Evaluation of alvimopan utilization at a four-hospital healthcare system

Purpose: To assess the appropriate utilization of alvimopan after addition to formulary. 

Methods: All patients who received at least one dose of alvimopan between January 1, 2011 and December 31, 2011 at any of four hospitals within the NorthShore University Health System were identified. Twenty-five percent of these patients were randomly selected for evaluation. Data collected includes demographics, surgical procedure performed, administration of preoperative dose, total number of postoperative doses administered, documented ileus during hospitalization, documented placement of nasogastric tube postoperatively, and appropriate discontinuation of therapy (defined as first documented bowel movement). 

Results: Two hundred and seventy-two patients received at least one dose of alvimopan over the 12-month evaluation period. Of these, 69 were randomly selected for evaluation. Ten out of 69 patients, receiving 72 doses, were administered alvimopan for non-bowel resection indications, demonstrating 14% of all doses given with inappropriate indication. Of patients administered alvimopan for appropriate indications, including open and laparoscopic bowel resection, 90 of 447 doses (20%) were administered after first documented bowel movement. In total, 162 out of 519 total doses (31%) were administered inappropriately. A preoperative dose was administered in 63 of 69 (91%) patients, with a mean of 7.5 total doses per patient. The mean time to discharge order written was 4.8 days.

Conclusion: This evaluation demonstrated that 69% of alvimopan use is appropriate, with opportunity to improve compliance related to indication for use, preoperative dosing administration, and appropriate discontinuation. Opportunities to reduce cost and improve appropriate utilization of alvimopan include development of alvimopan utilization guidelines and incorporation into surgical order sets. Additionally, multi-disciplinary education among nurses, physician assistants, anesthesiology, surgery, pharmacy and dieticians may prove beneficial.