Implementation of a Pharmacist-Managed IV to PO
Medication Conversion Program
Allison Miller Pollock, Pharm. D.,
Heidemarie Windham, Pharm.D., Candy Tsourounis, Pharm. D.
Supported by Caring Wisely, a project of the UCSF Center for
Healthcare Value – Delivery Systems Initiative
BACKGROUND
IV to PO Medication Conversion Protocol
CONCLUSIONS
 Intravenous (IV) to oral (PO) therapeutic interchange programs
have become common practice at institutions across the U.S.
 Adult and pediatric in-patients at UCSF Medical Center, UCSF
Benioff Children’s Hospital and UCSF Mt. Zion Hospital, with
enteral access receiving one of the 16 approved IV medications
The number of accepted conversions represented by month and
location varied over the course of the 6 months
 IV medications are often continued for patients who are
receiving other PO medications and have no obvious clinical
reason for IV medication administration
 The continuation of unnecessary IV medications results in
increased direct and indirect costs to patients and the institution
 At UCSF Medical Center, we spend over $80 million in yearly
medication acquisition costs for all patients; approximately
$50 million is spent yearly for inpatient use (blood products
excluded)
 Evidence suggests that properly managed IV to PO therapeutic
interchange programs can reduce medication acquisition costs
by X%
 Training of pharmacists and notification of house staff occurred
prior to the program go-live date, March 8, 2013
 Patients with the following were excluded from participation:
−Strict NPO
−Active GI bleed
−Documented SBO/ileus
−Persistent N/V
−Unconscious/unable to swallow with no enteral route available
−Impaired GI absorption (short gut, recent GI surgery within 72
hours or without return of flatus, gut edema, GI fistulas)
−Severe graft versus host disease (GVHD) or mucositis
−Continuous tube feeds for medications whose absorption may
be hindered with enteral nutrition interactions
GOALS
 To develop and implement a pharmacist-managed IV to PO
medication conversion program for patients hospitalized at
Benioff Children’s Hospital and adult patients hospitalized at
UCSF Medical Center and Mt. Zion Medical Center.
 To decrease IV medication utilization in hospitalized patients
by at least XX%
 To estimate the cost savings of the IV to PO medication
conversion program following implementation
In 2012, the Pharmacy & Therapeutics committee approved a
list of 16 medications eligible for IV to PO conversion and the
pharmacist-run protocol characterizing the IV to PO conversion
process
The cost savings for all 1328 accepted conversions across all
three locations approaches $10,000 per day of IV therapy
saved
RESULTS
CONCLUSIONS
Overview of accepted and rejected IV to PO conversions during the
initial 6- month period (March 18th – September 18th, 2013)
Drug
Acetaminophen
Azithromycin
Ciprofloxacin
Clindamycin
Doxycycline
Famotidine (adults)
Fluconazole
Pantoprazole/Lansoprazole
Levofloxacin
Linezolid
Metronidazole
Moxifloxacin
Ranitidine (peds)
Rifampin
Sulfamethoxazole/trimethoprim
Voriconazole
Total
# Accepted
Conversions
411
40
30
22
19
108
42
483
52
43
54
1
5
1
2
15
# Rejected
Conversions
37
1
3
6
1
3
7
24
5
3
3
1
4
0
0
3
1328
101
%
Rejected
9
2.5
10
27
5.2
2.7
16.6
4.9
9.6
6.9
5.5
100
80
0
0
20
 A pharmacist managed IV to PO conversion program resulted in
a significant reduction in the continuation of IV medications
 A cost analysis is in progress to estimate direct and indirect cost
savings
 What can you do?
 Review daily the need for IV medications especially when
patients are receiving other oral medications
 Transition patients from IV medications to PO when
clinically appropriate
 IV medications contribute to increased:
cost
length of stay
chance of infection and related complications
use of health care provider resources