Scale and spread of a quality improvement initiative promoting metronidazole IV to oral switch (IVOST) in the acute hospital setting: antimicrobial stewardship, patient safety, workforce and environmental sustainability benefits

In-hospital promotion of the oral route and IV to oral switch (IVOST) are key antimicrobial stewardship (AS) initiatives providing benefits for patients, staff and the environment, including reduced risk of line infections, medicine costs, nursing workload and plastic waste. A recent quality improvement (QI) initiative highlighting the environmental sustainability benefits of switching to oral metronidazole (bioavailability >90%) in surgical wards at the Royal Alexandra Hospital (RAH) resulted in a 45% median reduction in IV administrations.

Scale and spread of successful grass route QI initiatives in healthcare is essential to maximise benefits for patients, staff and the environment.  The aim of this study was to scale and spread the QI initiative promoting appropriative metronidazole IVOST to all inpatient wards in NHSGGC Clyde hospitals (RAH, Inverclyde Royal and Vale of Leven) and measure the impact on AS, drug costs, nursing workload and environmental sustainability.