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Impact of Peripheral Pressors and Midodrine in the ICU
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A6852 - Impact of Peripheral Pressors and Midodrine in the ICU
Author Block: K. Chapla1, W. Bringghold2; 1Pulmonary Critical Care, University of Wisconsin, Madison, WI, United States, 2Internal Medicine, University of Wisconsin, Madison, WI, United States.
RATIONALE: Placement of central lines and initiation of vasopressors is an integral component of critical care. In the spirit of the choosing wisely campaign introduced by the ABIM, we sought out a quality improvement initiative to help reduce placement of unnecessary central lines. The goal of our initiative was to reduce central line insertions and duration of central lines through the introduction of peripheral pressor and midodrine protocols. Additionally, we hope our intervention will eventually lead to reduced rates of CLABSI as well as length of stay in our medical ICU.
METHODS: A Quality Improvement Self-Certification Tool developed by our institutional IRB was used to verify that IRB review was not required. We developed a protocol for the safe administration and monitoring of peripheral vasopressors which was partially adopted from a study by Cardenas-Garcia et al.1 Following a series of multi-disciplinary meetings, an order panel was incorporated into our EMR. After a review of the literature regarding the safety and efficacy of oral midodrine, we also developed a protocol for the use of midodrine in appropriate patients on stable doses of IV vasopressors. The peripheral vasopressor protocol was implemented into our EMR January 2017. The protocolized use of midodrine was introduced May 2017. We used QlikView, an institutional database on quality metrics and benchmarks, to compare data from May-September 2017 to an equivalent period in 2015.
RESULTS: In the period from May to September 2017 there were 83 non-tunneled central line placements compared to 104 in the same period in 2015 (20% reduction). From May-September 2017 there were 217 vasopressor initiations in 130 unique patients compared to 142 vasopressor initiations in 93 unique patients from May-September 2015. There were 60 unique patients and 109 unique orders for midodrine in that same period in 2017 compared to 20 unique patients and 34 unique orders in 2015. Average ICU length of stay in 2017 was 8.56 days compared to 7.70 days in 2015.
CONCLUSIONS: Despite increased utilization of vasopressors in 2017 compared to 2015, we observed a reduction in central line insertions largely due to utilization of peripheral vasopressors. Furthermore, we observed a significant increase in midodrine use following implementation of our protocol; however, it is difficult to determine any significant impact on duration of central line use and ICU stay at this time.
REFERENCE: 1Cardenas-Gardica et al. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015; 10(9):581-84.
Author Block: K. Chapla1, W. Bringghold2; 1Pulmonary Critical Care, University of Wisconsin, Madison, WI, United States, 2Internal Medicine, University of Wisconsin, Madison, WI, United States.
RATIONALE: Placement of central lines and initiation of vasopressors is an integral component of critical care. In the spirit of the choosing wisely campaign introduced by the ABIM, we sought out a quality improvement initiative to help reduce placement of unnecessary central lines. The goal of our initiative was to reduce central line insertions and duration of central lines through the introduction of peripheral pressor and midodrine protocols. Additionally, we hope our intervention will eventually lead to reduced rates of CLABSI as well as length of stay in our medical ICU.
METHODS: A Quality Improvement Self-Certification Tool developed by our institutional IRB was used to verify that IRB review was not required. We developed a protocol for the safe administration and monitoring of peripheral vasopressors which was partially adopted from a study by Cardenas-Garcia et al.1 Following a series of multi-disciplinary meetings, an order panel was incorporated into our EMR. After a review of the literature regarding the safety and efficacy of oral midodrine, we also developed a protocol for the use of midodrine in appropriate patients on stable doses of IV vasopressors. The peripheral vasopressor protocol was implemented into our EMR January 2017. The protocolized use of midodrine was introduced May 2017. We used QlikView, an institutional database on quality metrics and benchmarks, to compare data from May-September 2017 to an equivalent period in 2015.
RESULTS: In the period from May to September 2017 there were 83 non-tunneled central line placements compared to 104 in the same period in 2015 (20% reduction). From May-September 2017 there were 217 vasopressor initiations in 130 unique patients compared to 142 vasopressor initiations in 93 unique patients from May-September 2015. There were 60 unique patients and 109 unique orders for midodrine in that same period in 2017 compared to 20 unique patients and 34 unique orders in 2015. Average ICU length of stay in 2017 was 8.56 days compared to 7.70 days in 2015.
CONCLUSIONS: Despite increased utilization of vasopressors in 2017 compared to 2015, we observed a reduction in central line insertions largely due to utilization of peripheral vasopressors. Furthermore, we observed a significant increase in midodrine use following implementation of our protocol; however, it is difficult to determine any significant impact on duration of central line use and ICU stay at this time.
REFERENCE: 1Cardenas-Gardica et al. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015; 10(9):581-84.
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