Brian L Erstad

PMID: 10119446;Abstract:

Objective: To identify patients receiving albumin, develop guidelines for albumin use, and examine distribution and billing procedures. Design: Case series. Setting: Tertiary care center. Patients: All patients received albumin in a four-week period. Patients were identified concurrently using intensive care unit surveys and the pharmacy computer system, and retrospectively using billing statements. Data were analyzed from 73 of 79 patients (92.4 percent); 6 (7.6 percent) had no record of albumin being ordered or administered. Pediatric patient data were used only in the financial calculations. Data Collection: Demographics and albumin dosages were recorded for all patients. Prescribing service and indications for use were recorded in adults. Albumin administered was compared with the amount billed to each patient. Main Results: Sixty adult patients aged 14-91 y (median 62) received 1-69 units (median 4 units [1 unit=12.5 g albumin]) and 470 total units. Surgical services prescribed albumin in 73 percent and medical services in 27 percent of the patients. Common indications for albumin included volume expansion (65 percent), as intraoperative fluid (13 percent), and to increase urine output (10 percent). The pharmacy computer system identified 63 percent of the patients. Of these, 13 percent were not billed for albumin they received. Examinations of patient billing statements found that up to $17,740 a year (15 percent) of albumin administered is not billed. The floor-stock distribution system used in the intensive care units contributed to most errors. Conclusions: Recommendations addressing the problems identified in this audit were made to the pharmacy, medical, nursing, and billing departments. Guidelines for albumin use were formulated and approved by the hospital's pharmacy and therapeutics committee.

Abstract:

Purpose: The authors conducted a retrospective chart review to determine if metoclopramide was being used properly for ileus and if it caused any adverse effects. Methods: All adult patients admitted to the institution's ICUs between November 10, 2000 and January 31, 2001 were evaluated for enrollment. Data was obtained from medication administration records, patient flow sheets, the computer-based laboratory and report systems, and a database of adverse drug events. Bowel movements were used to assess effectiveness. The primary endpoint was the length of time metoclopramide was continued after the first bowel movement. A secondary endpoint was the occurrence of any adverse effects related to metoclopramide administration. Results: There were a total of 32 patients who received metoclopramide for ileus during the time period studied. The average number of days people received metoclopramide was 11.5 ± 7.3 days. The mean time to first bowel movement was 1.7 ± 1.4 days. Patients had therapy continued after first bowel movement for an average of 10.7 ± 7.1 days. Extrapyramidal symptoms possibly occurred in 3% of the patients. Conclusion: The results suggest that metoclopramide was used for the treatment of ileus in ICU patients for prolonged periods of time. This overuse may place patients at risk for adverse events and may also occur at other institutions.

This study sought to identify the medication class most commonly prescribed for stress ulcer prophylaxis (SUP), assess trends in SUP utilization, and report the use of acid suppressive therapy stratified by bleeding risk.