An information system to promote intravenous-to-oral medication conversion

Many inpatients remain on expensive intravenous medications, even after they become able to take bioequivalent oral alternatives. We developed a computer intervention to identify such patients and to deliver alerts suggesting a switch to the oral medication. In the first phase of the project, alerts were delivered to pharmacists. The Brigham Integrated Computer System (BICS) was used to produce a daily report of patients receiving any of six targeted intravenous medications, who also had orders for an oral diet or other scheduled oral medications. Staff pharmacists screened the report and suggested IV to PO conversion in appropriate cases to the patient's nurses and/or physicians. Feedback was documented in the BICS system. Analysis of the pilot study showed that in 31.7% of cases, physicians agreed to change (or had just changed) the patient's medication from IV to PO. Further analysis of pilot (Phase I) data was performed against a variety of parameters in order to increase the fraction of alerts deemed appropriate for conversion. These more specific alerts can be sent directly to physicians.