Interdisciplinary Project Aimed at Reducing the Duration of Intravenous Nicardipine in Intracerebral Hemorrhage Patients (P3.101)

OBJECTIVE: To measure the impact of an interdisciplinary approach for reducing the duration of intravenous (IV) nicardipine in intracerebral hemorrhage (ICH) patients. BACKGROUND: IV nicardipine is effective for acute treatment of hypertension in the neurologic intensive care unit (ICU) for patients with ICH. As part of a quality improvement project, an interdisciplinary team of pharmacists and physicians developed guidelines, medication order sets, educational materials, and implemented criteria for early transition from IV nicardipine to oral antihypertensives. DESIGN/METHODS: From July 2011 to July 2012, patients with ICH who were administered IV nicardipine were reviewed and screened for eligibility. The control group was patients treated the year prior to these quality improvement measures. The duration of nicardipine treatment (median hours), estimated yearly cost, and length of ICU stay were measured. A total of 35 patients and 44 controls were studied. RESULTS: The median hours of IV nicardipine were substantially decreased from a baseline of 118 hours to 30 hours (P<0.001); total cost savings per year was $433,566 ($18,475 per patient); while the average ICU stay remained similar (8.4 days in the intervention versus 8.9 days, P<0.990). In a follow up study that occurred one year later involving a sample of 21 consecutive patients, the duration of IV nicardipine had increased to a median of 96 hours. CONCLUSIONS: A physician and pharmacist-led incentive project to initiate oral antihypertensive medications earlier was successful in reducing the duration of IV nicardipine in patients with ICH and led to substantial cost savings. A subsequent review following the incentive project showed an increase in time on IV nicardipine demonstrating the need for an ongoing interdisciplinary approach. Disclosure: Dr. Do has nothing to disclose. Dr. Petrovic has nothing to disclose. Dr. Azran has nothing to disclose. Dr. Crozier has nothing to disclose. Associate Editor: Annals of Neurology; Editor-In-Chief. Journal Watch Neurology; Editorial Capacity for Continuum,