Category: Federal Forum Posters
Purpose: ACCF/AHA 2013 guidelines recommend monitoring of aldosterone antagonists within 7 days of initiation due to the risk of hyperkalemia. Baseline data collected at our institution shows that 24% of HF patients initiated on spironolactone by the cardiology service have a potassium drawn in the outpatient setting within 7 days, and 38% of these patients have a potassium drawn within 14 days. This project seeks to improve the time to laboratory monitoring of aldosterone antagonists and to determine a standardized process that can be applied to other medications requiring close follow-up post-discharge.
Methods: This quality improvement project will be conducted at our institution from August 2018-March 2019. The primary metric of interest will be percent of patients to have potassium lab-draw within 14 days. Secondary metrics include: percent of patients to have potassium lab-draw in <7 days, >14 days, and ≥ 28 days, mean time to potassium lab-draw, and percent of patients with hyperkalemia. A retrospective chart review of 76 patients initiated on spironolactone by the cardiology service at our institution was utilized to determine the percentage of patients initiated on spironolactone who had a potassium drawn within 14 days of discharge at baseline. A process map will be utilized to evaluate the current process and identify defects. Process defects will be analyzed and process improvements will be implemented. The efficacy of each improvement cycle will be evaluated using an automated aldosterone antagonist report for all first-fill spironolactone/eplerenone prescriptions initiated in inpatient HF patients. Patients initiated on an aldosterone antagonist for an indication other than HF, or by a service other than cardiology, will be excluded. The prospective data collected from the automated report that reflects interventions will be compared against the baseline data to assess the impact of each intervention made.
Results: Not applicable
Conclusion: Not applicable
Emily Weigand– PGY1 Pharmacy Resident, VA Northeast Ohio Healthcare System, Shaker Heights, OH