Quality in Intravenous Medication Titration Orders for Enhanced Patient Safety in the Intensive Care Unit

In the Intensive Care Units (ICUs) of a hospital in the Western United States, the need for standardized guidance for Registered Nurses (RNs) to titrate IV medications (propofol, fentanyl, vasopressin) was identified as an important issue to support patient safety. Unclear orders and inadequate documentation place RNs in potential legal and ethical dilemmas and pose risks to patient safety. Methods: This project employed the Plan-Do-Study-Act cycle to address the deficiencies in medication titration processes. A multidisciplinary team reviewed existing policies and protocols, developed standardized titration instructions, integrated them into the electronic health record system, and provided education to ICU staff. Monthly chart audits were conducted to evaluate compliance with the new protocols. Results: The review identified several areas for improvement in current practices, leading to the development of standardized titration instructions for fentanyl, propofol, and vasopressin. Implementation efforts improved clarity and compliance, although challenges were encountered in workflow integration and staff adaptation. Monthly chart audits showed gradual improvement in compliance rates over time. Conclusions: This project has significantly improved medication titration processes in the ICU, enhancing patient safety and care quality. Standardized titration instructions provide clear guidance to healthcare staff, with plans to extend this approach to other titratable medications. Continued monitoring and refinement of implementation strategies are essential to sustain these improvements and benefit patients and the healthcare system.