Since 2005, we have implemented strategies for appropriate use of albumin products, obtaining positive results through 2008. In 2009, we introduced the following additional strategies: (1) change of concentration of hypertonic albumin, (2) evaluation of appropriateness of administration of isotonic albumin, and (3) promotion of description of the purpose of administration in the medical record. In the present study, we verified the efficacy of these strategies, conditions of use before and after the change of concentration of hypertonic albumin, and the patients' outcomes. We compared data collected in 2008 with those collected from 2009 to 2011. The ratio of volume of albumin to that of red blood cell products decreased from 1.72 to 1.17, the ratio of appropriate use of hypertonic albumin increased from 83% to 93%, and the total use of albumin decreased from 12,213 g to 6,818 g. After switching from albumin 25% to albumin 20%, the ratio of administration of hypertonic albumin decreased by half, and the amount administered decreased by about 70%, with no differences observed in terms of patients' outcomes. Introduction of comprehensive strategies and increases in the opportunity to make a recommendation directly to physicians probably resulted in an increased ratio of appropriate use and decreased ratio of administration. Because switching to albumin 20% did not affect patients' outcomes, this change seemed to be effective for controlling the total use of albumin.

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