Transcript Slide 1

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
 High cost drug
 Product of
AUSPMAN, PMH
Pharmacy
mL frozen syringe
What is the problem:
 Audit triggered by:
• Discarded syringes due to cold chain failure
• Retrospective cost analysis:
Source: Query Builder
Alteplase frozen syringes (1/1/10 to 21/3/12
(2 y 2 m)
RPH ($)
AHS ($)
3,900
14,740
 Audit should provide As:
• Why > use?
• ?Wastage factor (expiry date, incorrect storage)
• ?Adherence to policy + guidelines
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
No. of patients (n)
No. of doses administered
No. of doses given without doc
No. of doses adm without a
valid Rx
Indication for use
Renal physician consultation
Baseline Audit
(Apr 11 – Mar 12)
Post-Audit
(Apr 12 – Mar 13)
6
4
31 ( $4,288)
Mean = 5.2 doses/patient
(1 - 11 doses/patient)
7 ($995)
Mean 1.7 doses/patient
(1 – 2 doses/patient)
14
(45.2%)
0
(0%)
9
(29%)
0
(0%)
17 (54.8%) unblocking
14 (45.2%) for locking
6 (85.7%) for unblocking
1 (14.3%) for locking
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
Percentage %
90
80
Apr 2011 to Mar 2012
70
Apr 2012 to Mar 2013
60
50
40
30
20
10
0
doses adm
doses adm amount adm
with no doc in without a valid
unknown
NIMC
Rx
Use for
unblocking
CVC
Use as LOCK other Tx tried
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:
 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