Cleaning up Alteplase for unblocking occluded central venous catheter (CVC) in the renal dialysis...
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Transcript of Cleaning up Alteplase for unblocking occluded central venous catheter (CVC) in the renal dialysis...
Cleaning up Alteplase for unblocking occluded central venous catheter (CVC) in the
renal dialysis unit. S Lim,
Pharmacy Department,
Armadale Health Service
Overview:
NSQHS Med Safety Std 4 (empower clinicians to use med safely)
What is our problem? AHS Alteplase policy Audit Methodology Audit Results Discussions and recommendations Lesson learnt Success of these audits
Alteplase 2 mg/ 2 mL frozen syringe
High cost drug Product of
AUSPMAN, PMH Pharmacy
What is the problem:
Audit triggered by:• Discarded syringes due to cold chain failure• Retrospective cost analysis:
Audit should provide As:• Why > use?• ?Wastage factor (expiry date, incorrect storage)• ?Adherence to policy + guidelines
Source: Query Builder RPH ($) AHS ($)
Alteplase frozen syringes (1/1/10 to 21/3/12 (2 y 2 m)
3,900 14,740
AHS Alteplase Guiding Principles:
Restore patency to occluded CVC
Up to 2 doses of Alteplase (2mg) per episode
No efficacy + safety data for > than 2 doses
Method:
Baseline audit (April 2012):
• Retrospective analysis patients given Alteplase.
• Analytical period:• April 2011 to March 2012
• Data collection using compliance tools
Post-implementation audit (April 2013):
• Analytical period: • April 2012 to March 2013
Results
Baseline Audit(Apr 11 – Mar 12)
Post-Audit(Apr 12 – Mar 13)
No. of patients (n) 6 4
No. of doses administered 31 ( $4,288) Mean = 5.2 doses/patient
(1 - 11 doses/patient)
7 ($995)Mean 1.7 doses/patient
(1 – 2 doses/patient)
No. of doses given without doc 14 (45.2%)
0 (0%)
No. of doses adm without a valid Rx
9 (29%)
0 (0%)
Indication for use 17 (54.8%) unblocking14 (45.2%) for locking
6 (85.7%) for unblocking 1 (14.3%) for locking
Renal physician consultation 1 (3.2%)
6 (85.7%)
Results:
Results from the compliance audit on the use of Alteplase for Unblocking CVC lines, Renal Dialysis Unit, AHS
0
10
20
30
40
50
60
70
80
90
doses admwith no doc in
NIMC
doses admwithout a valid
Rx
amount admunknown
Use forunblocking
CVC
Use as LOCK other Tx tried
Per
cen
tag
e %
Apr 2011 to Mar 2012
Apr 2012 to Mar 2013
Discussions/Recommendations:
• Baseline Audit:
29% without a valid Rx
45.2% no doc after use Inappropriate PRN Rx
• Allow the use for 14 doses without proper review
• Potential for “Nurse Initiated Med or NIM”
45.2% for locking CVC• ?ensure future line patency• No evidence to protect
patency
• Re-audit:Re-audit:
100% valid RX
100% documentation of use
100% RX in “Once Only Med” section of NIMC:• Ensure proper review
every episode of use• Correct + proper use of
alteplase
Lesson Learnt:
Prevent misuse of alteplase:• Use “once only” section of NIMC to Rx up to 2
doses of alteplase• Empowering Renal physician to review the
usage of alteplase every episode:• Safe + proper use of potential toxic drug• Prevent misuse (not an NIM)• $ saving
Conclusion:
Compliance to NSQHS Std 4 (med safety):4.1 Develop + implement governance
arrangement, policy, procedures and protocols
4.2 Regular comprehensive assessment to identify risks + implement system change
4.3 Authorise clinicians to prescribe + administer meds.
4.5 Undertake quality improvement activities to enhance med safety
GO FREO