title: Standardization of continuous renal-replacement therapy fluids using a commercial product.
abstract: OBJECTIVE
  Patient safety and cost-control benefits achieved through a medical center's conversion to commercial fluids for continuous renal-replacement therapy (CRRT) are described.
  
  
  CONCLUSIONS
  In keeping with national patient safety recommendations, a medical center undertook a quality-improvement initiative to increase the standardization of CRRT fluids and associated patient care practices. After a feasibility study to ascertain CRRT fluid usage patterns and baseline costs, an appropriate commercial product was selected. The transition was implemented over several months in a three-phase process entailing (1) conversion to a commercial product for regional citrate anticoagulation, (2) changing the standard formula on preprinted orders to one that modeled a commercial product, and (3) conversion to the actual commercial product as the standard. Thorough education of all parties involved, as well as modifications to preprinted orders, occurred during each phase of the project. The use of the commercial product reduced the need for pharmacy compounding of CRRT fluids by more than 80%. A postconversion cost analysis indicated sharp reductions of product and labor (i.e., compounding) expenses relative to estimated baseline costs, with estimated total savings of at least $399,290 during the first six months after the conversion initiative. Implementation challenges included the need to manually adjust the potassium content of the commercial CRRT fluid and the need to provide i.v. supplementation of phosphorus and magnesium to some patients receiving the fluid. The initiative emphasized the need for institution-specific research and planning before conversion initiatives targeting CRRT fluids and other critical therapies, as well as proper education and training of all parties involved.
  
  
  CONCLUSIONS
  The standardization of CRRT fluids using commercially available products improved a medical center's compliance with patient safety standards and yielded substantial cost savings.
authors.affiliation: Aurora St. Luke's Medical Center, Milwaukee, WI 53215, USA. jon.godden@aurora.org
authors.forename: Jon
authors.initials: J
authors.lastname: Godden
authors.forename: Frank
authors.initials: F
authors.lastname: Spexarth
authors.forename: Melissa
authors.initials: M
authors.lastname: Dahlgren
mesh_terms: D002951:Citrates / Q000494:pharmacology; D002985:Clinical Protocols; D003363:Cost Control; D004339:Drug Compounding / Q000379:methods*; D017723:Drug Utilization Review; D006801:Humans; D019982:Organizational Case Studies; D061214:Patient Safety; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D051437:Renal Insufficiency / Q000628:therapy; D017582:Renal Replacement Therapy / Q000379:methods*; D000077559:Sodium Citrate
chemical_list: D002951:Citrates; D000077559:Sodium Citrate