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As propofol utilization increases, so do the safety risks of fast-acting anesthesia. Readily adaptable oversight procedures for propofol management by clinical pharmacists have led to the awarding of medication safety awards to two hospitals by the Delaware Valley Healthcare Council in Philadelphia (DVHC).
"[Propofol] is a fatty emulsion, and prolonged use can result in infection, high triglycerides, blood pressure drop, even pancreatitis and myocardial infarctions," said Van Hellerslia, Pharm.D., clinical coordinator in the department of pharmacy at Nazareth Hospital, Philadelphia, part of Mercy Health System and one of the award recipients. "The purpose of our program is to make certain there is sufficient follow-through, that use of propofol is limited to 48 hours," Hellerslia said.
"These kinds of results are related to the active participation by clinical pharmacists," said Hellerslia. "The whole point is having clinical pharmacists on the floors, knowing who is on propofol and for how long."
Implementing the new propofol monitoring policy came after "extensive discussions" last year among hospital pulmonologists, clinical R.Ph.s, and the chief medical officer. "Our decisions were predicated on evidence-based medicine," said Hellerslia, who led the effort to adopt the 48-hour policy. The hospital soon found that less sedation is associated with a decrease in the average number of ventilator days, which led to lower rates of ventilator-associated pneumonia and decreased length of stay in the critical care unit. After the policy was implemented, the average cost per propofol patient in the CCU fell by $3,640, with a potential annual savings of $728,000, said Hellerslia.
Improved procedures in the use of propofol at Main Line Health, part of the Jefferson Health System in Philadelphia, also resulted in cost savings and improved patient safety, leading that system to share the $5,000 DVHC 2006 medication safety award with Nazareth.
After review of existing literature, clinical pharmacists and medical personnel at Main Line developed and implemented a physician order form for the use of the drug, which became part of standard administration policy in January, said Richard Centafont, R.Ph., VP for pharmacy at Main Line Health. Use of the form has resulted in a reduction in the length and dosage of propofol infusion, he said, with a 39% drop in duration, a 22.5% reduction in dosing, and a 53% drop in cost per patient.
Propofol program has three key features
A policy of monitoring and controlling the use of propofol at Nazareth Hospital in Philadelphia has three key elements: