International Journal of Anesthesia and Clinical Medicine

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Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems

Received: Feb. 21, 2020    Accepted: Mar. 13, 2020    Published: Mar. 31, 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.

DOI 10.11648/j.ijacm.20200801.15
Published in International Journal of Anesthesia and Clinical Medicine ( Volume 8, Issue 1, June 2020 )
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), 2024. Published by Science Publishing Group

Keywords

Intrathecal, Pain Management, Quality Improvement, HFMEA

References
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[8] Lee HM, Ruggo V, Graudins A. Intrathecal Clonidine Pump Failure Causing Acute Withdrawal Syndrome with “Stress-Induced” Cardiomyopathy. J Med Toxicol. 2016 Mar; 12 (1): 134-8. doi: 10.1007/s13181-015-0505-9.
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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://download.sciencepg.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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    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.
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Author Information
  • Department of Pharmacy, University of Chicago Medicine, Chicago, United States

  • Department of Pharmacy, University of Chicago Medicine, Chicago, United States

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

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

  • Section