Abstract:
Introduction:
Early intravenous to oral switch (IV:PO) of antibiotics can reduce length of hospitalisation, risk of
intravenous (IV) catheter infections, and hospital costs. Pharmacists can play an instrumental role in the
implementation of an IV:PO initiative, leading to earlier IV to oral switch rates and reduction in costs
and risks associated with IV administration IV-line infections.
Aim:
To evaluate the financial and clinical impact of pharmacist-led IV:PO metronidazole in Auckland City
Hospital.
Method:
During a 3-month intervention period between 10 June - 30 September 2019, pharmacists screened
medication charts to identify patients who were receiving IV metronidazole; the ward pharmacist
initiated the switch for patients who met the IV:PO criteria. The comparator group were patients who
were treated with metronidazole prior to the implementation of the protocol (between 1st January 2018 –
31st December 2018) and their data was collected retrospectively. The main clinical outcome measures
were treatment duration, number of IV and oral doses, enteral intake and length of hospital stay. The
main financial measures were the acquisition costs of IV and oral metronidazole, consumables, and cost
of nursing time. Questionnaires were distributed to doctors, nurses, and pharmacists after implementation
to determine the acceptability of the switch service.
Results:
In total 203 patients were included in the study; 100 in the pre-intervention and 103 in the postintervention
groups. The monthly switch rate increased from 17% to nearly 80% by the end of the study
period. The implementation of the switch service did not significantly affect the probability of repeat
surgery, or readmission within 90-days of discharge when compared to patients who were not switched
(p>0.05). In addition, the projected cost-savings associated with the pharmacist-led switch service could
be somewhere between NZD 40,000 to NZD 60,000 annually. The switch service was supported by 83%
of doctors (n= 18), 90% of pharmacists (n= 20), and all nurses (100%) (n= 18).
Conclusion:
This study has shown that pharmacist-led IV:PO can result in a shorter IV treatment with reduced costs
to the hospital and no negative consequences on the patient. The service was largely supported by doctors,
nurses, and pharmacists.