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4CPS-214 Improving intravenous to oral switch by identifying and tackling barriers perceived by physicians and nurses
  1. S Von Winckelmann,
  2. E Boey,
  3. V Verheyen
  1. Imelda Hospital, Hospital Pharmacy, Bonheiden, Belgium


Background and importance Appropriate and timely switching of drugs from intravenous (IV) to oral administration is a good, safe and cost effective intervention. However, IV to oral switch guidelines are not always adhered to adequately.

Aim and objectives The aim of this study was to investigate how hospital pharmacists can promote IV to oral switches.

Material and methods An interventional before and after study was performed in a 500 bed regional hospital. Physicians and nurses completed a structured questionnaire asking about switch criteria, the main barriers for not switching and interventions to improve switch practice. Mean duration of non-appropriate IV therapy and number of IV to oral switches were retrospectively measured based on chart review and validated criteria over a 6 month periods before and after implementing a bundle of tailored interventions on an orthopaedic and geriatric ward.

Results The questionnaire was completed by 36 physicians and 29 nurses. The respondents agreed on the established IV to oral switch criteria. The reasons for not switching despite eligibility were mainly patient centred concerns: the patient feels ill (60%), swallowing difficulties (54%) and suspicion of non-adherence (55%). Interventions that they considered useful were predefined drug orders and reminders in the electronic prescribing system (58.5%) and the pharmacist contacting the prescriber in case of a possible switch (40%). A poster campaign concerning IV to oral switch for acetaminophen and antibiotics was implemented; the powder formulation of acetaminophen was included in predefined drug orders and patient specific advice was given by the pharmacist who checked the prescriptions in the pharmacy before drug dispensing (acceptance rate 79%). A total of 227 and 226 patients treated with intravenous acetaminophen and/or antibiotics, respectively, were included in the retrospective chart review before and after our interventions. This multimodal IV to oral switch strategy resulted in a reduction of the mean duration of non-appropriate IV therapy (total reduction of −7.25 hour, p=0.002, for acetaminophen reduction of −9.3 hour, p=0.001) and the number of IV to oral switches increased by 8.9% (p=0.027).

Conclusion and relevance Structural and proactive interventions by the hospital pharmacist resulted in a reduction of the duration of non-appropriate IV therapy and an increase in IV to oral switches. However, the cost effectiveness and sustainability of these interventions is questionable in a setting with limited clinical pharmacy resources.

References and/or acknowledgements No conflict of interest.

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