Weight-based protocols of rHuEPO have been shown to reduce the need for transfusions in critically ill patients. In our institution ICU use of erythropoietin accounts for less than 10% of total hospital usage, however this is the only location where weight based dosing is utilized. We evaluated the impact of applying weight based dosing of erythropoietin similar to that done in the ICU to all patients in the hospital.
The ICU, renal and hematology services collaboratively developed a weight based dosing protocol based on established literature. This protocol was automatically substituted by pharmacy whenever an erythropoietin dose was written in the hospital. Data was collected on dose adjustments and total usage.
During the first 90 days, 42 orders were evaluated of which 36 required adjustment. Prior to adjustment the total dose of erythropoietin ordered was 1,406,00 units. Following adjustment the total amount actually administered was 852,000 units resulting in a 39% decrease in utilization and approximately a $5,700 cost saving for that 90 day period. There were only 3 physician overrides of the protocol.CONCLUSIONS: A pharmacy implemented weight based dosing protocol for erythropoietin results in significant decreases in drug utilization and cost savings for the hospital.
Standardized non-physician directed protocols are an effective tool for appropriate medication dosing and reduction of pharmacy acquisition costs.
L.C. Rotello, Ortho Biotech. Speakers Bureau.