1. Effect of education on ADD-Vantage IV delivery system
activation rates in a community teaching hospital
1Eric Ly, 1Scott Mirgeler, 1Deo Mopera, 1Adam Odeh, 2Eric Bergstrom PharmD
1University of Arizona College of Pharmacy, 2Tucson Medical Center
Results
• Brainstorming the problems and possible solutions to the ADD-
Vantage inactivation rates at TMC yielded two interventions:
Additional education to nursing units on proper ADD-Vantage
activation, and a new Zosyn PYXIS alert prompting the individual
removing Zosyn from the PYXIS machine to allow ample time for
reconstitution.
• Intervention involved educating pharmacy liaisons regarding the
proper use of ADD-Vantage products. This resulted in the 30
pharmacy liaisons being educated, who then passed on the education
to 465 nurses among all respective hospital units.
• Data collected after the intervention to the nursing staff yielded a total
of 296 data points. Of those, 293 were successful activations and 3
were unsuccessful.
• Statistical analysis of the pre-intervention data with the post-
intervention data with the Chi-Square test yielded a statistically
significant difference between the pre and post-intervention results
(P< 0.001).
Results Continued
Implications
• The results of this project are important to assess if patients are
adequately receiving therapy when an ADD-Vantage product is
used and whether or not the ADD-Vantage drug delivery system
is safe and effective.
• A more complete assessment that all nurses have received
education on proper activation of the ADD-Vantage product.
• Continuing periodic ADD-Vantage education may have to be
implemented to ensure the absence or consistently low rates of
inactivations.
• Other products may have to be assessed as replacements for the
ADD-Vantage system.
• Investigate the patients’ indication for ADD-Vantage products, to
assess the various disease states that are not being effectively treated
when the ADD-Vantage system is not activated properly.
• Verify if continued education is statistically significant in keeping
ADD-Vantage inactivation rates relatively low.
• Assess the waste involved in ADD-Vantage inactivations.
• Measure the length of hospital stay of patients receiving the same
ADD-Vantage products for the same indication, comparing samples of
patients who received activated products against a sample of patients
who received inactivated products.
• Investigate alternate IV drug delivery systems, and assess their
appropriateness at TMC compared to ADD-Vantage.
Conclusions
• Obtaining a sufficient number of samples from underrepresented units
due to them not utilizing ADD-Vantage products as often as other units.
• Our convenience sampling method limited us from more consistent or
periodic data collection.
• The vast number of nurses to educate and ensuring they received it.
• The results may have been influenced by the Hawthorne effect, behavior
changing as a result of ADD-Vantage failure rates being monitored.
Future Projects
References
• Betz ML, Traw B, Bostrom J. The cost-effectiveness of two intravenous
additive systems. Appl Nurs Res. 1994 May; 7(2):59-66.
• D’Agata EM, Dupont-Rouzeyrol M, Ruan S et al. The impact of different
antibiotic regimens on the emergence of antimicrobial-resistant bacteria. PLoS
ONE. 2008; 3(12):e4038.
• DeRon MS, Craig SA, Parks NP. Monitoring system to verify activation of
ADD-Vantage system doses. Am J Hosp Pharm. 1989 Apr; 46 (4): 702.
• McLain M, Palese I. Activation rates of the ADD-Vantage medication delivery
system in a community teaching hospital. 2013 Apr.
Objective
Introduction
• ADD-Vantage is a user assembled IV drug delivery system.
• What the problem is: McLain and Palese (student study) performed a
study at Tucson Medical Center (TMC), a community hospital, that
found that the failure rate of activation of ADD-Vantage products was
6.92%. This correlates to roughly 1 out of 15 ADD-Vantage products
not being fully activated during the administration portion of the drug
delivery process leading to partial doses or no medication being given.
• Why it is important: A study by Betz et al. showed that ADD-Vantage
is cost-effective, so it is important to ensure that the ADD-Vantage
system is used correctly to ensure positive patient outcomes and
prevent product waste. Another study by D’Agata et al. showed that
interruption of antibiotic therapy promotes the survival of resistant
bacterial strains.
• What others have done about it: DeRon et al. performed a study that
involved education programs about the ADD-Vantage for pharmacy
and nursing staff. Results showed a <1% rate of improper activation.
Limitations
Methods
• Planned and conducted a meeting with TMC nursing staff to identify
problems and solutions with the ADD-Vantage drug delivery system.
• Helped create a new PYXIS alert, prompting proper use of the ADD-
Vantage activation methods for piperacillin/tazobactam (Zosyn).
• Planned and conducted 5 educational ADD-Vantage activating
technique meetings with TMC pharmacists ("train the trainer") to
provide the education to nurses on their respective nursing units.
• Acquired the appropriate training and credentials at TMC in order to
navigate EPIC, run ADD-Vantage reports, and access TMC patient
rooms for data collection.
• All group members were trained by the preceptor on how to collect
data consistently, ensuring a standardized method.
• Convenience sampling was used to collect data. Collection was done
by going into patients' rooms given ADD-Vantage medications, and
physically examining the hanging product for successful activations
or failures.
• Analyzed the collected data with the chi-square statistical test to
determine whether or not the interventions were significant in
decreasing ADD-Vantage inactivation rates, alpha level set at 0.05.
For more information please contact:
Dr. Terri Warholak: warholak@pharmacy.arizona.edu
Eric Ly: ericly@pharmacy.arizona.edu
Deo Mopera: dmopera@pharmacy.arizona.edu
Scott Mirgeler: mirgeler@pharmacy.arizona.edu
Adam Odeh: odeh@pharmacy.arizona.edu
Dr. Eric Bergstrom: eric.bergstrom@tmcaz.com
• After examining the data, the team has come to the conclusion that our
intervention with the nursing staff resulted in a statistically significant
reduction in improper administrations of ADD-Vantage products.
• It remains to be seen whether or not the results of the intervention will
have a lasting impact on the reduction of ADD-Vantage inactivation
rates.
• To identify the problems and possible solutions for the ADD-Vantage
inactivation rates at TMC.
• To implement an intervention at TMC which will help reduce the rates
of ADD-Vantage inactivations.
• To collect data after interventions were made.
• To statistically analyze the data to determine if the interventions were
statistically significant in decreasing the rate of ADD-Vantage
inactivations at the TMC.
Figure 1. Pre-data refers to data collected prior to the intervention. Post-data
refers to data collected after the intervention. A success was defined as the
inner plug completely disconnected and no drug powder remaining in the vial.
A failure was defined as the inner plug not disconnected and/or any drug
powder remaining in the vial. Post data revealed a statistically significant
change in the rate of failure compared to pre-data, 1.01% versus 6.92%
respectively (P<0.001).
Image 1. Examples of two ADD-Vantage activation failures
in which the inner plugs were not completely disconnected.
Image 2. Informational handout provided as part of the intervention.
0
50
100
150
200
250
300
Post-data successes Post-data failures
293
3 (1.01%)
NumberofProductsSampled
0
50
100
150
200
250
300
350
Pre-data successes Pre-data failures
323
24 (6.92%)
NumberofProductsSampled
Activation Successes and Failures Pre- and Post-Intervention