Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention
Background Intravenous albumin has limited indications supported by randomised controlled trials, yet it is often prescribed for indications not supported by evidence.Aim To reduce unnecessary transfusion of albumin.Interventions Under the leadership of a multidisciplinary quality improvement team,...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-04-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/13/2/e002534.full |
| _version_ | 1797205866086137856 |
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| author | Kerstin de Wit Andrew Stevens Jeannie Callum Liying Zhang Genevieve Digby Stephanie Sibley Samuel A Silver John McGugan Corey M Forster Shannon Halls Sabrina Allarakhia Dimpy Modi Wiley Chung Kendra Derry Jennifer Flemming Heather Mackulin Steven Montague Angela Sirosky-Yanyk |
| author_facet | Kerstin de Wit Andrew Stevens Jeannie Callum Liying Zhang Genevieve Digby Stephanie Sibley Samuel A Silver John McGugan Corey M Forster Shannon Halls Sabrina Allarakhia Dimpy Modi Wiley Chung Kendra Derry Jennifer Flemming Heather Mackulin Steven Montague Angela Sirosky-Yanyk |
| author_sort | Kerstin de Wit |
| collection | DOAJ |
| description | Background Intravenous albumin has limited indications supported by randomised controlled trials, yet it is often prescribed for indications not supported by evidence.Aim To reduce unnecessary transfusion of albumin.Interventions Under the leadership of a multidisciplinary quality improvement team, evidence-based recommendations were disseminated in tandem with a new electronic order set, an educational strategy, qualitative interviews with prescribers and a return policy change to reduce wastage.Implementation and evaluation Interventions were introduced in a staggered fashion. The primary outcome, appropriate use of albumin, was monitored and quantified using pre-intervention and post-intervention audits. Process measures included statistical process run charts of monthly usage of 5% and 25% albumin and wastage. Data on length of stay (hospital and intensive care), new inpatient starts on kidney replacement and mortality were collected as balancing measures.Results Appropriate albumin usage based on indication increased from 30% to 50% (p<0.0001). There was significantly less overall albumin usage in the post-intervention period compared with the pre-intervention period (negative coefficient, p<0.0001), driven by a major reduction in the utilisation of the 5% formulation (p<0.0001). Overall albumin usage was significantly lower in the post-intervention period, decreasing from 800 to 450 vials per month. The intervention resulted in significantly less wastage (negative coefficient, p=0.017). Mortality, length of stay and new starts on kidney replacement therapy remained constant throughout the study period.Conclusion Improved prescribing of albumin was achieved with a multifaceted approach. Substantial and sustained reductions in usage were achieved without negatively impacting patient-important outcomes. The estimated annual savings for the purchase cost of albumin was CAN $300 000. We provide a structured process for other organisations to optimise their use of albumin. |
| first_indexed | 2024-04-24T08:57:55Z |
| format | Article |
| id | doaj.art-b87d52d5d3ab4281a2f6a4717f07a6ea |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-04-24T08:57:55Z |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-b87d52d5d3ab4281a2f6a4717f07a6ea2024-04-16T05:05:09ZengBMJ Publishing GroupBMJ Open Quality2399-66412024-04-0113210.1136/bmjoq-2023-002534Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted interventionKerstin de Wit0Andrew Stevens1Jeannie Callum2Liying Zhang3Genevieve Digby4Stephanie Sibley5Samuel A Silver6John McGugan7Corey M Forster8Shannon Halls9Sabrina Allarakhia10Dimpy Modi11Wiley Chung12Kendra Derry13Jennifer Flemming14Heather Mackulin15Steven Montague16Angela Sirosky-Yanyk17Emergency Department, Hamilton General Hospital, Hamilton, Ontario, CanadaDepartment of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TTDepartment of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, CanadaSunnybrook Research Institute, Toronto, Ontario, Canada1Kingston Health Science Centre and Queen’s University, CanadaDepartment of Critical Care Medicine, Queen’s University, Kingston, Ontario, Canadaresearch fellowDepartment of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, CanadaFaculty of Medicine, Queen’s University, Kingston, Ontario, CanadaUniversity of Toronto, Toronto, Ontario, CanadaQueen’s University, Kingston, Ontario, CanadaDepartment of Medicine, Hamilton, Stockholm, Ontario, SwedenSurgery, Queen`s University, Kingston, Ontario, CanadaDepartment of Anesthesiology, Unity Health Toronto, Toronto, Ontario, CanadaDepartment of Medicine, Queen’s University, Kingston, Ontario, CanadaNursing, Kingston Health Sciences Centre, Kingston, Ontario, CanadaDepartment of Medicine, Kingston Health Sciences Centre, Kingston, Ontario, CanadaTransfusion Medicine, Kingston Health Sciences Centre, Kingston, Ontario, CanadaBackground Intravenous albumin has limited indications supported by randomised controlled trials, yet it is often prescribed for indications not supported by evidence.Aim To reduce unnecessary transfusion of albumin.Interventions Under the leadership of a multidisciplinary quality improvement team, evidence-based recommendations were disseminated in tandem with a new electronic order set, an educational strategy, qualitative interviews with prescribers and a return policy change to reduce wastage.Implementation and evaluation Interventions were introduced in a staggered fashion. The primary outcome, appropriate use of albumin, was monitored and quantified using pre-intervention and post-intervention audits. Process measures included statistical process run charts of monthly usage of 5% and 25% albumin and wastage. Data on length of stay (hospital and intensive care), new inpatient starts on kidney replacement and mortality were collected as balancing measures.Results Appropriate albumin usage based on indication increased from 30% to 50% (p<0.0001). There was significantly less overall albumin usage in the post-intervention period compared with the pre-intervention period (negative coefficient, p<0.0001), driven by a major reduction in the utilisation of the 5% formulation (p<0.0001). Overall albumin usage was significantly lower in the post-intervention period, decreasing from 800 to 450 vials per month. The intervention resulted in significantly less wastage (negative coefficient, p=0.017). Mortality, length of stay and new starts on kidney replacement therapy remained constant throughout the study period.Conclusion Improved prescribing of albumin was achieved with a multifaceted approach. Substantial and sustained reductions in usage were achieved without negatively impacting patient-important outcomes. The estimated annual savings for the purchase cost of albumin was CAN $300 000. We provide a structured process for other organisations to optimise their use of albumin.https://bmjopenquality.bmj.com/content/13/2/e002534.full |
| spellingShingle | Kerstin de Wit Andrew Stevens Jeannie Callum Liying Zhang Genevieve Digby Stephanie Sibley Samuel A Silver John McGugan Corey M Forster Shannon Halls Sabrina Allarakhia Dimpy Modi Wiley Chung Kendra Derry Jennifer Flemming Heather Mackulin Steven Montague Angela Sirosky-Yanyk Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention BMJ Open Quality |
| title | Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention |
| title_full | Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention |
| title_fullStr | Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention |
| title_full_unstemmed | Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention |
| title_short | Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention |
| title_sort | improving appropriate use of intravenous albumin results of a single centre audit and multifaceted intervention |
| url | https://bmjopenquality.bmj.com/content/13/2/e002534.full |
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