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.


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.

Publication Date


Presented At:

11th Annual BHSF Research Conference

Content Type


Baptist Health South Florida Affiliations:

Rosa Filomeno MSN, RN, CMSRN

Additional Authors:

Miguel Uribe, RN, CMSRN

Larissa Vega, BSN, RN, CMSRN, CPHQ

Aracely Olvera, MSN/ED, RN, CMSRN

Steven Trush, RN, CMSRN

Martha Gaitan, RN

Joyce Jones, BSN, RN, CMSRN

Open Access

Available to all.