Conversion of intravenous ranitidine to oral therapy

A two-phase drug program concentrating on inappropriate use of intravenous ranitidine is described at a 612-bed university teaching hospital. Phase 1 of the study was a retrospective audit of 50 randomly selected adult patients receiving i.v. ranitidine. The chart was reviewed for indications for therapy, rationale for i.v. ranitidine, median length of i.v. therapy, and appropriateness of i.v. use. Phase 2 consisted of concurrent monitoring of iv ranitidine solely to assess the appropriateness of the iv dosage form at our hospital. Staff pharmacists reviewed the patient's medication profile from the central pharmacy to determine if the patient had standing orders for any oral or nasogastric medications while concomitantly receiving iv ranitidine. An educational memo was placed in the patient's chart if the patient was concurrently receiving oral or nasogastric medications and i.v. ranitidine. In phase I, i.v. ranitidine was inappropriate either partially or totally in 51 percent of the cases. The median length of inappropriate i.v. therapy was five days. During the second phase, the pharmacy staff reviewed 4301 profiles of patients receiving i.v. ranitidine over eight months. Educational memos were placed in 451 patient charts (11 percent) where conversion from i.v. to oral therapy was feasible; a favorable follow-up occurred in 275 cases (61 percent). This would result in an estimated annual cost savings of $4,685. Based on our ranitidine use review, extrapolating the median length of inappropriate i.v. therapy to five days would result in a yearly cost savings of $23,425. This project demonstrated that staff pharmacists can impact on physician education and cost savings by routinely screening patient's medication profiles from the central pharmacy.