2012 OPEN FORUM Abstracts
DECREASE INHALED NITRIC OXIDE UTILIZATION AT A CHILDRENS HOSPITAL FROM A DRUG USE EVALUATION AND GUIDELINE IMPLEMENTATION.
Donna Parker, Joyce Baker; Childrens Hospital Colorado, Aurora, CO
Background: Inhaled Nitric Oxide (iNO) is only FDA approved in the treatment for hypoxic respiratory failure associated with pulmonary hypertension of the neonate. The majority of utilization of iNO is off label at our institution; constituting 89.1% of our total utilization and contributing to a 27.7% increase in expense annually. Method: A drug utilization evaluation (DUE) was done to compare utilization of iNO from 2008 and 2010. This included review of diseases, hours of utilization, appropriate use, length of therapy, and physician management. Literature review was done for three specific patient populations (AHRF, PPHN, Post op Cardiac) looking at efficacy of therapy and standard length of time on therapy. Based on our findings, guidelines for these three disease processes were written and implemented in Q2 of 2011. The guidelines focused on stricter inclusion criteria, establishing lowest tolerable dose, timeline to implement weaning, weaning process to prevent rebound, and stricter criteria for discontinuation. Education with the respiratory therapists and medical staff was done emphasizing specifics of the guidelines and weaning procedure. We also found value in educating the medical staff on the overall expense to the patient if left on iNO for an extended period of time. Results: Comparing total hours of iNO consumed from 2010 to 2011 we had an overall 16.1% reduction, with a potential $256,756 savings to the hospital. A review of iNO in each of the targeted disease processes found utilization in acute hypoxic respiratory failure patients decreased by 15.1% and persistent pulmonary hypertension of the newborn decreased by 14.7%. Our post operative cardiac utilization; which was already within the standard length of therapy reported in literature, increased by 23% in 2011 despite the same number of patients who received iNO. This is prospectively related to an increase complexity of the patients. Evaluation of additional disease processes outside our selected patient population revealed chronic lung disease and congenital diaphragmatic hernia patients had decreased consumption by 22.3% from 2010 to 2011. Conclusion: Implementation of inhaled nitric oxide (iNO) guidelines after an extensive drug utilization evaluation and aggressive education of the various health care teams has assisted in decreasing unnecessary use of iNO with an overall expense reduction to the hospital. Sponsored Research - None