Abstract: SA-PO257
Improving Rates of Epoetin Alpha Administration in ESRD Patients at Two Teaching Hospitals: A Quality Improvement Initiative
Session Information
- Anemia and Iron Metabolism: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 202 Anemia and Iron Metabolism: Clinical
Authors
- Parada, Xavier F., Mount Sinai St Luke's and West, New York, New York, United States
- Leuprecht, Lorenz, Mount Sinai St Luke's and West, New York, New York, United States
- El Hachem, Karim, Mount Sinai St Luke's and West , NY, New York, United States
Background
Adequate management of anemia in ESRD has important clinical implications for both patients and the healthcare system at large. It improves quality of life, prevents readmissions, decreases the need for transfusions while simultaneously improving efficiency of care. Subcutaneous (SQ) Epoetin Alpha (EPO) provides a dose-sparing advantage over Intravenous (IV) EPO. In hospitals A and B, following a switch in the process of EPO administration from IV during dialysis to SQ on the general floors, we noted rates of 19.5% and 14.5% of missed EPO doses at hospitals A and B respectively. Unrefrigerated, un-administered EPO doses are discarded leading to a significant waste and worsening hemoglobin levels. The aim of this QI initiative was to understand the roots and reduce missed EPO doses to <10% over 9 months.
Methods
We utilized the PDSA performance improvement model to manage this project. A multidisciplinary team including Nephrology, Nursing, Pharmacy and IT was created. We identified the most common cause of missed doses as an inpatient dialysis schedule switch (from Monday/Wednesday/Friday to Tuesday/Thursday/Saturday or vice versa) without a coinciding change in the EPO order. Our first intervention was the creation of an EMR alert notifying nurses to administer the dose as ordered regardless of patients' dialysis schedule and asking them to discuss with nephrology if they were to hold a dose. At month 5, we tested a second intervention: a collaborative nursing education about anemia management at Hospital B only, facilitated by a nephrologist and a nurse educator.
Results
The results of the study are summarized in Figure1. Following the creation of an EMR alert, there was only a mild and unsustained improvement in our rates at both hospitals. After nursing education at Hospital B, we noted a sustained improvement in our rates at Hospital B but not at Hospital A.
Conclusion
While technology is an important tool providing scale and efficiency in QI initiatives, the role of targeted Nursing Education remains an effective measure to prevent waste and sustain change.