1665: Standardization of Titratable Medication Practices Across a Large Healthcare System

Introduction: Titration of continuous infusions is a skill for which ICU Clinicians are trained and experienced. Regulatory findings related to titrating drips are a widespread challenge. Requirements for titrating medication orders can be difficult to execute at the bedside, especially with unstable patients and multimodal therapies. Leaders are responsible for structuring orders and policies to facilitate safe titration practices. This project took a comprehensive, multidisciplinary approach to improve titration of continuous Sedation, Analgesia, Vasoactive, & Cardiovascular medications across the continuum spanning ordering, policy, implementation, education, & monitoring in a large health system. Methods: Nursing, Pharmacy, Provider, Informatics, and Regulatory leadership from across a large organization came together to address the challenges of titration. A Titrating Medication policy was created in tandem with changes to titrating medication orders like range orders. Education was crafted by educational design and nursing professional development specialists. System and site leaders were engaged to support implementation. More than 3,250 nurses completed education, 1755 from critical care, 1156 ED, and 348 others. Approximately 100 Pharmacy leaders across the organization participated in a regulatory boot camp which included a focus on titration. Mechanisms for providing feedback have been circulated widely. Electronic audit tools were created for post-implementation monitoring. Results: There were 11 High-limited, High-pattern, or moderate pattern titration-based regulatory findings from triennial surveys across the health system the year and a half prior to go-live, including: documentation gaps, range and titration orders not followed, no target goals, and titrating meds off without order. Policy and orders went into effect with no adverse events reported and positive feedback from bedside clinicians. Since go-live, two sites have had triennial surveys with only one minor titration-based finding (pain documentation). Conclusions: Titration practices can be optimized through partnership and collaboration among disciplines even across a large healthcare system. Safe practices empower nurses through thoughtful orders and supportive policies that promote the highest regulatory and safety standards.