University of Virginia Health, Charlottesville, VA, USA.
Department of Medical ICU, University of Virginia Health, Charlottesville, VA, USA.
Am J Health Syst Pharm. 2023 Aug 18;80(Suppl 3):S97-S102. doi: 10.1093/ajhp/zxac360.
To describe the Plan-Do-Study-Act (PDSA) methodology utilized by a multidisciplinary team to address the discordance between ordering and administration of dexmedetomidine for sleep hygiene in the intensive care unit (ICU).
The addition of sleep hygiene as an indication for the use of dexmedetomidine at University of Virginia (UVA) Health led to discordance between the medication orders in the electronic medical record and the subsequent administration of dexmedetomidine. A multidisciplinary team implemented interventions that included modifying the order panel, streamlining the institutional formulary, developing institutional practice guidelines, and providing education to healthcare team members. After completion of the first PDSA cycle, the mean number of discordant order elements decreased to 1.96 out of 5 possible order elements from an initial 2.5 out of 5 elements before the interventions, meeting the aim to reduce the mean to less than 2. There was a significant decrease in the discordance in the duration of infusion (discordant for 14 of 30 orders before the interventions vs 1 of 28 orders after the interventions, P = 0.0002) but a significant increase in the discordance in the titration dose (discordant for 13 of 30 orders before the interventions vs 24 of 28 orders after the interventions, P < 0.0001). Other discordant order elements including the starting dose, maximum rate, and titration interval time decreased in frequency after the interventions, although the differences were not statistically significant. The interventions made during the first PDSA cycle are anticipated to lead to an estimated cost savings of up to $180,000 per year within the UVA Health system.
The multidisciplinary team utilizing a PDSA method to modify the order panel, streamline the institutional formulary, develop institutional practice guidelines, and provide education to healthcare team members was effective at reducing overall discordance between order intent and administration of dexmedetomidine for sleep hygiene in the ICU.
描述一个多学科团队使用计划-执行-研究-行动（PDSA）方法来解决重症监护病房（ICU）中用于睡眠卫生的右美托咪定的医嘱与给药之间的不匹配问题。
在弗吉尼亚大学健康系统（UVA Health），将睡眠卫生添加为使用右美托咪定的指征，导致电子病历中的药物医嘱与随后的右美托咪定给药之间出现不匹配。一个多学科团队实施了干预措施，包括修改医嘱面板、简化机构处方集、制定机构实践指南，并向医疗保健团队成员提供教育。在完成第一个 PDSA 循环后，从干预前的 5 个可能医嘱元素中的 2.5 个，降至 1.96 个不匹配的医嘱元素，达到了将平均值减少到 2 以下的目标。在输液持续时间方面的不匹配显著减少（干预前 30 个医嘱中有 14 个不匹配，而干预后 28 个医嘱中有 1 个不匹配，P = 0.0002），但在滴定剂量方面的不匹配显著增加（干预前 30 个医嘱中有 13 个不匹配，而干预后 28 个医嘱中有 24 个不匹配，P < 0.0001）。尽管差异没有统计学意义，但在干预后，其他不匹配的医嘱元素，包括起始剂量、最大速率和滴定间隔时间，其频率也有所降低。预计在 UVA Health 系统中，第一个 PDSA 循环中实施的干预措施每年可节省高达 18 万美元的成本。
利用 PDSA 方法修改医嘱面板、简化机构处方集、制定机构实践指南并向医疗保健团队成员提供教育的多学科团队，有效减少了 ICU 中用于睡眠卫生的右美托咪定的医嘱与给药之间的总体不匹配。
