PMID- 32191116
OWN - NLM
STAT- MEDLINE
DCOM- 20210728
LR  - 20220416
IS  - 1938-2715 (Electronic)
IS  - 1049-9091 (Linking)
VI  - 37
IP  - 11
DP  - 2020 Nov
TI  - Pharmacy-Led Quality Improvement Project on Pain Control Using Continuous 
      Subcutaneous Infusion of Opioids in an Inpatient Hospice Unit.
PG  - 885-889
LID - 10.1177/1049909120912954 [doi]
AB  - OBJECTIVES: The purpose of this quality improvement (QI) project was to improve 
      the overall process of implementing continuous subcutaneous infusion of opioids 
      (CSCIOs) at the West Palm Beach Veterans Affairs Medical Center and characterize 
      their use in the hospice unit. METHODS: A retrospective chart review from July 
      2014 to August 2017 was conducted to identify patients who had received CSCIO. 
      Results were analyzed with descriptive statistics.The business philosphy, 
      LEAN methodology "The 5 Whys" was utilized to identify the root causes for 
      delayed infusion timeliness and corrections were implemented by August 2018. 
      Follow-up retrospective time study completed from September 2018 to February 
      2019. RESULTS: Of the 107 patients identified, 7 were excluded and 100 were 
      reviewed. The mean age was 73 years, 94% male, and 86% Caucasian. A total of 55 
      veterans received morphine with an average final infusion rate of 2.5 mg/h. A 
      total of 45 Veterans received hydromorphone with a final infusion rate of 1.3 
      mg/h. The average infusion duration until death was 5 days. Pharmacy verified 94 
      (94%) orders and nursing verified 55 (55%) orders within 1 hour (gold standard). 
      Sixteen (16%) patients received CSCIO within 1 hour. The 5 Whys identified 
      nursing order verification and pharmacy lack of visual STAT order notification 
      for priority as the potential sources for infusion timeliness improvement. The 
      follow-up time study confirmed improvement in pharmacy delivery time from 29% to 
      75% on time. CONCLUSION: Pharmacist-led intervention directed to improve CSCIO 
      processes in an inpatient hospice unit utilizing LEAN QI methodology increased 
      timeliness of pharmacy CSCIO delivery.
FAU - Romero, Nayma Moya
AU  - Romero NM
AUID- ORCID: 0000-0003-3640-6136
AD  - West Palm Beach VA Medical Center, West Palm Beach, FL, USA.
FAU - DiScala, Sandra
AU  - DiScala S
AD  - West Palm Beach VA Medical Center, West Palm Beach, FL, USA.
FAU - Quellhorst, Jennifer
AU  - Quellhorst J
AD  - West Palm Beach VA Medical Center, West Palm Beach, FL, USA.
FAU - Silverman, Michael A
AU  - Silverman MA
AD  - West Palm Beach VA Medical Center, West Palm Beach, FL, USA.
LA  - eng
PT  - Journal Article
DEP - 20200319
PL  - United States
TA  - Am J Hosp Palliat Care
JT  - The American journal of hospice & palliative care
JID - 9008229
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Aged
MH  - Analgesics, Opioid/therapeutic use
MH  - Female
MH  - *Hospices
MH  - Humans
MH  - Infusions, Subcutaneous
MH  - Inpatients
MH  - Male
MH  - Pain/drug therapy
MH  - *Pharmacy
MH  - Quality Improvement
MH  - Retrospective Studies
OTO - NOTNLM
OT  - LEAN
OT  - analgesia
OT  - hospice
OT  - hydromorphone
OT  - morphine
OT  - opioid
OT  - pain
OT  - palliative care
OT  - subcutaneous
EDAT- 2020/03/20 06:00
MHDA- 2021/07/29 06:00
CRDT- 2020/03/20 06:00
PHST- 2020/03/20 06:00 [pubmed]
PHST- 2021/07/29 06:00 [medline]
PHST- 2020/03/20 06:00 [entrez]
AID - 10.1177/1049909120912954 [doi]
PST - ppublish
SO  - Am J Hosp Palliat Care. 2020 Nov;37(11):885-889. doi: 10.1177/1049909120912954. 
      Epub 2020 Mar 19.