Objective:

To identify intravenous (IV) medications with feasible enteral alternatives and assess the environmental and economic impacts of transitioning from IV to enteral administration in the ICU.

Approach:

• Medication Review: All IV medications dispensed in 2024 across eight ICUs were reviewed to determine the availability of enteral formulations and the feasibility of administration via feeding tube.
• Classification System: A multidisciplinary panel classified medications into two groups: 'Ready for IV-to-enteral substitution' and 'Requires monitoring before substitution' based on pharmacokinetic and safety data.
• Environmental and Economic Modeling: The environmental effects and acquisition costs of the five most frequently dispensed eligible medications were modeled using process-based life-cycle assessment.

Key Findings:

• Out of 269 dispensed IV medications, 63 had viable enteral counterparts.
• 54 medications (86%) were classified as 'Ready for IV-to-enteral substitution'.
• If 50% of IV administrations were replaced with enteral formulations, greenhouse gas emissions could decrease by 12.7 tCO₂e and medication costs by €73,784 annually.

Limitations:

• The analysis relied on pharmacy dispensing records, which may overestimate actual administration.
• Patient-level safety data and clinical outcomes were not available to confirm therapeutic equivalence post-substitution.
• The classification was primarily based on data from non-ICU populations.

Conclusion:

IV-to-enteral stewardship is a quality-improvement intervention that can reduce costs and promote environmental sustainability in critical care.