Policies that promote conversion of antibiotics from intravenous to oral route administration are considered “low hanging fruit” for hospital antimicrobial stewardship programs. We developed a simple metric based on digestive days of therapy divided by total days of therapy for targeted agents and a method for hospital comparisons. External comparisons may help identify opportunities for improving prospective implementation.
Policies that promote conversion of antibiotics from intravenous to oral route administration are considered (ie, intravenous [IV] to oral [PO] conversion protocols) are considered a simple, straightforward policy-level intervention for hospital antimicrobial stewardship programs (ASPs), sometimes referred to as “low-hanging fruit.” Such policies target patients receiving agents with high oral bioavailability. These protocols typically require pharmacists to use simple eligibility criteria to contact prescribing clinicians to recommend oral conversion or may allow automatic therapeutic interchange. Potential benefits of IV-to-PO conversion protocols include reductions in pharmacy and hospitalization costs, reduced use of intravenous lines and lowered risk of line-related complications, improved patient comfort, and reduced effort from nurses. These benefits accrued while maintaining treatment efficacy.
Although many hospitals have IV-to-PO protocols in place, few studies have assessed whether their institution is capitalizing on opportunities for IV-to-PO conversions. Additionally, some hospitals struggle to consistently perform IV-to-PO conversions due to competing priorities. We developed a simple calculation of digestive days of therapy (dDOT) divided by total days of therapy (tDOT) to assess how implementation of IV-to-PO conversion policies varied across hospitals, units, and targeted agents. We also developed reports with comparisons to other network hospitals to help assess and refine protocol implementation.