Conference Year

2016

Hospital/Entity

Homestead Hospital

Category of Abstract

Evidence Based Practice

Presentation Title

Nitroglycerin Administration Trim Project

Abstract

Nitroglycerin Administration Trim Project

By Rosa Filomeno MSN, CMSRN and Larissa C. Vega BSN, RN, CMSRN, CPHQ

Description/Background

In the USA, angina affects 10.2 million people with Coronary Artery Disease (CAD) (Sansone, 2010). CAD is the leading cause of death with chest pain being its primary manifestation (Gallagher, 2010). Sublingual nitroglycerin (SLNTG) is the first line drug of choice most commonly prescribed for chest pain and or in combination with morphine and oxygen (Gallagher, 2010). Early recognition and management is essential to reduce patient’s mortality and improve patient’s outcome.

In 2014 the staff of MS5 (medical surgical 5) identified SLNTG was not available in the pyxis during some of the chest pain rapid response. Though no negative patient outcomes were reported; there did exist a potential risk. Staff surveys indicated 63% of the time SLNTG bottle was not in the electronic medication dispensing system (PYXIS) even though the system showed it was. SLNTG was being lost costing the unit money and delays in care as nurses would hunt from pyxis to pyxis or hiding places for nitroglycerin.

Goals:

1) To increase the availability of Nitroglycerin

2) To reduce the waste of nitroglycerin

Action

A T.R.I.M. (lean methodology) project was designed in collaboration with Pharmacy and Performance Improvement departments. By identifying barriers, streamlining dispensing process and bar-coding technology, SLNTG was dispensed only 3 pills at a time rather then a bottle.

Outcomes

SLNTG was available in the pyxis for every chest pain rapid response during the trial period. The unit was able to reduce loss of nitroglycerin and save money. Cost of administration went from $253.88 to $0.00 dollars lost (zero) over period of three months and 100% of the time SLNTG was available. Future plans include disseminating the process hospital wide and increasing our savings throughout.

References

Gallagher,R., Belshaw,J., Kirkness, A., Roach, K., Sadler, L., and Warrington, D., (2010). Sublingual nitroglycerin practices in patients with coronary artery disease in Australia, Journal of Cardiovascular Nursing, 25(6), 480-486 Retrieved from http://search.proquest.com/docview/195787921?accountid=458

Henrikson, C. A., Howell, E. E., Bush, D. E., Miles, J. S., & al, e. (2003). Chest pain relief by nitroglycerin does not predict active coronary artery disease. Annals of Internal Medicine, 139(12), 979-86. Retrieved from http://search.proquest.com/docview/222190051?accountid=458

Sansone,J., and Murphy, R,. E., (2010). Chronic stable angina: disease progression or status quo? Clinician Reviews, 20(3), 18-2. Retrieved from http://search.proquest.com/docview/195787921?accountid=458

Savill, P. (2010). Chest pain of recent onset requires prompt diagnosis. Practitioner, 254(1730), 19-22, 2. Retrieved from http://search.proquest.com/docview/1009906504?accountid=458

Steele, R., McNaughton, T., McConahy, M., & Lam, J. (2006). ADVANCES: Chest pain in emergency department patients: If the pain is relieved by nitroglycerin, is it more likely to be cardiac chest pain? CJEM : Journal of the Canadian Association of Emergency Physicians, 8(3), 164-9. Retrieved from http://search.proquest.com/docview/195787921?accountid=458

Thanavaro, J. (2015). Chest pain, fever, and an abnormal electrocardiogram. The Journal for Nurse Practitioners, 11(1), 146-148. doi:http://dx.doi.org/10.1016/j.nurpra.2014.10.022

Zane, R. D. (2005). Chest pain relief after nitroglycerin: Aid to diagnosis? Journal Watch.Emergency Medicine, doi:http://dx.doi.org/10.1056/EM200509140000007

Objective of Presentation

To increase the availability of Nitroglycerin and to reduce the waste of nitroglycerin

Summary of Presentation

A T.R.I.M. (lean methodology) project designed in collaboration with Pharmacy and Performance Improvement departments to reduce the waste of nitroglycerin sublingual, increase availability, and save money.

