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Implementation of a Pharmacist-Managed IV to PO Medication Conversion Program

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Implementation of a Pharmacist-Managed IV to PO Medication Conversion Program. Allison Miller Pollock, Pharm. D., Heidemarie Windham, Pharm.D., Candy Tsourounis, Pharm. D. Supported by Caring Wisely, a project of the UCSF Center for Healthcare Value – Delivery Systems Initiative .

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Implementation of a Pharmacist-Managed IV to PO

Medication Conversion Program

Allison Miller Pollock, Pharm. D.,

Heidemarie Windham, Pharm.D., Candy Tsourounis, Pharm. D.

Supported by Caring Wisely, a project of the UCSF Center for Healthcare Value – Delivery Systems Initiative 

BACKGROUND

IV to PO Medication Conversion Protocol

CONCLUSIONS

  • The number of accepted conversions represented by month and location varied over the course of the 6 months
  • Adult and pediatric in-patients at UCSF Medical Center, UCSF Benioff Children’s Hospital and UCSF Mt. Zion Hospital, with enteral access receiving one of the 16 approved IV medications
  • Training of pharmacists and notification of house staff occurred prior to the program go-live date, March 8, 2013
  • Patients with the following were excluded from participation:
      • Strict NPO
      • Active GI bleed
      • Documented SBO/ileus
      • Persistent N/V
      • Unconscious/unable to swallow with no enteral route available
      • Impaired GI absorption (short gut, recent GI surgery within 72 hours or without return of flatus, gut edema, GI fistulas)
      • Severe graft versus host disease (GVHD) or mucositis
      • Continuous tube feeds for medications whose absorption may be hindered with enteral nutrition interactions
  • Intravenous (IV) to oral (PO) therapeutic interchange programs have become common practice at institutions across the U.S.
  • IV medications are often continued for patients who are receiving other PO medications and have no obvious clinical reason for IV medication administration
  • The continuation of unnecessary IV medications results in increased direct and indirect costs to patients and the institution
  • At UCSF Medical Center, we spend over $80 million in yearly medication acquisition costs for all patients; approximately $50 million is spent yearly for inpatient use (blood products excluded)
  • Evidence suggests that properly managed IV to PO therapeutic interchange programs can reduce medication acquisition costs by X%
  • The cost savings for all 1328 accepted conversions across all three locations approaches $10,000 per day of IV therapy saved

GOALS

RESULTS

CONCLUSIONS

  • To develop and implement a pharmacist-managed IV to PO medication conversion program for patients hospitalized at Benioff Children’s Hospital and adult patients hospitalized at UCSF Medical Center and Mt. Zion Medical Center.
  • To decrease IV medication utilization in hospitalized patients by at least XX%
  • To estimate the cost savings of the IV to PO medication conversion program following implementation

Overview of accepted and rejected IV to PO conversions during the initial 6- month period (March 18th – September 18th, 2013)

  • A pharmacist managed IV to PO conversion program resulted in a significant reduction in the continuation of IV medications
  • A cost analysis is in progress to estimate direct and indirect cost savings
  • What can you do?
    • Review daily the need for IV medications especially when patients are receiving other oral medications
    • Transition patients from IV medications to PO when clinically appropriate
    • IV medications contribute to increased:
          • cost
          • length of stay
          • chance of infection and related complications
          • use of health care provider resources
  • In 2012, the Pharmacy & Therapeutics committee approved a list of 16 medications eligible for IV to PO conversion and the pharmacist-run protocol characterizing the IV to PO conversion process
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