Laboratory test result monitoring is a critical step in assuring the safe and effective provision of home IV antibiotics. While BHI&RS has always performed this function, it was felt that there may be room for improvement with regard to adherence. BHI&RS launched a process improvement project which confirmed that there were opportunities for improvement. Opportunities for improvement were validated when BHI&RS chartered a workgroup to review, assess and redesign the workflow.
Baystate Home Infusion & Respiratory Services
- Working as a multidisciplinary team, the pharmacy manager, medical director, staff pharmacists, and several nurses developed a plan to improve compliance.
- In the initial phase, the pharmacy manager worked with the medical director to update our list of antibiotics and corresponding laboratory tests.
- Standards for obtaining lab orders at the start of therapy, which lab tests to monitor, and how to follow-up on clinically significant values were decided on, endorsed by the medical director, and implemented. They are included in the document “Plan for Clinical Monitoring of IV Antibiotic Therapy.”
- Results of lab tests are monitored at predetermined time targets and the results are documented in the medical record.
- When a clinically significant result is noted, the pharmacist reports the result to the prescriber in a timely manner with recommendations, and then documents the result of that interaction in the medical record.
- Any changes in recommendations, as well as the monitoring standard or follow-up action, are reviewed with the pharmacists and nurses to ensure understanding.
- If the prescriber does not agree with the recommended lab tests, they are referred to the medical director.
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