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Nitroglycerin Administration Trim Project

Nitroglycerin Administration Trim Project

By Rosa Filomeno MSN, CMSRN and Larissa C. Vega BSN, RN, CMSRN, CPHQ

Description/Background

In the USA, angina affects 10.2 million people with Coronary Artery Disease (CAD) (Sansone, 2010). CAD is the leading cause of death with chest pain being its primary manifestation (Gallagher, 2010). Sublingual nitroglycerin (SLNTG) is the first line drug of choice most commonly prescribed for chest pain and or in combination with morphine and oxygen (Gallagher, 2010). Early recognition and management is essential to reduce patient’s mortality and improve patient’s outcome.

In 2014 the staff of MS5 (medical surgical 5) identified SLNTG was not available in the pyxis during some of the chest pain rapid response. Though no negative patient outcomes were reported; there did exist a potential risk. Staff surveys indicated 63% of the time SLNTG bottle was not in the electronic medication dispensing system (PYXIS) even though the system showed it was. SLNTG was being lost costing the unit money and delays in care as nurses would hunt from pyxis to pyxis or hiding places for nitroglycerin.

Goals:

1) To increase the availability of Nitroglycerin

2) To reduce the waste of nitroglycerin

Action

A T.R.I.M. (lean methodology) project was designed in collaboration with Pharmacy and Performance Improvement departments. By identifying barriers, streamlining dispensing process and bar-coding technology, SLNTG was dispensed only 3 pills at a time rather then a bottle.

Outcomes

SLNTG was available in the pyxis for every chest pain rapid response during the trial period. The unit was able to reduce loss of nitroglycerin and save money. Cost of administration went from $253.88 to $0.00 dollars lost (zero) over period of three months and 100% of the time SLNTG was available. Future plans include disseminating the process hospital wide and increasing our savings throughout.

References

Gallagher,R., Belshaw,J., Kirkness, A., Roach, K., Sadler, L., and Warrington, D., (2010). Sublingual nitroglycerin practices in patients with coronary artery disease in Australia, Journal of Cardiovascular Nursing, 25(6), 480-486 Retrieved from http://search.proquest.com/docview/195787921?accountid=458

Henrikson, C. A., Howell, E. E., Bush, D. E., Miles, J. S., & al, e. (2003). Chest pain relief by nitroglycerin does not predict active coronary artery disease. Annals of Internal Medicine, 139(12), 979-86. Retrieved from http://search.proquest.com/docview/222190051?accountid=458

Sansone,J., and Murphy, R,. E., (2010). Chronic stable angina: disease progression or status quo? Clinician Reviews, 20(3), 18-2. Retrieved from http://search.proquest.com/docview/195787921?accountid=458

Savill, P. (2010). Chest pain of recent onset requires prompt diagnosis. Practitioner, 254(1730), 19-22, 2. Retrieved from http://search.proquest.com/docview/1009906504?accountid=458

Steele, R., McNaughton, T., McConahy, M., & Lam, J. (2006). ADVANCES: Chest pain in emergency department patients: If the pain is relieved by nitroglycerin, is it more likely to be cardiac chest pain? CJEM : Journal of the Canadian Association of Emergency Physicians, 8(3), 164-9. Retrieved from http://search.proquest.com/docview/195787921?accountid=458

Thanavaro, J. (2015). Chest pain, fever, and an abnormal electrocardiogram. The Journal for Nurse Practitioners, 11(1), 146-148. doi:http://dx.doi.org/10.1016/j.nurpra.2014.10.022

Zane, R. D. (2005). Chest pain relief after nitroglycerin: Aid to diagnosis? Journal Watch.Emergency Medicine, doi:http://dx.doi.org/10.1056/EM200509140000007