(1224) Think Positive: Improving Interdisciplinary Intravenous Medication Titration Management

Introduction: In reviewing safe medication practices, gaps were identified with nursing titration of IV medication infusions and provider ordering processes. Consequences of these gaps include potential risk of practicing outside the standards of care and vulnerabilities in medication management. Historical methods of auditing, performance management, and education rounds were not effective in sustainable change to meet required quality standards. A literature review yielded the updated regulatory standards, but little evidence to direct efforts on sustainable change management surrounding this practice. The group aimed to determine if the use of positive reinforcement would impact the compliance to IV medication titration standards by the interdisciplinary team.

Methods: A collaborative approach involving Intensive Care Unit (ICU) leadership was developed based on gap assessment and available literature. Multidisciplinary education focused on ordering and titration processes using multiple modalities, including use of electronic health record test environment, discussions during rounds and meetings, and email correspondence. One-on-one engagement with providers, pharmacy, and nurses helped recognize gaps, celebrate successes, and improve ordering processes. Peer feedback method using positive reinforcement and self-discovery was created through audits, rounding, and a unit-based raffle with prizes. Data was collected at baseline and three points post-implementation.

Results: Utilizing this approach, titrating IV medications according to expected standards dramatically improved by 84%, and provider order accuracy improved by 90%. Follow up data shows the practice management change maintained at 180 days. During the 2022 Joint Commission survey, the unit met standards for IV medication titration. The findings of the evidence-based project recognized further practice and process opportunities for improvement.

Conclusions: This project validated that a multidisciplinary-focused practice change, positive reinforcement and engagement created a motivated staff response, eased implementation, promoted buy-in, and transcended a culture change. The design and application of this project complimented the utilization of positive feedback versus punitive approach and can be effective for various practice changes.