Background The Regional Drug and Therapeutics Committee of Region Zealand are implementing rational pharmacotherapy within hospital and primary care, by recommending drugs that are rational for use in concern of particularly effectively, safety and totally drug expense for hospitals and primary care. After discharge from the hospital the GP tend to continue the drug chosen at the Hospital, hence the use at the hospitals affect the use in the primary care. To the hospitals oxycodone is only marginal more expensive than morphine but in primary care oxycodone is substantially more expensive.

Purpose To implement the recommendation of morphine instead of oxycodone, and thereby reduce the total drug expense for the healthcares system at Region Zealand.

Materials and methods The implementing was made step-by-step with follow-up. 1. Written information to the hospital wards and the GP, with advice to remove oxycodone from the standard assortment, and how to change patient treatment to morphine. 2. Dialogue with the wards by clinical pharmacist toward final agreement of removing oxycodone from the wards standard assortment. Written advice in the medical journal of every patient still treated with oxycodone. 3. Every 3rd-month a status report is made to the GP and the wards, with the data of their actual oxycodon consummation. 4. The Regional Drug and Therapeutics Committee follow the total consumption of oxycodone and strategy for further or repeated intervention is made.

Results One year after the start of implementation, the amount of morphine used (DDD) is increased from 25% to 50% in the hospitals and from 38% to 44% in primary care. The drug expense for the total healthcare system is thereby reduced by 7%. The implementation is still in process.

Conclusions The step-by-step quality implementation is successful to implement recommendation.