Switching patients from IV antibiotics to oral antibiotics is a critical step in patient care that can improve outcomes, reduce risks, and free up valuable nursing time. Nurses are the healthcare professionals who spend the most time with patients, so they are ideally positioned to identify when this switch is appropriate and to prompt clinicians to consider it. However, many nurses feel uncertain about how to initiate this process. This video aims to empower nurses with the knowledge and confidence needed to support IV to oral switches – or IVOS. Read More
The first step in considering an IVOS is identifying patients who may be ready to switch. Any patient on IV antibiotics should be considered for suitability. Key indicators include clinical improvement, such as the patient eating and drinking, being afebrile, and their vital signs returning to baseline. The patient must also be able to take oral or enteral medications – there should be no concerns about absorption of medicines from the gut. Deep-seated infections, such as meningitis or endocarditis, typically require prolonged IV therapy and usually need an infection specialist review to consider IVOS. Also, some patient groups may not tolerate oral antibiotics due to palatability issues with some antibiotics and may need to stay on IV antibiotics.
If a patient appears to meet these switch criteria, nurses can prompt the medical team for a review. A structured approach, like the SBAR framework – which stands for Situation, Background, Assessment, Recommendation – can be helpful in these conversations. For example, a nurse might explain: “Ms. Smith is on IV amoxicillin for pneumonia because she was vomiting on admission. She has been afebrile for 24 hours, is eating and drinking, and no longer requires oxygen. Her NEWS score has improved significantly. Can we switch her to oral amoxicillin now?” Documenting these discussions in the patient’s notes encourages ongoing review. While White Cell Count (WCC) and C-reactive protein (CRP) can useful infection markers, they do not need to be checked to initiate a discussion if the clinical criteria are met.
Using a decision support tool can help structure the process and guide you through it. These tools guide staff to review patients on IV antibiotics within 48 hours of the first dose being administered. They also highlight considerations that suggest a patient might be able to switch, and conditions that may require longer IV treatment but encourage regular reassessment.
The benefits of IVOS extend beyond improved patient care and safety. From a nursing perspective, the time savings are significant. Administering a single dose of IV antibiotics takes approximately 22 minutes, compared to just 80 seconds for an oral dose. IV access problems can also lead to extra time spent on cannula replacement, dressing changes, and regular monitoring. By reducing the need for IV administration, nurses can focus on other aspects of patient care.
There are also broader implications for hospital efficiency. Switching patients to oral antibiotics can shorten hospital stays, freeing up beds, and easing pressure on the healthcare system. For example, patients on oral antibiotics are typically more mobile and experience fewer complications, such as bloodstream infections associated with cannulas and side effects of medication. This not only improves patient experience but also reduces the risk of adverse events.
Cost and sustainability are additional considerations. Oral antibiotics are around 10 to 20 times cheaper than their IV counterparts, which also require additional equipment like giving sets, increasing the cost. Oral antibiotics also have a much lower environmental footprint, as they avoid the plastic waste, glass vials, and incineration associated with IV treatments.
Senior nursing staff can play a crucial role in fostering a culture that supports IVOS. By encouraging and mentoring colleagues, they can build confidence across the team. Discussing IVOS with patients is another important aspect, as it helps them to understand the benefits of oral antibiotics. Clear communication can reassure patients about the change in their treatment plan and its alignment with their recovery goals.
Switching from IV to oral antibiotics is a win-win for patients, nurses, and the healthcare system. It improves patient outcomes, frees up nursing time, reduces risks, speeds up discharge and optimises resource use. By recognising the signs of readiness, initiating informed discussions with prescribers, and documenting decisions, nurses can lead the way in ensuring timely and effective IVOS.
