Abstract
Intrathecal drug delivery systems (IDDS) have been a valuable therapeutic modality in the treatment of intractable chronic pain, typically reserved for cases where conservative pain management has failed. Given the high risk of this treatment and infrequent encounters with IDDS, it is essential to develop an institutional process to ensure the safe and effective management of patients. Our multidisciplinary team utilized healthcare failure mode and effects analysis (HFMEA™) to identify risks and redundancies in our current processes, subsequently implementing changes to prevent them. Risks identified included: handwritten orders, no standard order set, manual drug calculations, poor identification of IDDS upon hospital admission, and scarce nursing documentation of intrathecal medication. Following this step, our team incorporated tools and technologies to manage the more complex IDDS patients: standard order sets, computerized physician order entry (CPOE) systems, and computerized clinical decision support (CCDS) systems. Also, an excel calculator was introduced—seemingly the first of its kind in clinical practice—thus making the process more unique, thorough, and safe. There is a large body of evidence supporting the use of computerized physician order entry systems (CPOE) to reduce medication errors, and providing access to a computerized clinical decision support system (CDDS) at the time of prescribing to improve outcomes in patient care. Incorporating these tools into the management of IDDS patients is a significant opportunity to reduce risks and improve patient outcomes.
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