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Creating a Comprehensive IV Prostanoid Policy: Challenges and Lessons Learned from a New Pediatric PH Program

Patricia Lawrence

Usama Kanaan

J Cecil

G Clarendon

C Davis

L Montegna

L Rogers-Streck

C Watson Winn


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Conference: 2013 PH Professional Network Symposium

Release Date: 09.28.2013

Presentation Type: Abstracts

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Creating a Comprehensive IV Prostanoid Policy: Challenges and Lessons Learned from a New Pediatric PH Program

P. Lawrence, MSN, RN, CPNP-AC/PC; U. Kanaan, MD; A. Hawthorne, MS, RN-BC, CPN; J. Cecil, BSN, RN, CPN; G. Clarendon, MS, RN,CRRN, CNRN; C. Davis, MSN-Ed, BSN, BS, CCRN; L. Montegna, PharmD; L. Rogers-Streck, RN, BSN, CPHRM; C. Watson Winn, RN, BSN


OBJECTIVE: The need for a regional pediatric PH program was identified and created in the spring of 2011. The Pulmonary HypertensionProgram at Children’s Healthcare of Atlanta and Sibley Heart Center has become an important multidisciplinary pediatric PH center in thesoutheastern region of the United States. The aim of this poster presentation is to outline the important steps taken in quickly creating a detailedIV prostanoid policy for Children’s Healthcare of Atlanta, which prior to 2011, did not exist.

BACKGROUND: With early development of the PH program, the need for a comprehensive hospital policy around IV prostanoid delivery wasidentified. The PH PNP began process of engaging key hospital stakeholders by scheduling a small group forum on the importance of prostanoidsafety, particularly in the setting of expected rapid PH program growth. Program PNP outlined the importance of policy creation while the programwas in its earliest stages of development. Stakeholders from each of the clinical units which would be interfacing with PH patients included nursemanagers, unit educators, pharmacists and physicians. Program PNP interviewed other pediatric PH program practitioners in the United States,gaining insight into important components necessary to develop a detailed policy that utilized evidence-based research.

IMPLEMENTATION: Program PNP began policy creation process by first inviting nationally recognized PH NP speaker on prostanoid safety tomeet stakeholders, share published research findings around prostanoid safety, and share ideas on how to ensure best practices around IVprostanoid delivery. Less than two months later, a group was organized by PH medical director which included a larger cohort of members tobegin process of policy design. Group members included unit managers and educators, pharmacists, biomedical engineering, medication safetyrepresentative, legal department representative, unit medical directors, and service line nursing director. Crucial aspects of prostanoid policycomponents were determined, including how Children’s Healthcare of Atlanta would manage patients on home therapy requiring hospitalization.

FINDINGS: Program PNP used suggestions from all group members and incorporated best practices from other well-known pediatric PH centersto write one comprehensive policy for hospitalized patients using either epoprostenol (Flolan) or treprostinil (Remodulin). Sections were thenreviewed with the appropriate group members and edited to meet the needs of all units. Policy was written within five months, and editing wasfacilitated by an engaged group who understood need for a policy in a short time-frame. The policy was presented to Children’s Healthcare ofAtlanta Nursing Policy and Procedure Committee, and with few changes, was formally adopted into policy within 11 months of initial lecture byprostanoid safety expert. To date, no IV prostanoid medication errors have been recorded.

IMPLICATIONS AND FUTURE DIRECTIONS: Policy creation in a short time frame was facilitated by ‘buy in’ from key clinicians and administratorswho saw value in a policy which incorporated evidence-based data to ensure patient safety, and who were invited to participate in thedevelopment process from the beginning stages. Future directions include continuing to operationalize policy, educating ordering clinicians onpolicy content, and evaluating policy in an ongoing fashion.