CP-090 Adequacy of omeprazole solution prescription for administration by nasogastric tube applying a continuous improvement system (deming cycle)

Background The preparation of omeprazole in solution decreases its effectiveness, but it is necessary for those patients who need it to be administered via a nasogastric tube. If it is the case that the choice of formulation is due to swallowing problems, it would be preferable to open the oral capsule and suspend it in water or acidic juice, rather than administering the solution, improving the effectiveness of omeprazole and avoiding the unpleasant taste of the solution. Deming Cycle, circle PDCA (plan do check act) or spiral of continuous improvement is a strategy to continuously improve quality that consists of four steps. It is widely used by quality management systems. Purpose To assess the results of implementing an action plan designed to improve the prescription of omeprazole solution for administration by nasogastric tube. The protocol was guided by the Deming Cycle. Material and methods The study included patients who had been prescribed omeprazole in solution during their stay in a tertiary hospital. The management units where those patients were admitted were: internal medicine, oncology, otorrhinolaryngology, general surgery, infectious diseases, neurology and mental health, digestive system and nephrology. Data were collected from September to December 2014 (situation analysis) and from February to May 2015 (check). In January 2015, an improvement plan was implemented, consisting of a weekly review of each omeprazole solution prescription by a pharmacist (plan and do). Patients were confirmed to be using a nasogastric tube, otherwise it was proposed to switch treatment to omeprazole capsules. Results In the first period, 6 (23.1%) of 32 prescriptions were inadequate as the patients were not using a nasogastric tube. After implementing the improvement plan, in the second period, 12 (15.79%) of 76 prescriptions were inadequate. The internal medicine unit was responsible for 50% of these inappropriate prescriptions in the first period, and for 58.3% in the second period. Conclusion Implementation of an improvement plan resulted in an increase in the quality of the omeprazole solution prescription. Despite this improvement, there was still a percentage of inadequate prescriptions, which means we must continue applying the Deming Cycle in order to improve over time. No conflict of interest.