Impact of Pharmacist-led Intervention on Early Intravenous to Oral Antibiotics Switch Practice in Surgical Wards of Hospital Sibu

Abstract

Introduction:

Early intravenous to oral antibiotics switch (IVOS) is one of the essential elements in antimicrobial stewardship (AMS). Currently, the decision on the IVOS of antibiotics in Hospital Sibu based on the decision of clinicians in charge. A systematic interventional strategy by a pharmacist is required to facilitate IVOS.

Objective:

This study aimed to associate pharmacist’s intervention with the practice of early IVOS of antibiotics.

Methods:

This study was a cross-sectional study conducted in the surgical wards of Hospital Sibu. In the pre-intervention phase (April to June 2019), pharmacists performed the conventional practice of reviewing medication charts without informing prescribers about the IVOS of antibiotics. In post-intervention phase (August to October 2019), Pharmacists screened the antibiotic prescriptions and intervened by attaching printed checklist which contained IVOS criteria to patients’ medical notes on the day patients were eligible for the switch. Besides, IVOS stickers on antibiotic prescriptions serves as reminders.

Results:

A total of 68 and 60 subjects recruited in the pre-intervention phase and postintervention phase, respectively. The percentage of IVOS of antibiotics on the appropriate day was improved to 75.0% in the post-intervention phase compared to 51.5% in the pre-intervention
phase (p=0.006). The proportion of IVOS that performed upon discharge reduced significantly in the post-intervention phase (46.7% vs 75.0%, p=0.001). Mean antibiotic cost savings increased substantially in the post-intervention phase compared to the pre-intervention phase [MYR41.90 (SD=39.50) vs MYR22.00 (SD=34.93); p=0.003)]. However, the mean duration of the length of stay during the pre-intervention phase is not statistically significant shorter compared to the mean duration of the length of stay during the post-intervention phase (p= 0.514).

Conclusions:

Pharmacist initiated printed AMS recommendations might improve the percentage of IVOS of antibiotics on an appropriate day. Further study needs a larger sample size.