Document Detail

Standardization of continuous renal-replacement therapy fluids using a commercial product.
MedLine Citation:
PMID:  22517023     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Patient safety and cost-control benefits achieved through a medical center's conversion to commercial fluids for continuous renal-replacement therapy (CRRT) are described.
SUMMARY: 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.
CONCLUSION: The standardization of CRRT fluids using commercially available products improved a medical center's compliance with patient safety standards and yielded substantial cost savings.
Jon Godden; Frank Spexarth; Melissa Dahlgren
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists     Volume:  69     ISSN:  1535-2900     ISO Abbreviation:  Am J Health Syst Pharm     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-20     Completed Date:  2012-08-15     Revised Date:  2013-04-04    
Medline Journal Info:
Nlm Unique ID:  9503023     Medline TA:  Am J Health Syst Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  786-93     Citation Subset:  IM    
Aurora St. Luke's Medical Center, Milwaukee, WI 53215, USA.
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MeSH Terms
Citrates / pharmacology
Clinical Protocols*
Cost Control
Drug Compounding / methods*
Drug Utilization Review
Organizational Case Studies
Patient Safety
Pharmacy Service, Hospital / organization & administration*
Quality Improvement / organization & administration*
Renal Insufficiency / therapy
Renal Replacement Therapy / methods*
Reg. No./Substance:
0/Citrates; 1Q73Q2JULR/sodium citrate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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