Category: Professional Posters
Purpose: A 2018 Joint Commission medication management update indicated over 49% of hospitals surveyed were non-compliant with titratable infusion orders. Essential components of such orders include a starting dose, titration increment, frequency, goal, and maximum dose. A multidisciplinary team identified the opportunity to standardize titratable infusion orders to reduce the risk for conflicting or incomplete orders. The purpose of this project is to outline the development and implementation of the “infusion super panel” and its impact on driving standardized, safe and regulatory-compliant prescribing and administration practices of frequently used medication infusions in a multi-hospital health system.
Methods: Engaging senior leadership for support and strategic alignment was foundational in the early planning and resource allocation phases of this patient safety initiative. A multidisciplinary team was formed to ensure frontline input and appropriate subject matter expert representation including physicians, nurses, and pharmacists across various specialties such as emergency medicine, critical care, neurology, cardiology, and pediatrics. A structured meeting series was held to identify areas of opportunity and to develop the clinical build content based on most current evidence-based and best practice recommendations.
During the multidisciplinary team meetings, every medication record for titratable infusions was reviewed to ensure all regulatory requirements were met. The essential elements of titratable orders were built as required fields and defaulted to content that was most frequently used by bedside practitioners while still allowing the flexibility for customization when necessary. Rigorous user acceptance testing was completed by clinical and informatics subject matter experts for final approval and sign-off. The Organizational Learning Department developed and coordinated education for roll-out across all 11 hospitals.
Results: The infusion super panel combines a variety of innovative safeguards and clinical decision support tools such as interactive, cascading order questions, age-appropriate context, linked orders, as well as dose warning alerts and hard stops. A total of 160 medication records and 55 order sets were affected by the electronic medical record (EMR) build. This is estimated to impact approximately 11,800 patients and 34,800 medication orders yearly across the system. The successful implementation of the infusion super panel highlights the importance of a robust change control process and coordinated multidisciplinary team efforts with end-user involvement in identifying process gaps and finding solutions to help leverage innovative EMR functionality and clinical decision support in the safe and regulatory-compliant delivery of patient care.
Conclusion: Building complete, concise orders for titratable infusions in the EMR that meet regulatory requirements is a challenging task. Essential components of such orders include a starting dose, titration increment, frequency, goal, maximum dose, and/or instructions on when to notify the provider as applicable. During this project, we sought to reduce the risk for conflicting or incomplete orders and the need for re-work to ensure clear and complete content. Through implementation of the “infusion super panel”, we were able to address this challenge with the expertise of a multidisciplinary team.