Albumin audit results and guidelines for use. University Medical Center, Tucson, Arizona.
OBJECTIVE
To identify patients receiving albumin, develop guidelines for albumin use, and examine distribution and billing procedures.


METHODS
Case series.


METHODS
Tertiary care center.


METHODS
All patients received albumin in a four-week period. Patients were identified concurrently using intensive care unit surveys and the pharmacy computer system, and retrospectively using billing statements. Data were analyzed from 73 of 79 patients (92.4 percent); 6 (7.6 percent) had no record of albumin being ordered or administered. Pediatric patient data were used only in the financial calculations.


METHODS
Demographics and albumin dosages were recorded for all patients. Prescribing service and indications for use were recorded in adults. Albumin administered was compared with the amount billed to each patient.


RESULTS
Sixty adult patients aged 14-91 y (median 62) received 1-69 units (median 4 units [1 unit = 12.5 g albumin]) and 470 total units. Surgical services prescribed albumin in 73 percent and medical services in 27 percent of the patients. Common indications for albumin included volume expansion (65 percent), as intraoperative fluid (13 percent), and to increase urine output (10 percent). The pharmacy computer system identified 63 percent of the patients. Of these, 13 percent were not billed for albumin they received. Examinations of patient billing statements found that up to $17,740 a year (15 percent) of albumin administered is not billed. The floor-stock distribution system used in the intensive care units contributed to most errors.


CONCLUSIONS
Recommendations addressing the problems identified in this audit were made to the pharmacy, medical, nursing, and billing departments. Guidelines for albumin use were formulated and approved by the hospital's pharmacy and therapeutics committee.
Gales
B J
BJ
Baptist Medical Center, Oklahoma City 73112.
Erstad
B L
BL
D000418:Albumins / Q000627:therapeutic use*; D001130:Arizona; D002675:Child, Preschool; D002985:Clinical Protocols; D003211:Concurrent Review; D016527:Drug Costs / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D006745:Hospital Bed Capacity, 300 to 499; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D008330:Management Audit; D010350:Patient Credit and Collection / Q000592:standards*; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000458:organization & administration / Q000592:standards
D000418:Albumins