Time savings of weekly versus three-times-per-week administration of erythropoiesis stimulating agents in United States dialysis patients.

OBJECTIVE: Previous research suggests that erythropoiesis stimulating agent (ESA) administration in dialysis is a time-consuming task and switching to less frequently dosed ESAs may offer operational efficiencies. Our objective was to describe and measure the time spent on tasks in the ESA administration process in US dialysis centers, and to estimate potential efficiency gains of using weekly (QW) administration vs three-times-per-week (TIW) administration. METHODS: We conducted a time and motion study of staff time required to prepare, administer and document ESA doses. Dialysis centers using intravenous administration of TIW epoetin alfa (EPO) or QW darbepoetin alfa (DPO) were selected in pairs (one EPO, one DPO) from the same organization to help control for differences in ESA protocols and staffing patterns across organizations. ESA-related tasks were timed by trained observers. Time savings of TIW vs QW administration were estimated. Staff were interviewed about alternate activities that could be accomplished if time were saved in the ESA process. RESULTS: A total of 200 administrations were observed (81 DPO, 119 EPO). A mean of 2.26 (95% CI: 2.1-2.5) minutes per dose were required for ESA administration. ESA process time per administration did not vary significantly between EPO and DPO (p = 0.83). Estimated potential monthly staff time savings for an average facility of 70 patients totaled 23 hours, due to fewer ESA administrations using QW DPO. Patient education and fulfillment of care plans were identified as opportunities for improved care processes that could be implemented if staff time was freed up from the ESA process. LIMITATIONS: Results should not be generalized to other countries, ESAs and/or dosing frequencies. CONCLUSIONS: Switching from TIW EPO to QW DPO can result in time savings due to fewer administrations and provide opportunities to redirect nurse time towards activities aimed at improving patient care.

The VHA New England Medication Error Prevention Initiative as a model for long-term improvement collaboratives.

BACKGROUND: Quality improvement collaboratives (QICs) are a widely applied strategy for implementing change in health care organizations. Alternative collaborative methodologies were compared to gain insight into the elements important for QIC success. METHODS: A modified version of a previously described QIC evaluation tool was used to assess the methods and characteristics of the Medication Error Prevention Initiative (MEPI) and to compare MEPI with two other long-term ongoing QICs--the Vermont-Oxford Network's Neonatal Intensive Care QIC and the Northern New England Cardiovascular Disease Study Group, and the shorter-term Breakthrough Series QICs of the Institute for Healthcare Improvement (IHI). RESULTS: The modified QIC assessment tool was a useful framework for QIC assessment and comparison. The MEPI differed in scope of topic, team members, and the method for learning about and making improvements. CONCLUSIONS: Long-term QIC methods such as those used by MEPI may be particularly applicable when QICs address broad, complex, comprehensive, or organizationwide improvement needs.

Proper dose, preparation, and storage of botulinum neurotoxin serotype A.

PURPOSE: The proper dose, preparation, and storage of the formulation of botulinum neurotoxin serotype A (botulinum toxin type A) that is available in the United States (Botox) are described. SUMMARY: The recommended dose of botulinum toxin type A varies widely from 1.25 Units to 100 Units, depending on the site. Small initial doses are used for patients without previous treatment with botulinum toxin. Repeat injections often are required, and subsequent doses should be individualized based on response. Larger repeat doses often are used when the response to initial doses is insufficient. An antitoxin is available in the event of accidental poisoning. Botulinum toxin type A is reconstituted with preservative-free 0.9% sodium chloride. Therefore, it should be stored in a refrigerator and discarded if more than four hours elapse after reconstitution. CONCLUSION: The safe and effective use of botulinum toxin type A requires the proper dose, preparation, and storage by trained personnel only.

Considerations in darbepoetin alfa cost and reimbursement: a model for pharmacy managers.

With health care administrators focusing on the financial aspects of patient care, pharmacy budget managers must be able to evaluate all financial implications of drugs under formulary review. Clinical considerations, dosing equivalency, direct and indirect costs, payer mix, and reimbursement level are issues that should be considered by a multidisciplinary team. A pharmacoeconomic evaluation of darbepoetin alfa compared with epoetin alfa is presented as a model to help pharmacy budget managers address these issues and develop an evaluation of two high-cost drugs to determine which would be the better agent to have on their formulary.

Billing for inpatient hospital care.

Pharmacy personnel billing patients for services rendered is discussed. Billing for services is a critical function for maintaining the financial viability of health care institutions. Poor understanding of the system can lead to incorrect documentation, which can result in a claim rejection. The UB-92 provides hospitals with the proper format to request reimbursement for services provided. To ensure proper reimbursement, appropriate coding of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for diagnosis, procedures, and services provided is necessary. Ancillary services, such as pharmacy, play a crucial role in the completion of the bill by ensuring that the charge-master accurately represents the service provided. This information includes identification, charge, cost, and revenue codes. Hospital billing agents must also account for any outpatient visits that may have occurred within three days of admission, since these charges may need to be included on the hospital bill. In order for the billing process to be effective, it is important that all personnel have a thorough understanding of the billing process and be able to effectively communicate with each other.