Use of concurrent monitoring and a preprinted note to modify prescribing of i.v. cimetidine and ranitidine in a teaching hospital

Abstract

The use of concurrent monitoring and an informational note to modify physician prescribing of i.v. cimetidine and ranitidine is described. The study population consisted of all patients for whom i.v. cimetidine and ranitidine therapy was prescribed by house-staff physicians at an 850-bed, tertiary-care, university-affiliated hospital during February, March, and April 1987. Phase 1 of the trial consisted of an initial drug-use review of all eligible patients receiving therapy. In phase 2, the study population was divided into an intervention group and a control group. When therapy could be changed from the i.v. to the oral or nasogastric (NG) route of administration, an informational note was placed in the chart of the patients in the intervention group. Patients in the control group were also assessed daily for the appropriateness of conversion to oral or NG therapy. The following outcome measures were used to test the effectiveness of the intervention in modifying physician prescribing: mean number of i.v. doses and days of i.v. therapy per patient and mean number of inappropriate i.v. doses and days of i.v. therapy per patient. The drug acquisition costs for both groups were also analyzed. A total of 233 patients were monitored during the study period. The percentage of patients who did not receive oral therapy as soon as possible was not significantly different between the intervention (55%) and control (58%) groups. Patients in the intervention group received three to six fewer i.v. doses than patients in the control group and three to six additional oral doses.(ABSTRACT TRUNCATED AT 250 WORDS)