A mid-sized hospital's experience in indicator data collection

A hospital pharmacy department's experience in selection and use of indicators for measuring quality of care is described. At a 410-bed community teaching hospital, indicators were selected that would use data the department was already collecting. For the first indicator, "Patients on total parenteral nutrition (TPN) experiencing acid-base disorders," the goal was for no more than 20% of patients on TPN to have blood pH values outside the normal range, but 35% of patients were found to be outside the range. The standard TPN formula was examined and changed, after which only 16% of patients had pH values outside the normal range. For the second indicator, "Patients on TPN having negative nitrogen balance results," and the next two indicators, based on data available from the department's pharmacokinetics service, a similar process was followed. The department next examined incident reports and adverse drug reaction reports, categorized the drug-related problems represented, and established the indicator, "Patients on [nursing unit X] experiencing category 4 drug-related errors." Problems with indicator use included determining how an indicator relates to the quality of care and knowing how to analyze the data once they are collected. To maintain stature within their institutions by helping with the overall quality improvement effort, pharmacy departments need to expeditiously institute the use of indicators.