2003 OPEN FORUM Abstracts
TRACKING AND TRENDING OMITTED RESPIRATORY MEDICATION THERAPY
Rikki S. Bruinsma, RRT, CPFT, James J. Reagan, Jr., RRT, Stephen F. Grinton, MD, St. Luke's Hospital, Jacksonville, FL.
Background: Tracking omitted inhaled medication therapy is a common procedure for many respiratory care departments; however, there has been virtually no benchmarking and very little published data available on this topic. Recently, there has been an increasing amount of informal communication among respiratory department managers regarding what constitutes a missed treatment, what needs to be reported as a medication error, and what is an acceptable level of therapy omissions. Although there is agreement that all medication therapy omitted due to therapist unavailability (TNA) needs to be tracked and reported, there are differences in opinions as to whether or not one needs to track therapy omitted due to reasons beyond the control of the respiratory therapist. Nevertheless, it is our practice to monitor and trend all omitted respiratory medication therapy, regardless of the reason for the omission. It is our belief, through the implementation of performance improvement (PI) projects, it is possible to reduce the volume of omitted treatments; however, baseline data must first be collected and analyzed.
Method: St. Luke's Hospital is a 289-bed teaching facility that utilizes 58.5 FTEs to deliver all ordered respiratory care. Patient driven protocols have been in place since 1995. Documentation in the medical record is performed electronically using the Cerner Millenniumä product. A specialized report detailing omitted medication therapy is reviewed monthly and results are communicated to our department managers and various hospital committees.
RESULTS: Of the potential 61,693 inhaled medication treatments ordered between 10/01/02 and 06/30/03, 58,440 (94.73%) were delivered and 240 (0.39%) were omitted due to TNA and reported as medication errors. The remaining 3,013 (4.88%) treatments were omitted due to a variety of other reasons. Data for all omissions are graphed below:
Data was also aggregated in a variety of ways to identify trends related to patient care areas, shifts, and specific reasons for omission of therapy due to schedule conflicts and the inability to tolerate therapy.
CONCLUSION: By collecting data and establishing a relatively stable baseline over the past three quarters, we have the information necessary to begin the process of decreasing the volume of omitted therapy through formal PI initiatives.