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Cited by 1Healthcare cost, quality, practicesClinical practice guidelines implementationThyroid Disorders and Treatments

Intravenous levothyroxine stewardship program at a tertiary academic medical center

Marino, Kaylee K, Crowley, Kaitlin E, Tran, Lena K, Sylvia, Daniel, Dell’Orfano, Heather, DeGrado, Jeremy R, Szumita, Paul M·2021·American Journal of Health-System Pharmacy
DOI 10.1093/ajhp/zxab155
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Abstract

PURPOSE: Based on the pharmacokinetic profile of levothyroxine, a 3-day hold guideline for adult patients ordered for intravenous (IV) levothyroxine was implemented at a tertiary academic medical center. The purpose of this study was to evaluate the impact of the implementation of an IV levothyroxine hold guideline. METHODS: This single-center, retrospective analysis identified patients ordered for IV levothyroxine during a 13-week period before and after implementation of the guideline. The primary outcome was guideline adherence, defined as full implementation of the 3-day hold. Secondary outcomes included the number of IV levothyroxine administrations avoided in the post-guideline group, extrapolated yearly cost avoidance (EYCA) after guideline implementation, reasons for guideline non-adherence, and number of safety reports involving IV levothyroxine. RESULTS: A total of 166 and 134 patients met inclusion criteria for the pre- and post-guideline groups, respectively. Guideline adherence was observed in 94 (70.1%) patients, resulting in 276 vials saved in the 13-week post-guideline period, which translated to an EYCA of $139,877. Forty orders (29.9%) were non-adherent to the guideline, with the most common reason stated as nil per os (NPO). No difference in safety outcomes was seen between the pre- and post-guideline groups, as evidenced by 1 safety report in each group. CONCLUSION: We observed a high rate of adherence to an IV levothyroxine hold guideline. This was associated with a substantial cost savings over the study period with no increase in reported safety events. To our knowledge, this is the first published report of an inpatient IV levothyroxine 3-day hold guideline.

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Crossref · 10.1093/ajhp/zxab155

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  • A 3- to 5-day course of IV LT4 with subsequent oral tablets is recommended to prevent potential adverse events and to save costs.

    “A 3- to 5-day course of IV LT4 with subsequent oral tablets is recommended to prevent potential adverse events and to save costs (240, 241).”

    From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [241]

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Authors
Marino, K. K., Crowley, K. E., Tran, L. K., Sylvia, D., Dell’Orfano, H., DeGrado, J. R., & Szumita, P. M.
Affiliations
  • Brigham and Women's Hospital (US)
  • Massachusetts College of Pharmacy and Health Sciences (US)
Corresponding author
Marino, Kaylee K
ORCID
Venue
American Journal of Health-System Pharmacy
Publisher
Oxford University Press (OUP)
Published
2021-04-04
Volume
78
Issue
13
Pages
1200-1206
ISSN
  • 1079-2082 (ISSN-L)
  • 1535-2900
DOI
10.1093/ajhp/zxab155
OpenAlex
W3141964658
Cited by
1
References
27
Citations by year
2022: 1
FWCI
0.28
Type
journal article
Language
en
Open access
closed
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • American Journal of Health-System Pharmacy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Keywords
guideline adherence, cost avoidance, pharmacokinetics, nil per os
MeSH terms
Academic Medical Centers, Adult, Humans, Inpatients, Retrospective Studies, Thyroxine, Guideline Adherence

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