Aurora St. Luke's Medical Center, Milwaukee, WI 53215, USA.
Am J Health Syst Pharm. 2012 May 1;69(9):786-93. doi: 10.2146/ajhp110325.
Patient safety and cost-control benefits achieved through a medical center's conversion to commercial fluids for continuous renal-replacement therapy (CRRT) are described.
In keeping with national patient safety recommendations, a medical center undertook a quality-improvement initiative to increase the standardization of CRRT fluids and associated patient care practices. After a feasibility study to ascertain CRRT fluid usage patterns and baseline costs, an appropriate commercial product was selected. The transition was implemented over several months in a three-phase process entailing (1) conversion to a commercial product for regional citrate anticoagulation, (2) changing the standard formula on preprinted orders to one that modeled a commercial product, and (3) conversion to the actual commercial product as the standard. Thorough education of all parties involved, as well as modifications to preprinted orders, occurred during each phase of the project. The use of the commercial product reduced the need for pharmacy compounding of CRRT fluids by more than 80%. A postconversion cost analysis indicated sharp reductions of product and labor (i.e., compounding) expenses relative to estimated baseline costs, with estimated total savings of at least $399,290 during the first six months after the conversion initiative. Implementation challenges included the need to manually adjust the potassium content of the commercial CRRT fluid and the need to provide i.v. supplementation of phosphorus and magnesium to some patients receiving the fluid. The initiative emphasized the need for institution-specific research and planning before conversion initiatives targeting CRRT fluids and other critical therapies, as well as proper education and training of all parties involved.
The standardization of CRRT fluids using commercially available products improved a medical center's compliance with patient safety standards and yielded substantial cost savings.
描述一家医疗中心将连续肾脏替代疗法（CRRT）的医用液体转换为商业液体后所实现的患者安全和成本控制效益。
为了遵循国家患者安全建议，该医疗中心开展了一项质量改进计划，以提高 CRRT 液体的标准化和相关的患者护理实践。在进行了一项可行性研究以确定 CRRT 液体使用模式和基线成本之后，选择了一种合适的商业产品。该过渡过程分三个阶段实施，历时数月：（1）对区域枸橼酸盐抗凝的商业产品进行转换；（2）将预印医嘱的标准配方更改为模拟商业产品的配方；（3）将实际的商业产品转换为标准产品。在项目的每个阶段，都对所有相关方进行了全面的教育，并对预印医嘱进行了修改。商业产品的使用使 CRRT 液体的药房配制需求减少了 80%以上。转换后成本分析表明，与估计的基线成本相比，产品和劳动力（即配制）成本大幅降低，转换举措实施后的头六个月估计至少节省了 399290 美元。实施过程中的挑战包括需要手动调整商业 CRRT 液体的钾含量，以及需要为一些接受该液体的患者提供静脉补充磷和镁。该计划强调，在针对 CRRT 液体和其他关键疗法的转换举措之前，需要进行机构特定的研究和规划，同时需要对所有相关方进行适当的教育和培训。
使用商业上可获得的产品对 CRRT 液体进行标准化，提高了医疗中心对患者安全标准的合规性，并带来了可观的成本节约。
