Scale and spread of a metronidazole ‘Go Green’ IV to oral switch (IVOST) grassroots quality improvement initiative in Scotland’s largest acute health board

Promoting appropriate IV to oral switch (IVOST)1 is a fundamental antimicrobial stewardship (AS) initiative providing benefits for patients, staff and the environment including: reduced risk of cannula related infections, medicine costs, nursing workload and carbon footprint. A grassroots quality improvement (QI) initiative, highlighting the high oral bioavailability (>90%) of metronidazole and environmental benefits of IVOST in surgical wards at the Royal Alexandra Hospital (RAH), resulted in a 45% median reduction in IV administrations. Scale and spread of successful small scale QI initiatives, although challenging in the complex healthcare environment, is essential to maximize patient benefits and support attainment of national targets for antimicrobial resistance (AMR) and environmental sustainability.