ABSTRACT
Background: In 2017, a national drug shortage of small volume solutions significantly affected the preparation of intravenous antibiotics. In response, a continuous infusion administration protocol for piperacillin/tazobactam (PIP/TAZ) was implemented. Objective: To compare the outcomes of continuous to prolonged infusions of PIP/TAZ in the setting of drug shortages. Methods: This study is a single-center, retrospective cohort study in a community hospital of patients 18 years and older who received intravenous PIP/TAZ through 2 different dosing strategies of intravenous antibiotics from December 2016 to January 2018. Data were collected for 2 months on patients receiving prolonged infusions of PIP/TAZ prior to November 2017 and for 2 months on patients receiving continuous infusions of PIP/TAZ after November 2017. Results: A total of 90 patients who received PIP/TAZ via either prolonged (n = 47) or continuous infusion (n = 43) were evaluated. There were no differences between the groups in mortality (3 vs 2 deaths, P = 1.00), length of therapy (6 ± 4 vs 6 ± 3 days, P = .86), or length of stay (9 ± 7 vs 8 ± 6 days, P = .47). Additionally, no differences were noted between incidences of thrombocytopenia (P = .41), Clostridioides difficile infection (P = .48), acute renal failure (P = 1.00), seizures (P = 1.0), or 30-day readmission rates (P = .27). Conclusions: Administration of continuous infusion PIP/TAZ appears to be a viable mitigation strategy during small volume fluid shortages. Future cost-effectiveness studies may provide information on the financial impact of continuous infusions during costly drug shortages.
ABSTRACT
PURPOSE: One quality initiative that North Mississippi Medical Center (NMMC) included in its application for the Malcolm Baldrige National Quality Award (MBNQA) is described. SUMMARY: NMMC is a 650-bed, regional, nonprofit medical center that serves 22 counties in an area with approximately 600,000 people. The hospital received the MBNQA in 2006. NMMC's insulin performance-improvement team recognized a patient safety issue with the use of three insulin sliding scales that did not adequately meet the evidence-based standard of care for diabetes. The team developed a standard sliding-scale order set to enhance patient care and target blood glucose concentrations of 70-120 mg/dL. NMMC's quality initiatives aligned with the seven categories of the Baldrige Criteria for Organizational Performance Excellence-leadership; strategic planning; patient focus; measurement, analysis, and knowledge management; work-force focus; process management; and results. The insulin performance-improvement team included an endocrinologist, nursing staff, information technology staff, and a pharmacist. The goal of the insulin performance- improvement team was to develop a standard sliding insulin scale order set based on literature evidence, clinical knowledge, practitioner feedback, and information technology. The team considered the pharmacy department in the planning and implementation of the project, and pilot programs were conducted to best predict work-force issues. Inservice education was provided to nurses, pharmacists, and physicians over the course of several weeks. The team's attentiveness to time management created a seamless project. The three original sliding scales were discontinued, and the standard NMMC sliding scale was implemented on June 26, 2006. Because the Baldrige approach is versatile and flexible, it helped the insulin performance-improvement team at NMMC meet the challenging demands of health care. CONCLUSION: The Baldrige approach was successfully used to implement a standard insulin therapy protocol.
