IV Push Levothyroxine Mue Final
IV Push Levothyroxine Mue Final
Levothyroxine
100 mcg • 53 cents per tablet
tablet
Levothyroxine
• $103 per vial ~ 200x more expensive
100 mcg vial
2019 Levothyroxine IV Push MUE
23% of orders for patients NPO were strictly NPO for ≥ 3 days
$294,000 annually in cost-avoidable drug expenditure for IUH
Levothyroxine IV Push Restrictions
Implemented June 9, 2020
Outpatients
Exclusion Criteria Patients < 18 years of age
Continuous infusion levothyroxine
Med ordered without administered doses
Methods
Ball Memorial 16 12
Bedford 3 2
Bloomington 9 6
Methodist 23 17
North 14 10
Saxony 2 1
University 19 14
West 4 3
Total 97 70
IU Health Facility Approved Use, n (%)
Transplant
Thoracic Surgery
Pulmonary
Plastic Surgery
Otolaryngology
Multiple Trauma
Internal Medicine
Hospitalist
General Surgery
Gastroenterology
Cardiovascular Surgery
0 2 4 6 8 10 12 14 16 18 20
Unapproved Use Approved Use
A v e r a g e # o f I V P u s h A d m in is t r a ti o n s p e r
Analysis of Number of IV Push Administrations
350
300
250
200
150 310
100
136
50
0
2019 MUE 2020 MUE
Proportion of Approved vs. Unapproved Use
# of Reviewed Charts
70
60
50 40
47
40
30
20
30
10
23
0
2019 MUE 2020 MUE
S/P
Thyroid-
ectomy
9%
Suspected
Endo Consult Myxedema
31 %
Coma
19 %
Inappropriate Appropriate
Use Use NPO Orders ≥ 72 Hours
57 % 43 % 41 %
Analysis of Use that Did Not Meet Restriction Criteria
97% of patients (n=39) were on a thyroid product at home but were not
NPO for ≥ 72 hours before inpatient initiation
Levothyroxine PO (n=34) or IV (n=3)
Liothyronine (n=2)