IV to oral switch: a novel viewpoint

Abstract

Up to 80% of hospitalized patients receive IV therapy at some point during their admission.1 The risks of this have been widely reported and include increased incidence of phlebitis, infection, extravasation and medication errors when compared with oral therapies.2,3 Medicines administration via the IV route is essential in many scenarios; however, optimizing the timing of switch to oral treatment is often perceived as challenging causing IV therapy to be extended unnecessarily.4

One factor not always considered in the risk-benefit assessment is the workforce commitment required to administer IV medicines compared with their oral equivalents. To quantify this difference a medicines administration time-and-motion study was undertaken at University Hospitals Birmingham (UHB) during which all processes of ward-based medicines preparation, administration and disposal were timed by clinical pharmacists. A total of 87 IV (Table 1) and 140 oral medicine administrations were timed. Mean administration durations of 22 minutes and 5 seconds for IV and 80 seconds for oral with IQRs of 5 min 30 seconds and 40 seconds, respectively. This was not an IV to oral switch study and therefore details on indication and outcome were not collected. The results showed that each IV medicine administration required more than 20 min of additional nursing input relative to oral medication administration. Consequently, a patient receiving a single appropriate IV to oral switch of one medicine administered three times each day would release 1 h of nursing time each day from medicines administration tasks for other duties.