Pharmacy-Led Quality Improvement Project on Pain Control Using Continuous Subcutaneous Infusion of Opioids in an Inpatient Hospice Unit
| Autor: | Nayma Moya Romero, Sandra DiScala, Jennifer Quellhorst, Michael A. Silverman |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Quality management Palliative care Pain Pharmacy Infusions Subcutaneous 03 medical and health sciences 0302 clinical medicine Pain control 030502 gerontology medicine Humans 030212 general & internal medicine Aged Retrospective Studies Inpatients business.industry Hospices General Medicine Hydromorphone Quality Improvement Continuous subcutaneous infusion Analgesics Opioid Opioid Emergency medicine Female 0305 other medical science business medicine.drug |
| Zdroj: | American Journal of Hospice and Palliative Medicine®. 37:885-889 |
| ISSN: | 1938-2715 1049-9091 |
| Popis: | Objectives: The purpose of this quality improvement (QI) project was to improve the overall process of implementing continuous subcutaneous infusion of opioids (CSCIOs) at the West Palm Beach Veterans Affairs Medical Center and characterize their use in the hospice unit. Methods: A retrospective chart review from July 2014 to August 2017 was conducted to identify patients who had received CSCIO. Results were analyzed with descriptive statistics.The business philosphy, LEAN methodology “The 5 Whys” was utilized to identify the root causes for delayed infusion timeliness and corrections were implemented by August 2018. Follow-up retrospective time study completed from September 2018 to February 2019. Results: Of the 107 patients identified, 7 were excluded and 100 were reviewed. The mean age was 73 years, 94% male, and 86% Caucasian. A total of 55 veterans received morphine with an average final infusion rate of 2.5 mg/h. A total of 45 Veterans received hydromorphone with a final infusion rate of 1.3 mg/h. The average infusion duration until death was 5 days. Pharmacy verified 94 (94%) orders and nursing verified 55 (55%) orders within 1 hour (gold standard). Sixteen (16%) patients received CSCIO within 1 hour. The 5 Whys identified nursing order verification and pharmacy lack of visual STAT order notification for priority as the potential sources for infusion timeliness improvement. The follow-up time study confirmed improvement in pharmacy delivery time from 29% to 75% on time. Conclusion: Pharmacist-led intervention directed to improve CSCIO processes in an inpatient hospice unit utilizing LEAN QI methodology increased timeliness of pharmacy CSCIO delivery. |
| Databáze: | OpenAIRE |
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