Improving Care and Outcomes for Patients Receiving Titratable Vasopressors Medications: A Quality Improvement Project




Shenoy, Preeni

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The Surviving Sepsis Campaign guidelines (Dellinger, 2013) recommend that vasopressors be used to stabilize hypotensive patients unresponsive to volume resuscitation. Vasopressors are an integral part of hemodynamic management for patients with sepsis and septic shock. These medications are managed by nurses who initiate and increase infusion rates until patients are hemodynamically stable, then “wean” medications once therapeutic targets can be maintained. Vasopressors save lives but can also cause lethal complications, particularly when underdosed or overdosed. Therefore, it is critical that titration order instructions are clear and accurate so that weaning delays, practice variability, and medication errors are mitigated. The Joint Commission has set evidence-based safety standards on the use of vasopressors. Clear administration orders and accurate documentation are centerpieces of these guidelines. In the critical care unit at a community hospital in Texas, review of vasopressor use data revealed that a high percentage of patients remained on vasopressors after therapeutic endpoints had been met. A root cause analysis was conducted to identify reasons for weaning delays. Based on results, a quality improvement project was developed aimed at improving consistency in vasopressor titration practices and appropriate discontinuation. Interventions included creation of a Joint Commission compliant smart phrase addition to current computerized order sets clarifying vasopressor administration instructions, and an educational refresh for nurses on vasopressors management best practices. A Likert-scale tool was used to survey nurses on their confidence in managing vasopressors. The project results indicated improved timely vasopressor weaning and a statistically significant improvement with a p value of 0.00 in nursing self-confidence with vasopressor management.



Vasopressors titration, Critical care nurse's self-efficacy, Weaning vasopressors, Electronic titration order sets, Titration of norepinephrine, Nurse's confidence, Vasopressors titration, Electronic instructions order sets