Implementation of intravenous push antibiotics in response to a national fluid shortage

From the 2018 HVPAA National Conference
Norman Mang (Parkland Health and Hospital System), Jessica Ortwine (Parkland Health and Hospital System), Deepak Agrawal (University Texas Southwestern Medical Center), Wenjing Wei (Parkland Health and Hospital System), Anisha Ganguly (University Texas Southwestern Medical School), Kavita Bhavan (University)

Background

In the wake of Hurricane Maria, there was a nationwide shortage of infusion mini bags. To limit usage of infusion minibags, Parkland Memorial Hospital shifted outpatient IV antibiotic administration from infusion to “IV push” administration, in which more concentrated suspension is administered via a simple syringe in a single bolus.

Objectives

To safely administer IV antimicrobial treatment via IV push in an effort to limit usage of infusion mini bags during a national shortage of infusion bags.

Methods

Starting in November 2017, patients requiring long-term IV antimicrobial treatment were transitioned to receive antibiotics by IV push instead of infusion. Per the Parkland self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) protocol, patients were screened and trained to self-administer IV antibiotics at home prior to hospital discharge. These patients were followed in the Parkland OPAT clinic, where patients self-administering IV antibiotics are monitored for treatment efficacy, PICC line maintenance and adverse events.

Results

200 patients completed antimicrobial therapy with IV push method with 100% success rate and no reported complications. As a result using IV push rather than infusion, estimated following supplies were saved: 3,000 less IV fluid bags, 1000 IV tubing, and 50% fewer gloves and alcohol swabs, amounting to approximately $22,000 of cost savings for a patient going home on once a day antibiotic therapy. In addition, teaching time for the transitional care nursing team was reduced on average by 50% per patient with the new method. Preliminary patient satisfaction surveys indicate greater satisfaction with the new method due to decreased infusion time from 30 min via traditional drip approach to 3-5 minutes with the new IV push method.

Conclusion

Out of necessity, Parkland Memorial Hospital was able to implement IV push as a safe, cost-effective, and viable alternative to traditional IV antibiotic administration as infusion. Use of IV push antibiotics resulted in $22,000 of cost savings in this three-month interval and reduced utilization of a critical resource currently facing a nationwide shortage.

Implications for the Patient

IV push is a favorable alternative to administration via a pump or gravity due to time saving, cost reduction, and convenience. The results from our implementation of IV push suggest that expensive pumps and time-consuming gravity administration may not be necessary for safe, efficacious administration of IV antibiotics.

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