Protocol Development and Quality Improvement

Answer: D

Financial justification for a critical care pharmacist has

been shown by the impact of clinical pharmacists on

critically ill patients. The critical care pharmacist can

reduce adverse events in the critically ill population,

reduce order prescribing errors, optimize the correct

drug for the correct disease process, decrease the LOS,

reduce medication administration errors, and reduce

inappropriate antibiotic use. One of the main financial

impacts on critically ill patients is antimicrobial

therapy. Using an anticoagulation reversal stewardship

program will most affect the institution (Answer

D is correct). Developing protocols is important in

streamlining practice in the critically ill population and

can reduce health care costs, and prescribing errors and

medication administration errors can result in adverse

events to the patient, but none of these would have the

most significant effect on finances (Answers A, B, and

C are incorrect).

Practice environment constraints include financial

disincentives (not enough staff to support delirium

screening), organizational constraints (screening

process takes up valuable nursing time), perception

of liability (if the screen is conducted and the test is

positive, the provider will be blamed), and patient

expectations (Answer B is correct). Another barrier

to implementing delirium screening includes the key

stakeholders’ standard or routine work of the process,

which is based on opinion, not evidence (Answer A

is incorrect). A third barrier involves the professional

context and includes clinical uncertainty. Practitioners

may believe they have adequate skills to act. In addition,

information overload occurs with the vast amount of

literature being published. An example of a knowledge

barrier includes providers being unfamiliar with how

to perform delirium screening (Answer C is incorrect).

A fourth barrier is when the key stakeholders’ opinion

does not agree with screening patients for delirium

because of changes in evidence-based medicine and

possible knowledge gaps (Answer D is incorrect).

Answer: A

Evaluating the use of pharmacotherapy in SUP in the

ICU is best suited for an MUE (Answer A is correct).

The goal of an MUE is to ensure optimal medication

therapy management and improve patient safety and

outcomes for drug-related processes—in this case,

pharmacotherapy in SUP. Although one component of

an MUE is PI, a review of the quality should occur

before determining whether a PI project is necessary

(Answer B is incorrect). An interventional MUE

incorporates a review of quality in the form of making

a pharmacotherapeutic intervention—PI. Although

reviewing ADE data and medication error data from

the ICU is helpful in detecting and determining

problems associated with the use of pharmacotherapy

in SUP, these are isolated events and are reporter-

dependent, and a lack of reports does not ensure that

the use of pharmacotherapy in SUP is appropriate

(Answers C and D are incorrect). Only an MUE is a

robust and comprehensive method of evaluating the

use of pharmacotherapy in SUP.

Answer: B

Evaluating the management of warfarin-induced

hypoprothrombinemia is best suited for an MUE. The

goal of an MUE is to ensure optimal medication therapy

management and improve patient safety and outcomes

for drug-related processes; an MUE is drug-, drug

class–, or disease-specific—in this case, management

of warfarin-induced hypoprothrombinemia (Answer

B is correct). Quality assurance is a process for

monitoring the effectiveness and safety of the

medication use process that includes prescribing,

dispensing, and administering medications. Evaluating

pharmacist verification times for routine orders in the

ICU, drug interaction warnings on the CPOE system,

and duplicate warnings on the CPOE system is not

necessarily drug- or disease state–specific and is best

suited for a QA review (Answers A, C, and D are

incorrect).

Answer: A

The next best step is determining which patients with

cardiac arrest should receive targeted temperature

management. (Answer A is correct). Best practices

have already been identified, so additional literature

evaluation is not needed. (Answer B is incorrect).

Finally, data will be collected on the current process of

managing targeted temperature management (Answer

D is incorrect), which will be evaluated to determine

the areas for improvement in the outcome desired.

The current process has already been determined, as

provided in the question (Answer C is incorrect).