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Best Practice Advisory (BPA) Trigger Alerts using Electronic Health Record System to facilitate safe management of Pulmonary Arterial Hypertension patients with Continuous Infusion of Prostaglandins

Laura Daugherty

Navneet Lather

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Conference: 2017 PH Professional Network Symposium

Release Date: 10.06.2017

Presentation Type: Abstracts

File Download: 2017 PHPN Abstract 1029

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Abstract presented at the 2017 PH Professional Network Symposium held in Bethesda, MD on October 5-7, 2017

Purpose

To develop and implement best practice advisory (BPA) alerts within Electronic Health Record (EHR) system to facilitate communication and improve patient safety for patients with pulmonary arterial hypertension (PAH) using continuous infusion of Prostaglandins (PG).

Background

Safe management of continuous infusion of PG for PAH patients requires training of hospital staff. In a large hospital network (HN), training on safe infusion of PG is often limited to hospital staff on select hospital units. Adverse outcomes and serious errors can occur during hospital encounters outside of these specialty units. Some current EHR systems have capacity to build BPA alerts to alert providers of special safety information on these patients. We hypothesize that using a BPA alert for infused PG patients would decrease medication related errors and provide better provider communication.

Methods

Key triggers for PAH were identified and a BPA was developed for the EHR system at a single hospital within a large HS consisting of five hospital facilities. The key triggers for alert included epoprostenol or treprostinil infusion on the home medication list at any time. The alert read, “Patient is receiving a continuous infusion of PG through a CADD pump. Do not disconnect the pump for any reason. Do not stop the infusion during a “code blue.” Call the PAH team for further information,” and specific contact phone numbers for PAH team were provided. The BPA alerted users including emergency room (ER) physicians, nurses, and paramedics. Simultaneously, an alert is generated for the PAH clinic notifying PAH staff that a patient on PG infusion has presented to our HS, providing patient’s location. A Reporting Workbench report allows us to track BPA usage and the actions the staff took in response to the warning.

Results

From April 2015 to November 2016, we had 19 encounters of PAH with 1 near miss at ER of a non-PAH trained facility. From December 2016 to May 2017 after implementation of BPA alert for PAH patients on infusion PG, alert occurred for total of 18 patients. Interestingly, 2 PAH patients from outside facilities were also identified with the BPA alert at ER of these non-PAH trained facilities. No serious errors involving PAH patients have been encountered at non-PAH trained units since the BPA was implemented. Physicians and nursing staff from non-PAH trained units have reported increased confidence in providing safer care for PAH patients because important safety information and contact resources are given to them at the point of service.

Conclusion

The process improvement using EHR BPA alerts for PAH patients resulted in increased knowledge and awareness of continuous infusion PG amongst bedside clinicians within the Hospital system. We believe that implementation of treatment-specific BPA trigger alerts can reduce errors and improve safety of continuous infusion of PG amongst PAH patients.