.jpg "Michael Thuyns, BCCCP, BCPS, PharmD photo")
Michael Thuyns, BCCCP, BCPS, PharmD
Critical Care Clinical Pharmacy Specialist
Renown Regional Medical Center
Reno, NV
Disclosure information not submitted.
Title: Impact of a Clinical Practice Guideline on Albumin use in the Intensive Care Unit
Introduction: Albumin is a widely prescribed blood product derivative and colloid. Its desired effects include increased oncotic pressure and plasma volume expansion. Despite a strong physiologic rationale for use, there are limited data to suggest albumin administration improves clinical outcomes for many indications. The purpose of this study is to evaluate the percentage of albumin prescribed for an appropriate indication and to evaluate overall albumin use after creation of an institutional clinical practice guideline.
Methods: This retrospective chart review evaluated albumin utilization before and after implementation of a clinical practice guideline in adult critically ill patients. A thorough literature review was conducted and five approved indications were identified and used to create an albumin guideline. These indications were chosen due to having the strongest level of evidence to support improved clinical outcomes. These indications were spontaneous bacterial peritonitis, hepatorenal syndrome, paracentesis, plasmapheresis, and volume resuscitation post cardiac surgery. The administration of albumin for these indications was defined as appropriate use, while all other indications were defined as inappropriate use. Our electronic medical record system was updated to force providers to select an indication when ordering albumin. The historical comparator group evaluated patient data from July 2020 to October 2020, while the intervention group evaluated data from January 2021 to April 2021.
Results: During the four month time frame serving as a historical comparison, 591 administrations of albumin 5% or 25% occurred in our intensive care units (ICU). After implementation of our guideline, 164 administrations occurred in a four month period resulting in a 72% reduction in albumin administrations. In the historical comparator group, 17.8% of albumin orders were for approved indications compared to 66% of orders in the intervention group.
Conclusion: Implementing a clinical practice guideline for albumin use was effective at reducing overall albumin use in our ICUs. Furthermore, a higher percentage of albumin was ordered for indications in which there is stronger data to support improved clinical outcomes. Other institutions could adopt similar methodology to reduce unnecessary cost and improve quality.