Metronidazole intravenous formulation use in in-patients in Kapkatet District Hospital, Kenya: a best practice implementation project

Background Inappropriate use of intravenous antibiotic in hospitals impacts on therapeutic efficacy, bacterial resistance, cost and iatrogenic infections. The potential harm from misuse calls for an intervention to improve the use of intravenous antibiotics in hospitals. Intravenous to oral Switch therapy is one way of minimizing overprescribing of antibiotics injections. Aims/objectives Implementation of evidence based practice with regard to administration of metronidazole intravenous formulation in an in-patient setup. Methods The project was conducted over a period of six months. Pre and post implementation audit were used to assess the documentation of Metronidazole injection use in 65 patients medical records and the compliance rate compared. The audit utilized four evidence based criteria recommended by the Joanna Briggs Institute. Results Post Implementation audit of metronidazole intravenous to oral conversion evidence-based criteria showed an increase of more than 40% compliance in all the four criteria utilized. Discussion and conclusion The increase in medical record documentation indicated the contribution of audit, feedback and re-audit cycles to bring about change in clinical practice. This project has demonstrated that metronidazole intravenous formulation switch to oral therapy can be implemented, which can result in a reduction in cost, patient discomfort and iatrogenic infections. For long term sustainability of the outcome, guidelines and pharmacist leadership is essential, as well as follow up assessment of progress to determine the effectiveness of switch therapy in reduction of cost.