ABSTRACT
Background: Tech-Check-Tech (TCT) allows a pharmacy technician to perform the final check of medications prepared by another technician. The effect of a TCT program on the time required to process medications in a hospital pharmacy has not been previously reported. Objective: To evaluate the effect of implementing a TCT program on the time required to prepare, check, and deliver medications to automated medication supply systems (AMSS) located throughout an academic medical center. Methods: The primary outcome was the difference in mean total time required to process AMSS medications between pre- and post-implementation periods. Forty-five days pre-TCT implementation was compared to 45 days post implementation. To assess the effect of the TCT program on pharmacist-time allocation, median times required to verify stat and routine medication orders in the computerized physician order entry (CPOE) system were analyzed. Results: Mean total time spent processing AMSS medications was 24.16 ± 2.98 hours and 16.79 ± 2.65 hours for the pre- and post-TCT implementation periods, respectively (difference of 7.37 hours; 95% CI, 6.19-8.55 hours; p < 0.0001). Median verification times for stat medication orders were 5 (interquartile range [IQR], 2-12) minutes before and 4 (IQR, 2-9) minutes after TCT implementation (p < 0.0001). For routine orders, median verification times were 12 (IQR, 4-30) minutes before and 7 (IQR, 3-18) minutes after implementation (p < 0.0001). Conclusions: The total time required to process AMSS medications was significantly reduced after a TCT program was implemented in an academic medical center. Pharmacist medication order verification times were also significantly reduced.
ABSTRACT
BACKGROUND: The use of intravenous bicarbonate in diabetic ketoacidosis (DKA) may be considered for patients with a pH less than 6.9 according to the American Diabetes Association. The impact of this therapy on resolution of acidosis in patients with DKA is unclear. OBJECTIVE: To determine whether the use of intravenous bicarbonate therapy was associated with improved outcomes in patients with severe DKA who were seen in the emergency department. METHODS: This review was conducted from 2007 to 2011 in the emergency department of a tertiary teaching hospital. Adults diagnosed with DKA with an initial pH less than 7.0 were included. Patients were stratified into 2 groups based on receipt of intravenous bicarbonate. The primary study outcome was time to resolution of acidosis, defined as return to pH greater than 7.2. Secondary outcomes included length of stay; continuous infusion insulin use; and intravenous fluid, po tas si um, and insulin requirements within the first 24 hours of hospital admission, beginning upon admittance to the emergency department. We also conducted a subgroup analysis of patients with an initial pH less than 6.9. RESULTS: There was no significant difference in time to resolution of acidosis (8 hours vs 8 hours; p = 0.7) or time to hospital discharge (68 hours vs 61 hours; p = 0.3) between patients who received intravenous bicarbonate (n = 44) compared with those who did not (n = 42). The median dose of intravenous bicarbonate was 100 mEq (100-150) for patients who received intravenous bicarbonate. Insulin and fluid requirements in the first 24 hours were significantly higher in patients who received intravenous bicarbonate compared with those who did not (100 units vs 86 units; p = 0.04 and 7.6 L vs 7.2 L; p = 0.01, respectively). There was no significant difference in hours of continuous insulin infusion (27 hours vs 26 hours; p = 0.09) or potassium requirements in the first 24 hours of hospital stay (135 mEq vs 120 mEq; p = 0.84). CONCLUSIONS: Intravenous bicarbonate therapy did not decrease time to resolution of acidosis or time to hospital discharge for patients with DKA with an initial pH less than 7.0.