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Introduction: Each year the pharmacy enterprise reviews the top 25 inpatient medication expenditures to assess for optimization in medication use. In 2022 vasopressin, a vasopressor agent used in critically ill patients, was the #1 inpatient medication expenditure with a total cost of $2.7 million USD. A multi-pronged approach was developed to optimize the use of vasopressin in critically ill patients in a cost-efficient manner, that would not impact patient outcomes or the ability to prescribe vasopressin in clinical practice. Methods: This was a quality improvement initiative that compared vasopressin expenditure for inpatient use in the 2022 and 2023 calendar year at Henry Ford Health. A multidisciplinary intervention was developed that looked at optimizing purchasing, preparation, and dosing of vasopressin. The outcomes assessed in this quality improvement project included overall acquisition cost of vasopressin, vasopressin utilization, and prescribing practices. A three-faceted approach was taken that focused on 1. vasopressin product selection, 2. modifying the vasopressin dose used for sepsis based on published evidence, and 3. increasing the stability time for vasopressin based on recent stability data. Results: This initiative resulted in a decrease of vasopressin acquisition cost by $1.8 million dollars without impacting the prescribing practices of front-line clinicians between years (2022 vasopressin orders: 2241; 2023 vasopressin orders: 2242). A similar duration of vasopressin use per patient was documented. There was a 4.6% decrease in the number of bags batched between years (2022: 6381 vs 2023: 6098) lending to increased efficiency of product utilization. The use of the vasopressin 0.03 unit/minute (new dose approved) order represented < 1% of orders in 2022 and 45.1% of orders in 2023 (dose change made in Epic in July of 2023). Conclusions: The Plan-Do-Check-Act (PDCA) cycle was utilized for this initiative and resulted in a significant cost reduction in vasopressin cost without influencing clinical practice. Each step to optimize vasopressin applied this PDCA cycle and pro-actively engaged multidisciplinary team members prior to changes for both feedback and approval. Ideas generated were cut when they introduced safety concerns with marginal anticipated optimization.

Publication Date

3-12-2024

Publisher

Henry Ford Health

City

Detroit, Michigan

Comments

2024 Quality Expo Winner

Vasopressin is #1: Optimization of Vasopressin Use with a Multidisciplinary Health System Approach

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