Variation in Inpatient Costs of Hematopoietic Cell Transplantation Among Transplant Centers in the United States

Viengneesee Thao, Ezra Golberstein, William Thomas, Katy Backes Kozhimannil, Lih-Wen Mau, Jaime M. Preussler, Ellen Denzen, Navneet S. Majhail
2014 Biology of Blood and Marrow Transplantation  
Pediatric Blood and Marrow Transplant unit had been using the Omni pump, which was a multi chamber pump capable of running four medications at one time and had unique tubing. The Omni was able to run syringe medications as well as medications in bags. The implementation forced Nursing Practice Council (NPC) to brainstorm a line and pump set-up that would provide an equivalent process and workflow as the Omni. Unfortunately, the Sigma can only run one bag medication at a time and does not have
more » ... and does not have the capability to run a syringe medication. The new set-up would require four Sigma pumps and two syringe pumps to replace the one Omni. METHOD: Two months prior to implementation, NPC created a poster displaying a line set-up that could accommodate the needs to administer multiple IV medications simultaneously per patient into a double lumen Hickman. In addition, NPC implemented a standardized pump set-up to supplement the line set-up by creating an "BMT Amplatz pole" order where every patient admitted receives the pumps pre set-up from supply chain. Monthly audits were done to check staff compliance and were reported in a monthly unit newsletter. Yearly competencies are used to evaluation assimilation of knowledge. A survey will be conducted showing staff satisfaction. RESULTS: Since implementation of the standard line and pump set-up, our cyclosporine line contamination has been zero, which is a decrease. Based on ICAREs, Our medication errors related to infusion in the wrong lumen and incompatibilities with other medications has decreased from 12 in 2011, eight in 2012 and two in 2013 to date. We continue to have low BSI rates that are below the nation average. From informal verbal surveys, we have heard an increase in staff satisfaction related to productivity and time management. CONCLUSION: Based on the results, we know that the standardization has decreased medication errors and increased staff satisfaction. We continue to evaluate the effectiveness of the standardization set-up and continue to look for ways to improve patient care and safety.
doi:10.1016/j.bbmt.2013.12.192 fatcat:wahvhjrquncv3cjjwdifnss4ra