Implementation of an intravenous to oral switch policy for antimicrobials in a secondary care setting

Abstract number: P1283

Dunn K., O'Reilly A., Treacy V., Rogers T., Bergin C.

Objectives: Sequential therapy is defined as the timely transition from parenteral to oral antimicrobial therapy. It is promoted as intravenous therapy is more expensive, has significant adverse effects, is time consuming for staff and is not always more efficacious.

To develop and issue guidelines to clinical pharmacists on enacting an intravenous to oral switch policy in a large Irish teaching hospital.

To implement an intravenous to oral switch policy, and to examine the effect of this policy.

To find out if an earlier switch to an oral antimicrobial resulted in a shorter hospital stay.

To record where empiric treatment was prescribed, if the initial antimicrobial chosen complied with the hospital empiric guidelines.

To calculate cost savings generated from the implementation of the stategy.

Methodology: This was a prospective, controlled before and after study. A control and study group were included. The intervention consisted of the application to the drug chart of stickers promoting an oral switch along with a guide on the criteria for switch. Duration of intravenous treatment, the number of days after the criteria were met before antimicrobials were switched to oral, length of stay and cost savings were measured. Compliance with the hospital empiric antimicrobial guidelines was assessed.

Results: The study included 236 patients prescribed 289 intravenous antimicrobial courses. The duration of intravenous treatment reduced significantly between the pre- and post-intervention periods, when comparing the study group to the control group (p = 0.02). The number of days after the criteria for switching was met before the patient was switched to oral antimicrobials reduced significantly post-intervention in the study group compared to the control group (p = 0.017). The median length of stay did not reduce. The intervention was cost effective, and resulted in some cost savings, ([euro]6.41 per patient in the post-intervention study group). 88.8% of prescriptions were concordant with the empiric antimicrobial prescribing guidelines.

Conclusions: Implementation of the strategy resulted in a reduced duration of intravenous antimicrobial treatment, with resulting cost savings. There was no reduction in the median length of stay, likely due to social reasons and other co-morbidities lengthening stay. This strategy is to be rolled out to all general medical and surgical wards in the hospital.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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