to January 2018, cost avoidance from ordering PO as opposed to IV agents was $524,788 with 1,843 IV to PO conversions performed by both providers and pharmacists. A total of 65% of the eligible antimicrobials were ordered via the PO route. Based on these findings a multifaceted approach to further expand the initiative was undertaken.
The IV to PO decision support system improves the efficiency of IV to PO review process and reduces time spent reviewing charts of patients who do not meet criteria for conversion. The development of automated monthly metrics is an efficient method to assess the effectiveness of the program as well as identify key areas for future development.
J. Ortwine, None
K. Alvarez, None
B. Prokesch, None
See more of: Poster Abstract Session