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One Hospital’s Successful ADE Harm Reduction Strategies

Wednesday, December 6, 2017

Pomona Valley Hospital has improved ADE harm through specific strategies targeting each category of drug-related harm. For example, opioid harm reduction was achieved, in part, through setting maximum daily dose limits and single dose checking in the pharmacy system based on patient age. Below are the strategies used by Pomona Valley Hospital to achieve low ADE rates.

Anticoagulation ADE

To reduce anticoagulation ADEs, Pomona Valley Hospital uses the following strategies:

  • Pharmacy monitoring of daily INR/aPTT
  • Pharmacist-driven protocol and verification of warfarin orders
  • Warfarin and Lovenox alerts in the EHR for companion lab orders of INR or platelets

Hypoglycemica ADE

Pomona Valley Hospital’s reduction in hypoglycemic events resulted from efforts to reduce variations in practice via use of standardized procedures and order sets for patient care. These efforts included:

  • Re-implementing the meal tray bundle (glucose check, meal tray, and insulin delivery within 30 minutes).
  • Tracking hypoglycemia by time of day and providing a bedtime snack to avoid early morning hypoglycemia.
  • Responding to previous hypoglycemic events to avoid future events.
  • Continuing to educate staff about rechecking events within 30 minutes and reviewing causes of hypoglcyemia. 

Opioid ADE

Pomona Valley Hospital’s strategies to reduce opioid drug-related harm included:

  • Using the pharmacy electronic system’s opioid max dose per day and single dose checking for geriatric, adult, pediatric, and neonatal populations. 
  • Implementing end tidal CO2 monitoring.
  • Monitoring anesthesia care in procedural areas.
  • Implementing a multidisciplinary review, approach, and communication strategy to opioid management.