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H-2 Blocker/Proton Pump Inhibitor Therapeutic Interchange
and IV to PO Conversion (Adults)
 

Automatic Therapeutic Interchange

This pharmacy-based initiative allows for the interchange of non-formulary H2 antagonists and proton pump inhibitors. Each order for these agents will be converted to therapeutically equivalent doses. This applies to both the intravenous (IV) and the oral (PO) routes of administration. Documentation of this interchange will be made in the medication administration record (MAR). The roles of each health care professional are detailed below.

Pharmacists

·         Convert order to the proper dose and route of famotidine or pantoprazole.

·         Document the conversion in the notes field of the MAR.

Nurses

·         Identify the conversion to formulary agent in the notes field on the MAR.

Physicians

·         Physicians are encouraged to prescribe the formulary agent initially. 

IV to PO Conversion

This pharmacy-based initiative allows for the conversion of IV famotidine or pantoprazole to the oral dosage form when:

·         The patient has a functioning GI tract, defined as tolerating tube feeds at 40 ml/hr or 1000 ml/day of fluids by the enteral/PO route; AND

·         The patient is tolerating other oral medications.

Both criteria must be met before a patient qualifies for conversion to PO therapy. Documentation of this conversion will be made in the progress notes and orders section of the medical record. The roles of each health care professional are detailed below.

Pharmacy

·         A list of patients on IV famotidine or pantoprazole will be generated each day for review. Each patient on the list will be assessed for possible conversion according to the criteria described above.

·         Eligible patients will be converted to PO agents.

·         For each patient converted under this policy, there will be documentation in the progress notes of the medical record. A verbal order will be written by the pharmacist as "IV to PO conversion per P&T Committee/ [Pharmacist’s Signature]".

Nursing

• Nurses are encouraged to identify patients that are eligible for PO medications and to request that the physician issue an order for PO famotidine or pantoprazole.
• Nurses are not authorized to write a verbal order without physician authorization.

Physicians

• Physicians should write initial IV famotidine or pantoprazole orders as "IV/PO to be switched when the patient can tolerate PO medications."
• If a physician disagrees with the automatic conversion, he/she may override the conversion by noting that the patient is to remain on the IV dosage form in the orders section of the medical record.
   

Table 1.  Proton Pump Inhibitor Therapeutic Interchange
 

Table 2.  Famotidine Dosage Recommendations

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Approved by P&T Committee: 12/05 | Posted on: 12/30/05 | For Internal University of Kentucky Chandler Medical Center Use Only

Comments to Ann Hamlin, Last Modified: August 13, 2006
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