Assessment of intravenous to oral medications conversion practice at a UAE tertiary care hospital: A retrospective observational study

Abstract

Background: Many patients admitted to the hospital are initially started on intravenous (IV) medications due to their clinical conditions that necessitate only the use of the parenteral route of administration. As the patient’s clinical status improves and the patient can tolerate oral intake, drugs can be converted from IV to oral (PO) form. Switching IV to PO treatment, in a timely manner, is an effective and safe approach that leads to improved rational use of medications and contributes to overall cost savings. This study aims to assess the current practices of IV to PO conversion practice in intensive care unit (ICU) settings, with regards to antibiotics, proton pump inhibitors, and acetaminophen. Methods: Retrospective, cohort study performed from October 2020-October 2022 in a tertiary care hospital in the UAE. All patients were admitted to the ICU and had received an IV antibiotic, proton pump inhibitors or acetaminophen for more than 48 hours, were able to eat or tolerate oral formulation and enteral feeding, patients with intact gastrointestinal tract and the absence of bowel abnormalities, adequately absorbed oral medications via the oral, gastric, or nasogastric tube route. Results: Most of the study participants were admitted to infectious disease as primary diagnosis, with pneumonia being the most prevalent type of infection followed by Skin and Soft Tissue Infections (SSTIs). Beta-lactams were the most frequently prescribed antibiotic class (52.5%), followed by vancomycin (12.7%). The majority of the patients (84.7%) were able to tolerate an oral diet (either since the time of admission or later after clinical improvement), and 92.4% of them showed clinical improvement. 89% of the patients were good candidates for IV to PO switch, however, the medical team failed to do the switch. The total cost for the total duration of IV therapy was 119,400 AED (USD 32,500). Patients who were not candidates for the IV to PO switch became later able to tolerate oral diet and medications for an average of 3 days. Nevertheless, they were not switched during these days. Thus, upon calculating the costs, we found that 18,377 AED (USD 5000) could have been saved if the IV to PO switch was done timely. Conclusion: Intravenous to peroral conversion practice was infrequent. Improper IV to PO conversion practice was significantly associated with beta-lactams, acetaminophen and PPIs. Awareness of IV to PO conversion practice and short-term training for healthcare teams is vital for better IV to PO conversion practice.