Implementation of continuous infusion of blood coagulation factors at an academic medical center

Abstract

A multidisciplinary initiative to promote more cost-effective use of blood factor derivatives and increase pharmacist involvement in associated order verification, dispensing, and monitoring activities is described. After an evaluation of a hospital's procedures for the use of blood factor derivatives identified inconsistencies and opportunities for cost savings, a revised medication-use process promoting continuous infusion of selected products (factors VIII, IX, and VIII/von Willebrand factor) was developed by pharmacy staff with input from physicians and nurse educators. The implementation of the enhanced medication-use procedures included (1) the publication of a compendium of key information on commonly used blood factors, including specific guidance on dosing and administration, (2) the use of Web-based educational modules targeting pharmacists and nurses, (3) greater involvement by pharmacists in blood factor order justification and verification, (4) routine pharmacist assessment of pertinent laboratory values and other determinants of optimal dosing, and (5) refined procedures for changing i.v. tubing. Surveys of pharmacists conducted before and after the practice changes indicated a significant increase in their knowledge of blood factor products and evidence-based best practices for the management of hemophilia. Through a multidisciplinary initiative involving pharmacists, physicians, and nurses, new procedures to promote continuous infusion of selected blood factor products were implemented. Results of a postimplementation survey indicated that educational tools were effective in increasing pharmacists' knowledge of blood factor derivatives and hemophilia management.