Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems

Angela Kerins; Randall Knoebel; David Dickerson; Magdalena Anitescu

doi:doi:10.11648/j.ijacm.20200801.15

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Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems

Angela Kerins, Randall Knoebel, David Dickerson, Magdalena Anitescu

Published in International Journal of Anesthesia and Clinical Medicine (Volume 8, Issue 1)

Received: 21 February 2020 Accepted: 13 March 2020 Published: 31 March 2020

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Abstract

Intrathecal drug delivery systems (IDDS) have been a valuable therapeutic modality in the treatment of intractable chronic pain, typically reserved for cases where conservative pain management has failed. Given the high risk of this treatment and infrequent encounters with IDDS, it is essential to develop an institutional process to ensure the safe and effective management of patients. Our multidisciplinary team utilized healthcare failure mode and effects analysis (HFMEA™) to identify risks and redundancies in our current processes, subsequently implementing changes to prevent them. Risks identified included: handwritten orders, no standard order set, manual drug calculations, poor identification of IDDS upon hospital admission, and scarce nursing documentation of intrathecal medication. Following this step, our team incorporated tools and technologies to manage the more complex IDDS patients: standard order sets, computerized physician order entry (CPOE) systems, and computerized clinical decision support (CCDS) systems. Also, an excel calculator was introduced—seemingly the first of its kind in clinical practice—thus making the process more unique, thorough, and safe. There is a large body of evidence supporting the use of computerized physician order entry systems (CPOE) to reduce medication errors, and providing access to a computerized clinical decision support system (CDDS) at the time of prescribing to improve outcomes in patient care. Incorporating these tools into the management of IDDS patients is a significant opportunity to reduce risks and improve patient outcomes.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 8, Issue 1)
DOI	10.11648/j.ijacm.20200801.15
Page(s)	18-25
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Intrathecal, Pain Management, Quality Improvement, HFMEA

References

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APA Style

Angela Kerins, Randall Knoebel, David Dickerson, Magdalena Anitescu. (2020). Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems. International Journal of Anesthesia and Clinical Medicine, 8(1), 18-25. https://doi.org/10.11648/j.ijacm.20200801.15

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ACS Style

Angela Kerins; Randall Knoebel; David Dickerson; Magdalena Anitescu. Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems. Int. J. Anesth. Clin. Med. 2020, 8(1), 18-25. doi: 10.11648/j.ijacm.20200801.15

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AMA Style

Angela Kerins, Randall Knoebel, David Dickerson, Magdalena Anitescu. Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems. Int J Anesth Clin Med. 2020;8(1):18-25. doi: 10.11648/j.ijacm.20200801.15

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@article{10.11648/j.ijacm.20200801.15,
  author = {Angela Kerins and Randall Knoebel and David Dickerson and Magdalena Anitescu},
  title = {Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {8},
  number = {1},
  pages = {18-25},
  doi = {10.11648/j.ijacm.20200801.15},
  url = {https://doi.org/10.11648/j.ijacm.20200801.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20200801.15},
  abstract = {Intrathecal drug delivery systems (IDDS) have been a valuable therapeutic modality in the treatment of intractable chronic pain, typically reserved for cases where conservative pain management has failed. Given the high risk of this treatment and infrequent encounters with IDDS, it is essential to develop an institutional process to ensure the safe and effective management of patients. Our multidisciplinary team utilized healthcare failure mode and effects analysis (HFMEA™) to identify risks and redundancies in our current processes, subsequently implementing changes to prevent them. Risks identified included: handwritten orders, no standard order set, manual drug calculations, poor identification of IDDS upon hospital admission, and scarce nursing documentation of intrathecal medication. Following this step, our team incorporated tools and technologies to manage the more complex IDDS patients: standard order sets, computerized physician order entry (CPOE) systems, and computerized clinical decision support (CCDS) systems. Also, an excel calculator was introduced—seemingly the first of its kind in clinical practice—thus making the process more unique, thorough, and safe. There is a large body of evidence supporting the use of computerized physician order entry systems (CPOE) to reduce medication errors, and providing access to a computerized clinical decision support system (CDDS) at the time of prescribing to improve outcomes in patient care. Incorporating these tools into the management of IDDS patients is a significant opportunity to reduce risks and improve patient outcomes.},
 year = {2020}
}

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TY  - JOUR
T1  - Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems
AU  - Angela Kerins
AU  - Randall Knoebel
AU  - David Dickerson
AU  - Magdalena Anitescu
Y1  - 2020/03/31
PY  - 2020
N1  - https://doi.org/10.11648/j.ijacm.20200801.15
DO  - 10.11648/j.ijacm.20200801.15
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 18
EP  - 25
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20200801.15
AB  - Intrathecal drug delivery systems (IDDS) have been a valuable therapeutic modality in the treatment of intractable chronic pain, typically reserved for cases where conservative pain management has failed. Given the high risk of this treatment and infrequent encounters with IDDS, it is essential to develop an institutional process to ensure the safe and effective management of patients. Our multidisciplinary team utilized healthcare failure mode and effects analysis (HFMEA™) to identify risks and redundancies in our current processes, subsequently implementing changes to prevent them. Risks identified included: handwritten orders, no standard order set, manual drug calculations, poor identification of IDDS upon hospital admission, and scarce nursing documentation of intrathecal medication. Following this step, our team incorporated tools and technologies to manage the more complex IDDS patients: standard order sets, computerized physician order entry (CPOE) systems, and computerized clinical decision support (CCDS) systems. Also, an excel calculator was introduced—seemingly the first of its kind in clinical practice—thus making the process more unique, thorough, and safe. There is a large body of evidence supporting the use of computerized physician order entry systems (CPOE) to reduce medication errors, and providing access to a computerized clinical decision support system (CDDS) at the time of prescribing to improve outcomes in patient care. Incorporating these tools into the management of IDDS patients is a significant opportunity to reduce risks and improve patient outcomes.
VL  - 8
IS  - 1
ER  -

