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Collaboration Improves Patient Care Outcomes: A Team Approach to Inpatient Management of Pulmonary Arterial Hypertension (PAH) Patients Requiring Prostacyclin Therapy

Tania Von Visger

Laura Voth

Todd Tussing

Larry Matula


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Conference: 2009 PH Resource Network Symposium

Release Date: 09.24.2009

Presentation Type: Abstracts

Tania Von Visger, MS, APRN, CNS, CCNS, PCCN; Laura Voth, PharmD, BCPS; Todd Tussing, MS, RN, NE-BC; Larry Matula, MBA, BSN, RN
The Ohio State University Medical Center, Columbus, OH

PURPOSEThe objective is to demonstrate the positive effects of a collaborative practice model between pharmacists, nurses and physicians in the management of PAH patients. Complex nursing management care is required, as patient admissions for PAH are considered high-risk and low-incidence. Due to this technical complexity, a higher level of nursing competency is needed to ensure patient safety. Since October 2004, the 8 Progressive Care Unit (8PCU) at The Ohio State University Medical Center (OSUMC) has worked to ensure safe and effective care by focusing on staff education and training through an interdisciplinary team approach.

BACKGROUNDThe Joint Commission cites ineffective communication as the most common cause for sentinel events. Communication through a collaborative practice model is essential to the management of PAH patients receiving prostacyclin therapy. At OSUMC, this collaboration has led to the development of several initiatives to improve patient safety for these patients. The success of these initiatives stems from the interdisciplinary approach that OSUMC practices.

METHODOLOGYThe event reporting system was utilized to assess specific patient care quality improvement outcomes. Retrospective data analysis of medication-related and care management-related events was conducted for the calendar years 2005 and 2008. A comparison of events between these years was evaluated. Since 2005, the following collaborative initiatives have been implemented at OSUMC. • Development of Policy & Therapeutics-approved Epoprostenol Policy and Procedure • Development of Treprostinil Policy and Procedure (Policy & Therapeutics approval pending) • July 2008: 4-hour CE workshop on prostacyclin management • 2006 & 2008 Quest for Nursing Excellence: Presentation on IV prostacyclin management • CNS & Stat RN education on prostacyclin home infusion pumps • Mandatory annual RN competency including "hands-on" practice of specific nursing skills required for prostacyclin therapy management • Mandatory annual RN competency using computer-based-learning module

FINDINGSMedication-related and care management-related event repor ts were compared before and after the implementation of the initiatives. There were 7 of 78 event reports filed in 2005, and 7 of 141 event reports filed in 2008 which related to prostacyclin therapies. The comparative data analysis showed that the percentage of reported adverse events related to prostacyclin therapies decreased from 8% (2005) to 5% (2008). An event severity score ≥ 3 (based on the OSUMC scoring system) for prostacyclin therapy related events was 33% in 2005, compared to 0% in 2008.

IMPLICATIONSAt OSUMC, collaboration through a multi-disciplinary team of nurses, pharmacists and physicians has lead to the development of policies and education tools to benefit the safety of the pulmonary hypertension patient. Our comparative data shows that these initiatives have positively benefited patient care and improved patient safety overall. The work of the interdisciplinary team, and the common goal that all members share to provide the best patient care, have led to these successful outcomes.