Changeovers of vasoactive drug infusion pumps: impact of a quality improvement program.
BACKGROUND
Hemodynamic instability following the changeover of vasoactive infusion pump (CVIP) is a common problem in the intensive care unit. Several empiric methods are used to achieve CVIP. We hypothesized that the variation in these procedures could generate some morbidity. We sought to assess the effects of the standardization of practice, as a quality improvement program, on the CVIP-induced incidents.


METHODS
We performed a prospective before-and-after intervention study including all adult patients with a diagnosis of cardiovascular failure who received a continuous infusion of vasoactive drugs or inotropic drugs. After a baseline preimplementation period (phase 1), a standardized 'quick change method' of CVIP using two syringe drivers was implemented in our intensive care unit (phase 2). Endpoints (rate and distribution of incidents: variations of systolic blood pressure >20 mmHg or heart rate >20 beats/min, and arrhythmias) were registered in both 3-month phases.


RESULTS
We studied a total of 913 CVIP events (phase 1, 435 events; phase 2, 478 events) from 43 patients. Patient characteristics were not significantly different among phases, with a majority of the patients having septic shock. The frequency of incidents was significantly (P < 0.0001) reduced in phase 2 (5.9%, n = 28) versus phase 1 (17.8%, n = 78). This effect was observed whichever catecholamine was used. More than 98% of incidents were blood pressure variations, with a similar distribution of the nature of incidents in both phases.


CONCLUSIONS
The present study illustrates that adverse events are common following CVIP, and illustrates the positive impact of a quality improvement program to enhance inpatient safety related to this current process of care.
Argaud
Laurent
L
Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Emergency and Medical Intensive Care, Lyon F-69003, France. laurent.argaud@chu-lyon.fr
Cour
Martin
M
Martin
Olivier
O
Saint-Denis
Marc
M
Ferry
Tristan
T
Goyatton
Agnes
A
Robert
Dominique
D
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D002395:Catecholamines / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007260:Infusion Pumps / Q000009:adverse effects / Q000592:standards*; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000592:standards; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D002316:Cardiotonic Agents; D002395:Catecholamines; D014662:Vasoconstrictor Agents