Pharmacist-managed intravenous to oral step-down program.

In an effort to provide cost-effective pharmaceutical care at a 650-bed community hospital, a pharmacist-managed intravenous to oral step-down program was developed and implemented. As part of this program, satellite pharmacists review daily the charts of patients receiving 1 or more of 10 targeted drugs given intravenously. Based on a predetermined set of criteria and their clinical judgment, pharmacists recommend that physicians switch to the oral formulation of the targeted drugs if appropriate. This program has been in place for 7 months, during which time 223 recommendations were made. Of these recommendations, 190 were accepted and implemented, resulting in a cost savings of $21,596.00. When annualized, the expected savings is $37,000.00 or nearly the salary of one full-time pharmacist. This program has been well accepted by physicians and pharmacists. It appears to be having a positive impact on physician awareness of using oral medications when appropriate.