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Changeovers of vasoactive drug infusion pumps: impact of a quality improvement program

机译：血管活性药物输注泵的更换：质量改进计划的影响

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BackgroundHemodynamic 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.Materials and methodsWe 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.ResultsWe 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.ConclusionThe 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.
机译：背景技术血管活性输液泵（CVIP）更换后的血流动力学不稳定是重症监护病房中的常见问题。几种经验方法可用于实现CVIP。我们假设这些程序的变化会产生一定的发病率。我们试图评估作为质量改进计划的实践标准化对CVIP引起的事件的影响。材料和方法我们进行了一项前瞻性的干预前后研究，包括所有诊断为心血管衰竭的成年患者连续输注血管活性药物或正性肌力药物。在基线预实施阶段（阶段1）之后，在我们的重症监护室（阶段2）中使用两个注射器驱动器实施了CVIP的标准化“快速更改方法”。在这两个3个月的阶段中均记录了终点（事件的发生率和分布：收缩压> 20 mmHg或心率> 20次/分钟和心律不齐的变化）结果我们总共研究了913例CVIP事件（阶段1,435）事件;来自2位患者的2期478事件）。不同阶段的患者特征无明显差异，大多数患者患有败血性休克。与第一阶段（17.8％，n = 78）相比，第二阶段（5.9％，n = 28）的事件发生频率显着降低（P <0.0001）。无论使用哪种儿茶酚胺，都可以观察到这种效果。超过98％的事件为血压变化，两个阶段的事件性质分布相似。结论本研究表明CVIP后不良事件很常见，并说明了质量改善计划对提高患者安全性的积极影响与目前的护理过程有关。

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