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LETTERS: Stephen Black NHS financial crisis: signs of crisis or hope? BMJ 2006; 332: 914-b [Full text]

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A novel way of relieving the NHS financial deficit

Anwar Chahal, S. Ahsan Raza   (18 June 2006)

A novel way of relieving the NHS financial deficit 18 June 2006
Anwar Chahal, Cardiology King's College Hospital, London, SE5 9RS, S. Ahsan Raza Send response to journal: Re: A novel way of relieving the NHS financial deficit	As the NHS plunges further into the red, the search for innovative cost-cutting measures increases. On a very recent ward round, we were initially intrigued to notice one of our patients with Clostridium difficile diarrhoea taking IV vancomycin orally. At first we thought the IV infusion had been left on the patients table by mishap. We duly asked the patient to stop and informed the senior nurse. To our utter bewilderment we were informed this was the desired route. We explained this was an IV preparation being taken orally ?! The ward pharmacist enlightened us with the rationale: this was cheaper than purchasing oral preparations. Our concern was patient care, and whether the paradoxical constitution and route of administration were causing harm -we checked the BNF. A 28 pack of 125 mg tablets costs £66.23, whereas vancomycin power for reconstitution as an infusion costs £8.05 for a 500 mg vial and £16.11 for a 1g vial, demonstrating a clear financial saving. Furthermore, a small note at the bottom states the infusion powder 'can be used to prepare solutions for oral administration'. Innovative cost-cutting measures? You decide. Competing interests: None declared