Better Pairing Propofol Volume With Procedural Needs: A Propofol Waste Reduction Quality Improvement Project

Abstract

BACKGROUND AND OBJECTIVES: Propofol facilitates deep sedation without requiring intubation and is often used by infusion to maintain sedation. Variability in ordering and preparation strategies resulted in significant propofol volumes wasted at the conclusion of procedures in our clinic. With drug shortages now common, we designed a quality improvement initiative to reduce our propofol waste. METHODS: Data collection during the preintervention phase reflected current practice trends. Two propofol dosing tables ($50 or ,50 kg) were designed to estimate the volume of propofol infusion required for sedations spanning 15 to 180 minutes. Nurses prepared propofol infusions as directed by these tables. The primary outcome measure was reduction in waste when the infusion was prepared by standardized strategy versus usual practice. Balancing measures included occurrences of insufficient infusion volume and premature awakenings from deep sedation. Waste volumes were plotted and displayed chronologically in statistical process control charts for the clinic and individual providers. RESULTS: A total of 155 patients received a propofol infusion to maintain deep sedation. The preintervention phase included 77 patients, and the intervention phase included 78 patients. Special cause variation was achieved in the intervention phase. Median (interquartile range) propofol waste volume per procedure declined from 45.6 mL (24.3-71 mL) to 14.3 mL (9.6-19.4 mL), representing a 68% waste reduction. CONCLUSIONS: Using an internally derived systematic approach to ordering and preparing a propofol infusion, we reduced variability, reduced propofol waste, and created cost savings for our organization. This approach is tailorable to other infusions and clinical settings.

The Role of Electronic Medical Records in Reducing Unwarranted Clinical Variation in Acute Health Care: Systematic Review

“…Almost all the studies were based on the implementation of an intervention (new or refined) into a clinical setting (35/36, 97%) with 1 qualitative analysis of EMRs by clinicians [36]. Most studies were quality or process improvement based (28/36, 78%) [33][34][35]37,[39][40][41][42][43][44][45][47][48][49]51,52,54,55,58,59,[61][62][63][64][65][66][67] [33][34][35][36][39][40][41][42][43][46][47][48]50,52,54,58,60,62,63,65,66,70]. Many papers addressed the minimization or elim...…”

“…Most studies were quality or process improvement based (28/36, 78%) [33][34][35]37,[39][40][41][42][43][44][45][47][48][49]51,52,54,55,58,59,[61][62][63][64][65][66][67] [33][34][35][36][39][40][41][42][43][46][47][48]50,52,54,58,60,62,63,65,66,70]. Many papers addressed the minimization or elimination of a particular drug prescription/use (17/36, 47%) [39,40,…”

“…Regarding overall disposition, most studies reported positive results (30/36, 83%) [33][34][35][37][38][39][40][41][42][43][45][46][47][48][49][50][51][52][53][54][58][59][60][62][63][64][65][66][67]70], while a minority reported mixed [44,55,56] or negative results [36,57,61] (3/36, 8% each). That is, the authors concluded in most studies that the EMR was used successfully as part of an initiative to address clinical variation.…”

The Natural Order of Time: The Power of Statistical Process Control in Quality Improvement Reporting

“…By providing multiple data points over time, the reader and the team can see that there was perhaps something nonrandom happening in the system before the time of the actual intervention. Notice the multiple consecutive data points below the mean line in Fig 2 of Kicker et al' s 1 article. This pattern is an example of special cause variation and indicates a change in the system before the main intervention, which the authors discuss in the results.…”

“…Kicker et al 1 should be commended for their use of SPC to report their team' s propofol waste reduction QI initiative. Readers can learn from the interventions they incorporated to reduce waste and improve value, but we should also not miss the opportunity to learn from the methods of analyzing and reporting their data.…”