Burden of Low Molecular Weight Heparin Switching in the UK and Canada

OBJECTIVES: To explore the administrative time and cost burden on hospital formularies in the United Kingdom (UK) and Canada (CA) associated with non-medical switching of low-molecular weight heparins (LMWH).

METHODS: A self-complete survey was administered to chief hospital pharmacists (CHP) in CA and UK. Administrative activities associated with switching were presented to participants. CHPs were asked to rank activities based on time spent and associated costs incurred. An estimation of average time spent on each activity was requested. Opinions on the importance of the administrative burden on switch decision making were also gathered.

RESULTS: 30 responses were collected (CA: n=15; UK: n=15). Updating protocols and training staff are ranked as having both the greatest time and the greatest cost burden on hospitals. In the average switching week, the activities with the greatest time burdens are updating protocols (15%), training staff (12%) and hospital and pharmacy-wide commutation for CA; updating protocols (18%) and stock management (10%) for the UK, with updating procurement systems and training staff as joint third (9%). Most CHPs (CA; UK) believe the administrative time burden to be very important (60%; 60%) in LMWH switch decision making.

CHPs report time spent by staff as the main source of hospital costs, followed by IT and technology. CHPs (CA ; UK) believe the cost burden to be important in LMWH switch decision making: very important (40%; 67%); somewhat important (53%; 27%). Few CHPs believe it to be somewhat not important (6.7%; 6.7%) and none not at all important.

CONCLUSIONS: During LMWH switches, CHPs spend a considerable portion of their working week on switching-related administrative tasks and believe the burden to be very important in switch decision making. Formulary committee members should ensure they consider the high level of administrative burden when making decisions to switch products on formulary.