Implementation of a Pharmacist-Managed IV to PO Medication Conversion Program Allison Miller Pollock, Pharm. D., Heidemarie Windham, Pharm.D., Candy Tsourounis, Pharm. D. BACKGROUND GOALS IV to PO Medication Conversion ProtocolCONCLUSIONS  Intravenous (IV) to oral (PO) therapeutic interchange programs have become common practice at institutions across the U.S.  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%  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 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 RESULTS Overview of accepted and rejected IV to PO conversions during the initial 6- month period (March 18 th – September 18 th, 2013) The number of accepted conversions represented by month and location varied over the course of the 6 months Supported by Caring Wisely, a project of the UCSF Center for Healthcare Value – Delivery Systems Initiative  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  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 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