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A4968 - The Impact of Pharmacists Versus Physicians on the Conversion from Intravenous (IV) to Oral (PO) Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease (COPD)
Author Block: A. F. A. Basilim1, L. Calkins2, M. Alshibani1, S. Perona2; 1Pharmacy college, University of Arizona, Tucson, AZ, United States, 2Pharmacy Department, Northwest Medical Center, Tucson, AZ, United States.
INTRODUCTION: In Chronic Obstructive Pulmonary Disease (COPD) exacerbation, using oral (PO) corticosteroids has been shown to be as effective as intravenous (IV) administration. When patients can safely absorb oral medications, the cost and convenience benefits of an IV to PO conversion strategy have been demonstrated. In an effort to decrease length of stay and reduce cost, Northwest Medical Center (NMC) established a pharmacist-mediated IV to PO conversion protocol for corticosteroids in patients with a COPD exacerbation diagnosis. A small pilot conducted shortly after protocol initiation compared to historical controls did not demonstrate significant differences; however, the protocol was underutilized and patient numbers were small. OBJECTIVES: The purpose of this study was to evaluate the impact of pharmacists’ intervention versus physicians’ on the length of stay, time to conversion, and readmission rate after the implementation of the conversion program. METHODS: This was a retrospective, observational study of patients admitted to a community hospital with a diagnosis of COPD exacerbation between October 1, 2014 and March 30, 2016. Patients on a ventilator, receiving a single IV corticosteroid dose, with asthma, without COPD exacerbation or who died prior to conversion were excluded. Electronic medical records were reviewed for: demographic data, time to conversion, hospital length of stay, and readmission within 30 days. Primary outcomes included hospital length of stay and time to conversion; secondary outcome was 30-day readmission rate due to COPD exacerbation. This study was approved by NMC’s Institutional Review Board. RESULTS: Of 459 patients enrolled, 259 patients met the inclusion criteria and 200 were excluded. The majority of patients (n = 207, 79.9%) received physicians intervention and 52 (20.1%) received intervention by a pharmacist. Mean length of stay 4.2 ± 2.45 days in the physicians group vs. 4.49 ± 2.14 days in the pharmacists group was not significantly different (P = 0.43). A statistically significant difference in mean time to conversion was demonstrated; 2.45 ± 2.18 days vs. 2.15 ± 0.88 days in the physicians and pharmacists groups respectively (P = 0.049). There was no statistically significant difference between groups in patient 30-day readmission rates due to COPD exacerbations; 18 (8.7%) in the physicians group vs. 7 (13.5%) in the pharmacists group (P = 0.29). CONCLUSIONS: This study showed that pharmacists’ intervention in the conversion of corticosteroids from IV to PO could shorten time to conversion; however, it did not affect hospital length of stay or readmission rates.