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Author Information

Angela Kerins

Department of Pharmacy, University of Chicago Medicine, Chicago, United States
Randall Knoebel

Department of Pharmacy, University of Chicago Medicine, Chicago, United States
David Dickerson

Department of Anesthesiology, Critical Care and Pain Medicine, Northshore University Healthsystem, Evanston, United States
Magdalena Anitescu

Department of Anesthesia and Critical Care University of Chicago Medicine, Chicago, United States

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Plain Text BibTeX RIS

APA Style

Angela Kerins, Randall Knoebel, David Dickerson, Magdalena Anitescu. (2020). Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems. International Journal of Anesthesia and Clinical Medicine, 8(1), 18-25. https://doi.org/10.11648/j.ijacm.20200801.15

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ACS Style

Angela Kerins; Randall Knoebel; David Dickerson; Magdalena Anitescu. Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems. Int. J. Anesth. Clin. Med. 2020, 8(1), 18-25. doi: 10.11648/j.ijacm.20200801.15

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AMA Style

Angela Kerins, Randall Knoebel, David Dickerson, Magdalena Anitescu. Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems. Int J Anesth Clin Med. 2020;8(1):18-25. doi: 10.11648/j.ijacm.20200801.15

Copy | Download

@article{10.11648/j.ijacm.20200801.15,
  author = {Angela Kerins and Randall Knoebel and David Dickerson and Magdalena Anitescu},
  title = {Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {8},
  number = {1},
  pages = {18-25},
  doi = {10.11648/j.ijacm.20200801.15},
  url = {https://doi.org/10.11648/j.ijacm.20200801.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20200801.15},
  abstract = {Intrathecal drug delivery systems (IDDS) have been a valuable therapeutic modality in the treatment of intractable chronic pain, typically reserved for cases where conservative pain management has failed. Given the high risk of this treatment and infrequent encounters with IDDS, it is essential to develop an institutional process to ensure the safe and effective management of patients. Our multidisciplinary team utilized healthcare failure mode and effects analysis (HFMEA™) to identify risks and redundancies in our current processes, subsequently implementing changes to prevent them. Risks identified included: handwritten orders, no standard order set, manual drug calculations, poor identification of IDDS upon hospital admission, and scarce nursing documentation of intrathecal medication. Following this step, our team incorporated tools and technologies to manage the more complex IDDS patients: standard order sets, computerized physician order entry (CPOE) systems, and computerized clinical decision support (CCDS) systems. Also, an excel calculator was introduced—seemingly the first of its kind in clinical practice—thus making the process more unique, thorough, and safe. There is a large body of evidence supporting the use of computerized physician order entry systems (CPOE) to reduce medication errors, and providing access to a computerized clinical decision support system (CDDS) at the time of prescribing to improve outcomes in patient care. Incorporating these tools into the management of IDDS patients is a significant opportunity to reduce risks and improve patient outcomes.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems
AU  - Angela Kerins
AU  - Randall Knoebel
AU  - David Dickerson
AU  - Magdalena Anitescu
Y1  - 2020/03/31
PY  - 2020
N1  - https://doi.org/10.11648/j.ijacm.20200801.15
DO  - 10.11648/j.ijacm.20200801.15
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 18
EP  - 25
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20200801.15
AB  - Intrathecal drug delivery systems (IDDS) have been a valuable therapeutic modality in the treatment of intractable chronic pain, typically reserved for cases where conservative pain management has failed. Given the high risk of this treatment and infrequent encounters with IDDS, it is essential to develop an institutional process to ensure the safe and effective management of patients. Our multidisciplinary team utilized healthcare failure mode and effects analysis (HFMEA™) to identify risks and redundancies in our current processes, subsequently implementing changes to prevent them. Risks identified included: handwritten orders, no standard order set, manual drug calculations, poor identification of IDDS upon hospital admission, and scarce nursing documentation of intrathecal medication. Following this step, our team incorporated tools and technologies to manage the more complex IDDS patients: standard order sets, computerized physician order entry (CPOE) systems, and computerized clinical decision support (CCDS) systems. Also, an excel calculator was introduced—seemingly the first of its kind in clinical practice—thus making the process more unique, thorough, and safe. There is a large body of evidence supporting the use of computerized physician order entry systems (CPOE) to reduce medication errors, and providing access to a computerized clinical decision support system (CDDS) at the time of prescribing to improve outcomes in patient care. Incorporating these tools into the management of IDDS patients is a significant opportunity to reduce risks and improve patient outcomes.
VL  - 8
IS  - 1
ER  -

Copy | Download