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- 25 Nov 2024, 09:03
#6096
In the evolving landscape of antimicrobial stewardship, the Intravenous-to-Oral Switch (IVOS) has emerged as a crucial intervention that's transforming patient care. This comprehensive guide explores the benefits, implementation, and decision-making process behind IVOS therapy.
What is IVOS and Why Does it Matter?
IVOS (Intravenous-to-Oral Switch) represents a strategic shift in antimicrobial therapy where patients are transitioned from intravenous to oral medication when clinically appropriate. This evidence-based practice has demonstrated numerous benefits for both patients and healthcare facilities.
Key Benefits of IVOS:
- Reduced risk of bloodstream and catheter-related infections
- Lower equipment costs and carbon footprint
- Shortened hospital stays
- Enhanced patient mobility and comfort
- Increased nursing time availability for patient care
When Should Healthcare Providers Consider IVOS?
The recommended audit standard suggests that all patients on IV therapy should undergo:
- Prompt review from the first dose of IV antimicrobial
- Formal assessment within 48 hours
- Daily evaluations thereafter
Essential Criteria for IVOS Decision-Making
1. Enteral Route Assessment
Healthcare providers must confirm:
- Proper gastrointestinal tract function
- No evidence of malabsorption
- Safe swallowing ability or enteral tube administration
- No significant concerns about patient adherence
- No vomiting episodes in the past 24 hours
2. Clinical Improvement Indicators
Providers should verify:
- Improving clinical signs and symptoms of infection
- Temperature stability (between 36-38°C for 24 hours)
- Decreasing Early Warning Score (EWS)
- White Cell Count trending toward normal range
- Declining C-Reactive Protein (CRP) levels
Special Considerations and Exceptions
Some infections require careful evaluation before implementing IVOS, including:
- Bloodstream infections
- Empyema
- Endocarditis
- Meningitis
- Osteomyelitis
- Severe soft tissue infections
- Septic arthritis
- Undrained abscesses
Note: Even with these conditions, IVOS might still be appropriate within 48 hours under specialist guidance.
Best Practices for Implementation
Daily Monitoring Protocol:
1. Assessment of patient's clinical status
2. Review of infection markers
3. Evaluation of gastrointestinal function
4. Documentation of decisions and rationale
Healthcare Team Roles:
- Pharmacy teams prompt prescribers for IVOS consideration
- Prescribers assess oral switch options
- Specialists provide guidance for complex cases
IVOS represents a significant advancement in antimicrobial stewardship, offering numerous benefits for both patients and healthcare systems. By following these evidence-based guidelines and maintaining careful patient monitoring, healthcare providers can effectively implement IVOS while ensuring optimal patient outcomes.
*Note: This guide is based on the National Antimicrobial IVOS Criteria, co-produced through a UK-wide multidisciplinary consensus process involving 279 participants.*
What is IVOS and Why Does it Matter?
IVOS (Intravenous-to-Oral Switch) represents a strategic shift in antimicrobial therapy where patients are transitioned from intravenous to oral medication when clinically appropriate. This evidence-based practice has demonstrated numerous benefits for both patients and healthcare facilities.
Key Benefits of IVOS:
- Reduced risk of bloodstream and catheter-related infections
- Lower equipment costs and carbon footprint
- Shortened hospital stays
- Enhanced patient mobility and comfort
- Increased nursing time availability for patient care
When Should Healthcare Providers Consider IVOS?
The recommended audit standard suggests that all patients on IV therapy should undergo:
- Prompt review from the first dose of IV antimicrobial
- Formal assessment within 48 hours
- Daily evaluations thereafter
Essential Criteria for IVOS Decision-Making
1. Enteral Route Assessment
Healthcare providers must confirm:
- Proper gastrointestinal tract function
- No evidence of malabsorption
- Safe swallowing ability or enteral tube administration
- No significant concerns about patient adherence
- No vomiting episodes in the past 24 hours
2. Clinical Improvement Indicators
Providers should verify:
- Improving clinical signs and symptoms of infection
- Temperature stability (between 36-38°C for 24 hours)
- Decreasing Early Warning Score (EWS)
- White Cell Count trending toward normal range
- Declining C-Reactive Protein (CRP) levels
Special Considerations and Exceptions
Some infections require careful evaluation before implementing IVOS, including:
- Bloodstream infections
- Empyema
- Endocarditis
- Meningitis
- Osteomyelitis
- Severe soft tissue infections
- Septic arthritis
- Undrained abscesses
Note: Even with these conditions, IVOS might still be appropriate within 48 hours under specialist guidance.
Best Practices for Implementation
Daily Monitoring Protocol:
1. Assessment of patient's clinical status
2. Review of infection markers
3. Evaluation of gastrointestinal function
4. Documentation of decisions and rationale
Healthcare Team Roles:
- Pharmacy teams prompt prescribers for IVOS consideration
- Prescribers assess oral switch options
- Specialists provide guidance for complex cases
IVOS represents a significant advancement in antimicrobial stewardship, offering numerous benefits for both patients and healthcare systems. By following these evidence-based guidelines and maintaining careful patient monitoring, healthcare providers can effectively implement IVOS while ensuring optimal patient outcomes.
*Note: This guide is based on the National Antimicrobial IVOS Criteria, co-produced through a UK-wide multidisciplinary consensus process involving 279 participants.*
