The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

IMPLEMENTATION OF A STANDARDIZED ORDER SET FOR THE APPROPRIATE USE OF INHALED PULMONARY VASODILATOR THERAPY

Lisa Cracchiolo, Darnetta Clinkscale,Tiyonda Valentine-Cook; Barnes JewishHospital, St. Louis, MO,MO

Background: In 2004 a research study at our institution demonstrated that the mechanism of action of Epoprostenol (Flolan) is similar to inhaled nitric oxide, with minimal systemic side effects. Subsequently, the decision was made to create a process to assure appropriate and effective use of Nitric Oxide (NO). Nitric oxide has been approved by the FDA for use in term and near-term neonates with hypoxic respiratory failure, and had been used in the adult population for off label and investigative purposes. Inhaled Flolan is similar in its clinical effect and was felt to be an acceptable substitute in most clinical situations. Method: Inhaled Nitric Oxide was administered to patients per physician orders, prior to the process change. Initial steps in the improvement process included monitoring the usage, costs and outcomes of patients on inhaled nitric oxide by the Respiratory Care Services (RCS) department. In 2006, a standardized vasodilator order set was developed by a multi-disciplinary team. The team included: Respiratory Care Services, Pharmacy, Nursing, Critical Care Physicians as well as Chief Medical Officer (CMO). The order set was designed to identify specific attending physicians appointed by the CMO; who would have to approve the appropriate clinical use of inhaled nitric oxide on patients. The goal of implementation of an order set was to assure appropriate utilization of inhaled nitric oxide versus Flolan. Results: Comparison of the variation and mean hours of NO utilization; prior to the order set and after implementation are: much less variation indicated by smaller “whisker” on post-intervention graph and a decrease in mean hours billed at 421.6 hours during period 1 to 238.9 hours during period 2. This improvement approaches statistical significance with a p=.083. Conclusion: Inhaled Flolan has been shown to be equal to inhaled nitric oxide in its clinical effects, at a significantly reduced cost. With the development of a standardized vasodilator order set; we are able to safely and effectively administer clinically appropriate care while also reducing costs. Sponsored Research - None

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