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Improving Order Accuracy of Inpatient Intravenous Prostacyclin Therapy

Traci Stewart


Ryan Hobbs

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Conference: 2009 PH Resource Network Symposium

Release Date: 09.24.2009

Presentation Type: Abstracts

Traci Stewart, RN, MSN; Ryan Hobbs, RPh
University of Iowa Hospitals and Clinics, Iowa City, IA

PURPOSEProstacyclin inpatient admission order errors were identified and corrected by a clinical pharmacist prior to administration. This raised concern for potential medication errors when inaccurate order information was disseminated. Improved accuracy of medication orders is a necessity when patients on intravenous (IV) prostacyclin therapy transition from an outpatient to inpatient care setting.

BACKGROUNDAccuracy of IV prostacyclin medication orders require correct dose, dosing weight, concentration, and pump rate to assure continuity of therapy. Accurate prostacyclin dosing information is difficult to access in the medical record. Knowledge gaps regarding prostacyclin therapy exist for inpatient medicine residents. PH nurse coordinators communicated current prostacyclin dosing information to the inpatient staff physicians for planned admissions. Patients and families are instructed to page PH coordinators when admitted to a local hospital or accessing emergency treatment. Resident physicians attempt to obtain current prostacyclin dose information from medical record for patients transferred or admitted after office hours without PH coordinator involvement.

METHODOLOGYAdmission prostacyclin orders were tracked for accuracy after prostacyclin ordering errors were identified by clinical pharmacist. During a three month period, nine patients were admitted on IV prostacyclin therapy and eight prostacyclin medication order errors were identified by clinical pharmacist on an inpatient step-down telemetry unit or cardiovascular intensive care unit. The pharmacist confirmed prostacyclin dosing and administration information with patient, reviewed the medical record, and confirmed dosing with the PH nurse coordinator. The pharmacist corrected inpatient medication orders and prevented errors in medication administration.

FINDINGSSix errors involved physicians omitting part of the necessary order information, one error involved an inaccurate dosing weight, and one error was related to communication of inaccurate cassette concentration. Based on these findings, PH nurse coordinators began communicating current prostacyclin dose information to the pharmacist by text page or email prior to a planned admission. The pharmacist confirms dosing information with the patient, then facilitates order entry of the intravenous prostacyclin therapy. Staff physicians are directed to page the PH coordinator for after office hour admissions and transfers. Since this communication change was implemented, the six patients admitted on prostacyclin therapy have had no prostacyclin medication order errors.

IMPLICATIONSAccuracy of prostacyclin admission orders is essential to maintain efficacy, minimize toxicity, and prevent prostacyclin infusion errors. Inaccurate prostacyclin orders were common, requiring correction by the pharmacist. Direct communication between the pharmacist and the PH coordinator in conjunction with the physicians improved accuracy of admission prostacyclin orders.