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Purpose: Standardized processes to order and prepare medications can decrease the potential for error and provider uncertainty. Our health system utilizes a standardized concentration policy, smart infusion pumps, and the electronic health record (EHR) to catalog, order, and deliver intravenous medications. A need for a more proactive and formalized process to ensure medication listings are harmonized between these 3 resources was identified. Standardizing these resources can reduce confusion, reduce time spent in pharmacy operations and nursing workflow, and may improve patient safety. The purpose of this quality improvement project was to compare and resolve inconsistencies between these 3 sources and to create a new process to assure uniformity in a complex work environment.
Summary: An audit-style comparison and evaluation of entries for continuous infusions within the standardized concentration policy, the pump library, and the EHR was conducted. All continuous infusion entries within any one of these 3 sources were included. Key exclusion criteria included pediatric and neonatal infusions, intermittent infusions, and infusions in procedural areas. We compared the policy, the pump library, and the EHR to identify, document, and resolve discrepancies in medication name, concentration, rate, and volume; fluid restriction concentration; and upper and lower pump limits. A new method to ensure proactive continuity and consistent updates to the 3 sources was implemented into existing operational workflows. To address the 187 discrepant entries identified, we recommended a total of 82 updates to policy (n = 48), the pump library (n = 30), or the EHR (n = 4).
Conclusion: Standardizing infusion resources will reduce confusion, and improve pharmacy operations, nursing workflow, and patient safety.Reference:
Christensen SM, Andrews SR, Fox ER. Development of a proactive process to harmonize policy, infusion pump library, and electronic health record entries for continuous infusions at an academic medical center. Am J Health Syst Pharm. 2022 Dec 25:zxac384. doi: 10.1093/ajhp/zxac384. Epub ahead of print. PMID: 36566506.