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General and Risk Management, Patient Safety (including: medication errors, quality control)
Protocol for the control and rationalisation of the use of albumin in Avellino
  1. G. Valentino,
  2. P.E. Di Blasi,
  3. S. Monaco,
  4. L. Giannelli
  1. 1A.O.S.G. Moscati, Farmacia, Avellino, Italy

Abstract

Background Albumin is an essential plasma protein for the regulation of the oncotic pressure. The huge divide between scientific theory and its clinical application has repeatedly limited the control and the effort to rationalise its use. In 2009, our hospital board established a private operational unit of control (N.O.C.), which aimed to regulate prescribing. The evaluation of the appropriateness of the use of albumin produced results that highlighted its inappropriate use. The initial analysis showed that 80% of the prescriptions were incorrect and 30% mentioned an incorrect ‘indication’.

Purpose To establish a pathway rationalising the use of albumin in order to spread awareness of the correct use of such a precious substance and reduce its inappropriate use.

Materials and methods The first part of our research evaluated the use of albumin to the extent where the authors could emphasise its inappropriateness. In the second stage of our research The authors analysed several scientific publications and, in collaboration with N.O.C.'s clinics and members, the authors developed a protocol to guide the correct use of albumin. Consequently, The authors also produced a system for requesting human albumin that helps the clinician in charge to choose more appropriate indications.

Results Since this new model has been introduced, the use of albumin has decreased and its off-label use has been sharply reduced. In 2009, about 80% of 4000 prescriptions contained errors. In particular, 30% of the total prescriptions were off-label for their indication, while 24% did not report for the values of albumin required for the calculation of the administered dose. However in 2010 only 10% of the requests had an off-label indication.

Conclusions The new model produced by the hospital board in Azienda Ospedaliera San Giuseppe Moscati, Avellino has successfully abolished the off-label use of albumin and rationalised its use.

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