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Switching patients from IV to oral form of drugs could save millions, reduce adverse events

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Switching hospitalized patients able to take medication by mouth from intravenous to pill forms of the same drugs could safely save millions of dollars a year.

In a review of computerized records for the year 2010, conducted at The Johns Hopkins Hospital in Baltimore, researchers estimated savings of more than $1.1 million in the Department of Medicine alone-not including surgical patients-by swapping out 4 commonly prescribed IV medications with their oral equivalents.

The medications reviewed in the study were chlorothiazide (a medication used to treat high blood pressure and address fluid retention), voriconazole (an anti-fungal), levetiracetam (to stop seizures) and pantoprazole (for acid reflux).

"Assuming that all patients were indeed eligible for the equivalent oral medication, the use of IV medication contributes to more than $1.16 million in medication acquisition cost alone," said Dr Lau.

By combining Hopkins' computerized provider order entry (CPOE) system, researchers examined whether patients receiving these drugs intravenously were also prescribed other medications orally or if they were being fed solid meals, another indication that they would likely be able to swallow pills. In 2010, a total of 10,905 doses of the 4 medications were given by IV to patients admitted through the Department of Medicine. Dr Lau said the drugs are given even more frequently in surgery patients.

By developing an electronic reminder in the CPOE that alerts the prescriber of potential clinical eligibility for oral medication, "there may be a reduction in the use of IV medication, the cost of acquiring and administering IV medication, and adverse events such as IV-associated bloodstream infection," he explained. "Health IT, in the form of electronic medical records, CPOE, and clinical decision support systems, and its meaningful use is a national priority. These are tools that are being adopted by hospitals across the country. This study is one example of the potential impact that health IT could have on cost reduction and quality improvement."

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