Epoetin alfa protocol and multidisciplinary blood-conservation program for critically ill patients.
OBJECTIVE
An evidence-based epoetin alfa protocol and a multidisciplinary blood-conservation program were implemented in a medical intensive care unit (MICU) and surgical intensive care unit (SICU).


CONCLUSIONS
Baseline data were collected to evaluate the use of epoetin alfa and red blood cell (RBC) transfusions in our MICU and SICU. An evidence-based protocol for epoetin alfa use and a multidisciplinary blood-conservation program were designed, approved, and implemented. Preprotocol patients consisted of a convenience sample of 18 patients receiving epoetin alfa for various indications who were admitted to our MICU and SICU from January 1 to December 31, 2002. The postprotocol sample consisted of 40 patients who received epoetin alfa for the treatment of anemia due to critical illness who were admitted to the MICU and SICU from March 25 to May 23, 2003. Postprotocol data were collected and compared with baseline data. All patients seen in the MICU and SICU, during the postprotocol period, regardless of whether they were receiving epoetin alfa, were included in the multidisciplinary blood-conservation program. Postprotocol data showed statistically significant improvements in epoetin alfa dosing and monitoring and in the use of adjunctive therapy. Pharmacist-initiated blood-conservation strategies resulted in several blood-draw reductions and discontinuations. Statistically significant reductions in the number of RBC units transfused per patient and per intensive care unit (ICU) day were also observed.


CONCLUSIONS
An epoetin alfa protocol and a multidisciplinary blood-conservation program contributed to rational prescribing of epoetin alfa and to a reduction in the number of RBC units transfused per patient and per ICU day.
Pell
Lindsay J
LJ
Department of Pharmacy, The Ohio State University Medical Center, Columbus, OH 43210, USA.
Martin
B Shane
BS
Shirk
Mary Beth
MB
D000740:Anemia / Q000628:therapy*; D001800:Blood Specimen Collection / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D016638:Critical Illness / Q000628:therapy*; D000068817:Epoetin Alfa; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D004921:Erythropoietin / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000008:administration & dosage* / Q000627:therapeutic use; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D011994:Recombinant Proteins
D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa