Background When it was found by the Brits Hospital Pharmacy and Therapeutics Committee (PTC) in 2000 that simvastatin was responsible for extremely high costs in a district hospital, it was decided to undertake a quality improvement study to assess and, if appropriate, rectify the situation.

Methods A Quality Improvement team was chosen, standards of care were set in relation to national and international standards and a baseline survey was undertaken. The survey was done by taking the files of 50 patients on lipid- lowering drugs (LLDs) and looking at their patient profiles, e.g. smoking, diabetes, use of Premarin®, etc. The team found a gap between best practice as spelt out by the standards set and the reality. A plan of action was then formulated and put into action for six months, after which the survey was repeated with another 50 patients. The total number of patients on LLDs, as well as the cost to the hospital per month, was also calculated.

Results It was found that 147 patients (50 files were selected on a monthly basis out of the 147 patients) were taking LLDs and that there was hardly ever information regarding body mass index (BMI), family history, diet, smoking and other supportive information in the file. The cost per month was R14 570,50, and most of the patients had had treatment initiated by general practitioners.

The plan of action included that all the above preventive measures were noted in the files after discussions with patients, the use of the national guidelines to decide who really qualified for LLDs, and the exploration of the possibility of cerivastatin as a cheaper option to simvastatin.

As a result of this process, the number of patients qualifying for simvastatin fell to less than 30, with the associated costs falling to R3 122,00.

Conclusion We found the quality improvement process to be a powerful tool for change when using relevant evidence in order to change a specific situation.