SHM Converge Scientific Abstract ePoster Gallery-Missed Doses or Missed Opportunities: Evaluation of Implementing Standardized Medication Administration Times for Inpatients Receiving Hemodialysis

Missed Doses or Missed Opportunities: Evaluation of Implementing Standardized Medication Administration Times for Inpatients Receiving Hemodialysis

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This retrospective quality improvement study evaluated whether a pharmacist-driven process for standardizing medication administration times could reduce missed or delayed doses in hospitalized patients receiving intermittent hemodialysis. The intervention was implemented between the pre-period (July–September 2019) and post-period (July–September 2021) at Eskenazi Health.<br /><br />The intervention included standardized administration times based on dialyzability, workflow changes to flag active hemodialysis orders for daily renal review, pharmacist documentation templates, and pharmacist education on optimal timing and antihypertensive management.<br /><br />Patients were included if they were inpatients who received hemodialysis at least once and received at least one medication from four groups: antihypertensives, antiepileptics, anticoagulants, or antimicrobials.<br /><br />Results showed improvement in timing of medications overall. Combined missed and delayed doses decreased significantly from 17.9% pre-implementation to 9.3% post-implementation. Delayed doses also declined significantly for all medications combined (from 5.2% to 4.1%) and for antihypertensives in particular (from 16.5% to 4.5%). Missed doses trended lower but were not statistically significant overall.<br /><br />For clinical outcomes, fewer patients receiving antihypertensives required intervention for hypotension after implementation (38% to 10%), while hypertension events increased (13.4% to 32.5%). For antimicrobials, incorrect scheduling around dialysis decreased significantly (5.5% to 0.9%), indicating better alignment with dialysis timing. No seizure or clotting events occurred in either group.<br /><br />Overall, the standardized, pharmacist-driven medication timing process improved administration reliability and antimicrobial scheduling, with mixed effects on blood pressure-related outcomes.

Asset Subtitle

Christie Davis

Meta Tag

Author List Abbie Blunier, Christie Davis, Christopher Geik, Jessica Whitten, Karishma Deodhar, Megan Cheatham

Category Research

Concept Standardized Medication Administration Times

Concept Hemodialysis

Concept Medication Time

Concept Pharmacist Intervention

Concept Missed Dose

Distinguished Non-Finalist

Presenter Organization Eskenazi Health

Presenting Author Christie Davis

Track Quality Improvement

Keywords

pharmacist-driven process

medication administration times

hemodialysis

missed doses

delayed doses

retrospective quality improvement

antihypertensives

antimicrobials

dialysis timing

hospitalized patients

Standardized Medication Administration Times

Hemodialysis

Medication Time

Pharmacist Intervention

Missed Dose