The Impact of a Pharmacist-led Intravenous to Oral Conversion of Metronidazole

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.