title: Changeovers of vasoactive drug infusion pumps: impact of a quality improvement program.
abstract: 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.
authors.affiliation: Hospices Civils de Lyon, Hôpital Edouard Herriot, Department of Emergency and Medical Intensive Care, Lyon F-69003, France. laurent.argaud@chu-lyon.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.forename: Martin
authors.initials: M
authors.lastname: Cour
authors.forename: Olivier
authors.initials: O
authors.lastname: Martin
authors.forename: Marc
authors.initials: M
authors.lastname: Saint-Denis
authors.forename: Tristan
authors.initials: T
authors.lastname: Ferry
authors.forename: Agnes
authors.initials: A
authors.lastname: Goyatton
authors.forename: Dominique
authors.initials: D
authors.lastname: Robert
mesh_terms: 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*
chemical_list: D002316:Cardiotonic Agents; D002395:Catecholamines; D014662:Vasoconstrictor Agents