Sibi Parayil, CCRN, RN, AGACNP
Nurse Practitioner
Veterans Affairs Maryland Health Care System - Baltimore Division
Baltimore, MD
Disclosure information not submitted.
Kimberly von Nordeck, PharmD, BCPS
Clinical Pharmacist
VA Maryland Health Care System, United States
Disclosure information not submitted.
Sara Toscano, CCRN
Clinical Applications Specialist
VA Maryland Health Care System, United States
Disclosure information not submitted.
John Brown, MD
Director, Clinical Informatics
VA Maryland Health Care System, United States
Disclosure information not submitted.
Tina McClendon, MHA, MSN
SICU Nurse Manager
VA Maryland Health Care System, United States
Disclosure information not submitted.
Kendra Jones, RN
SICU RN
VA Maryland Health Care System, United States
Disclosure information not submitted.
Karla Burgess
MAS
VA Maryland Health Care System, United States
Disclosure information not submitted.
Eugene Koh, MD
Associate Professor, Orthopedics Surgery
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Tina Jacob, ACNP
SICU Nurse Practitioner
VA Maryland Health Care System, United States
Disclosure information not submitted.
Sridevi Praveen, ACNP
SICU Nurse Practitioner
VA Maryland Health Care System, United States
Disclosure information not submitted.
Kanan Fernandes, ACNP
SICU Nurse Practitioner
VA Maryland Health Care System, United States
Disclosure information not submitted.
Sylvia Ayers, ACNP
Nurse Practitioner
VA Maryland Health Care System, United States
Disclosure information not submitted.
Nora Cheung, MD
Assistant Professor, Surgery
R. Adams Cowley Shock Trauma Center, United States
Disclosure information not submitted.
Kathleen To, MD, FACS,FCCM
Assistant Professor of Surgery
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center
Baltimore, Maryland, United States
Disclosure information not submitted.
Title: Virtual ICU Admission: Harnessing the Electronic Medical Record System to Enhance Patient Safety
Introduction: In our facility, pharmacy regulations require patient admission prior to verification and dispensation of any ordered medications. If the medication is pulled by the nurse and dispensed prior to pharmacy verification, this is considered an override. High override practices pose a patient safety concern for potential medication errors and drug diversion. The goal of the Virtual Surgical Intensive Care Unit (VSICU) pilot project was to expedite pharmacy processing and thus timely delivery of pain medications to patients coming directly to the ICU from the Operating Room (OR).
Methods: Between July 1 to Dec 31, 2020, we piloted the VSICU protocol at a community medical center for all patients scheduled for Orthospine Surgery and with expected postop admission to the SICU. On the day of surgery, the ICU clerk electronically admitted each patient to the VSICU environment. Rudimentary postop VSICU medication orders were placed by the SICU team. Pharmacy was able to verify and release these orders while the patient was still physically in the OR, enabling the ICU nurse to pull medications immediately upon patient arrival to the unit. Postoperatively, the patient status was updated to the regular ICU electronic environment for the remainder of ICU admission orders for postop care. As part of the VSICU project, a retrospective analysis of Orthospine patients charts admitted in from Oct 1 to Dec 31, 2019 was conducted to compare medication override practices prior implementing the VSICU pilot.
Results: During the period of our pilot protocol, 63 patients underwent Orthospine surgeries requiring admission to the SICU postoperatively. The SICU Omnicell reported 68 critical overrides in 3,129 transactions (2.17%) from Oct-Dec 2019; of the 26 Orthospine patients in that quarter, 8 patients required narcotic overrides (31%). By comparison, after implementation of the pilot, only 8 of 63 Orthospine patients (13%) required narcotic overrides, and 6 of the 8 were during the first two months of the VSICU implementation (p value < 0.05).
Conclusions: The creation of a virtual admission process allowed time for the pharmacy to verify and release medication orders, improved the timely administration of postoperative pain meds, and led to fewer medication overrides overall.