Interventions to obtain an early switch from intravenous to oral antibiotic therapy in a Dutch teaching hospital: translating studies into clinical practice

Abstract

Several studies [1, 2] have shown that a similar therapeutic outcome is obtained in patients who made an early switch from intravenous (i.v.) to oral antibiotic therapy, and those who did not make this switch. Benefits of an early switch are patient comfort and mobility, reduced length of hospital stay and cost savings. The purpose of this study is to reduce the number of days with unnecessary intravenous antibiotic therapy in hospitalized patients. We defined intravenous to oral switch criteria based upon a publication of Sevinc et al. [3]. We also set up a multidisciplinary team (medical microbiologist, hospital pharmacists, physicians, nurses and quality assurance manager) that guided interventions. Adherence to these criteria was measured on internal medicine wards before (‘control’ group) and after interventions (‘intervention’ group). The primary parameter was the number of days with unnecessary intravenous antibiotic therapy. Interventions consisted of: 1; Oral presentations of switch criteria guidelines to physicians and nurses, 2) handing out pocket size switch guideline cards to prescribing physicians and 3) actively suggesting switch therapy to physicians on a daily basis when patients were identified who fulfilled switch criteria, yet were not switched. In the control group, only 26% (9/35) of patients eligible to be switched were actually switched within the predefined timeframe, resulting for the whole group to a total amount of 96 unnecessary i.v. days (median 2). In the intervention group 84% (37/44) of patients switched within time, leading to a total number of only 9 unnecessary i.v. days (median 0) (Figure 1). Material cost savings (antibiotics and medical supplies) obtained in the intervention group were ξ 3250 in 2 months. The study is now being extended to surgical wards. Preliminary results on these wards are similar to those obtained on the internal medicine wards. After successful implementation is reached on all wards, an annual cost reduction for the hospital (777 beds) of ξ 87 000 is expected. In conclusion, simple interventions can lead to a significant reduction of unnecessary intravenous antibiotic therapy and substantial cost savings. Figure 1 Days with unnecessary i.v. antibiotic therapy per patient.