Pennsylvania Hospital Creates Beta Blocker Program With AHRQ Report
AHRQ's Evidence Report No. 43, Making Health Care Safer: A Critical Analysis of Patient Safety Practices, is the basis for a new program at Saint Vincent Health Center in Erie, Pennsylvania, that incorporates the post-operative use of beta-blockers for select high-risk cardiac patients. After a successful four-month pilot program, staff members are expanding the program to the entire hospital.
Saint Vincent distributed 50 copies of Chapter 25, AHRQ's summary of the use of peri- and post-operative beta-blockers, half to anesthesia providers and half to surgeons and nursing leaders. After the information was distributed, there was "increased awareness of research that beta-blockers should have a definite improvement in patient outcomes," says Steve Osborn, VP, Clinical Quality and Patient Safety at Saint Vincent.
"The program was initially piloted by the anesthesia providers. Originally, they were trying for a coordinated program in which there would be agreement with surgeons for which patients should have the drug both peri-operatively and post-operatively. Eventually, they moved to simply giving the peri-op dose to all candidates who met the criteria, [leaving] it up to the surgeon whether he/she would continue post-op," explains Osborn.
"Next we piloted the program in two post-op nursing units. The problem had been that beta-blockers were not allowed to be administered in an IV route outside of critical care/telemetry units. Most routine post-op patients are not in these critical care units, nor is it even good for routine post-op patients to be on these units. So, we had to convince the nursing leadership to allow 'regular' staff nurses to administer IV beta-blockers (after being trained by a PharmD)," continues Osborn.
An order set was created which specified regular vital sign monitoring, allowing for safe administration of the beta-blocker by these post-op floor nurses. The order set was reviewed and approved by division chiefs in cardiology, family practice, and internal medicine.
"During the pilot, which lasted about four months, there were no critical issues with the beta-blocker use (e.g., hypotension, bradycardia, etc.)," says Osborn.
After analyzing the pilot's results, the use of IV beta-blockers was extended to all nursing units. Subsequently, the focus has been to roll the program out hospital-wide. The use of beta-blockers has been discussed at the full department of surgery and department of medicine meetings, in an article in the physicians' newsletter, and via a grand rounds held exclusively on this topic. Hospital management sent letters to certain surgeons, encouraging them to attend the grand rounds.
While Saint Vincent has not actively monitored beta-blocker use, due to lack of resources, they do review all post-op complications. Any post-op cardiac events will be reviewed to see if a beta-blocker was prescribed appropriately.
Established in 1875, Saint Vincent Health Center is a not-for-profit, 450-bed tertiary care facility. More than 300 staff physicians provide care in 35 medical and surgical specialties and subspecialties.
Making Health Care Safer: A Critical Analysis of Patient Safety Practices: Summary. July 2001. AHRQ Publication No. 01-E057. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/ptsafety/summary.htm.