Objectives: 

Improve medication-related variable ICU costs by increasing value related to a locally identified high-frequency/high-cost medication, IV acetaminophen.

Design: 

Structured quality improvement initiative using the Institute for Healthcare Improvement’s Model for Improvement.

Setting: 

Twenty-three–bed tertiary PICU.

Patients: 

All patients admitted to the PICU receiving IV acetaminophen during the study period of 2015–2018.

Interventions: 

PICU staff survey, education to close nurse/provider knowledge gap, optimization of order sets and electronic health record order entry, improving oral/enteral medication transition, and optimization of pharmacy dispensing.

Measurements and Main Results: 

The primary outcome of interest was IV acetaminophen doses per patient day reported as a 12-month rolling average. Baseline IV acetaminophen prescribing prior to the study period was initially 0.55 doses per patient day, and in 2014, there were 3,042 doses administered. IV acetaminophen is $43 per dose. The rolling 12-month average post intervention was 0.33 doses per patient day. Enteral and rectal doses increased from 0.42 to 0.58 doses per patient day. Opioid utilization varied throughout the study. A 40% reduction in IV acetaminophen equated to a $35,507 cost savings in a single year.

Conclusions: 

IV acetaminophen is prescribed with high frequency and impacts variable PICU costs. Value can be improved by optimizing IV acetaminophen prescribing.

中文翻译：

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使用质量改进措施减少PICU中的IV对乙酰氨基酚的使用。

目标： 

通过增加与本地确定的高频/高成本药物IV对乙酰氨基酚有关的价值，提高药物相关的可变ICU成本。

设计： 

结构化质量的提高利用研究所医疗改进的模型改进计划。

设置： 

第二十三张第三级PICU。

耐心： 

在2015–2018年的研究期间，所有入院PICU的患者均接受了静脉对乙酰氨基酚。

干预措施： 

PICU人员调查，缩小护士/服务提供者知识差距的教育，优化订单集和电子健康记录订单输入，改善口服/肠内药物过渡以及优化药房分配。

测量和主要结果： 

感兴趣的主要结果是每位患者每天的静脉对乙酰氨基酚剂量，报道为12个月的滚动平均值。研究期开始前的基线静脉注射对乙酰氨基酚的最初剂量为每位患者每天0.55剂，2014年共给药3,042剂。静脉对乙酰氨基酚为每剂$ 43。干预后12个月的平均滚动剂量为每位患者每天0.33剂。肠和直肠的剂量从每位患者每天0.42剂量增加到0.58剂量。阿片类药物的利用在整个研究中有所不同。静脉注射对乙酰氨基酚减少40％，相当于一年可节省35,507美元的成本。

结论： 

静脉使用对乙酰氨基酚的处方频率很高，会影响PICU的可变成本。通过优化静脉对乙酰氨基酚处方可以提高价值。