JOPHON NCPD (2024 Jul/Aug) Improving 1-Deamino-8-D Arginine Vasopressin (DDAVP) Challenges in Pediatric/Young Adult Patients with Bleeding Disorders: A Quality Improvement Study-JOPHON NCPD (2024 Jul/Aug) Improving 1-Deamino-8-D Arginine Vasopressin (DDAVP) Challenges in Pediatric/Young Adult Patients with Bleeding Disorders: A Quality Improvement Study

JOPHON NCPD (2024 Jul/Aug) Improving 1-Deamino-8-D Arginine Vasopressin (DDAVP) Challenges in Pediatric/Young Adult Patients with Bleeding Disorders: A Quality Improvement Study

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Pdf Summary

This quality improvement (QI) study addressed frequent process errors during desmopressin (DDAVP) “challenge” testing in pediatric/young adult patients with inherited bleeding disorders, primarily von Willebrand disease (vWD). Because patient response to DDAVP varies, a standardized test dose (intranasal or IV) with correctly timed laboratory measurements is recommended before using DDAVP for surgery prophylaxis or bleeding treatment. At Nationwide Children’s Hospital, the hemostasis team found that DDAVP challenges were often compromised by laboratory-related errors, preventing reliable assessment of hemostatic response.<br /><br />Using a Plan-Do-Study-Act framework, the team aimed to reduce DDAVP challenge assessment errors from a 36% baseline to 0% by December 2021 and sustain improvements for one year. Baseline review (22 patients, median age 13 years; mostly type 1 vWD) showed errors were not due to medication dosing but to laboratory workflow issues: incorrect timing of post-DDAVP blood draws, incomplete lab panels, mislabeled/mis-sequenced results when orders were released all at once, and missed 3–4 hour samples.<br /><br />Root causes were identified via multidisciplinary analysis (e.g., label printing practices, non-sequential lab order release, variability in infusion nursing staff familiarity, lack of a clear guideline, and challenges obtaining the 4-hour sample). Interventions included: (1) a detailed clinical practice guideline for infusion/lab staff covering administration steps, monitoring, fluid restriction, and exact lab draw timing; (2) revised standardized order sets pairing DDAVP dosing with disorder-specific labs at baseline, 1 hour, and 4 hours; (3) staff education and proactive coordination by hemostasis nurses; and (4) patient/family education plus an option to complete the 4-hour draw at a closer outpatient lab.<br /><br />Post-intervention (14 patients), errors dropped to 0% and were sustained for one year (with one early error caught and corrected). The project reduced repeat challenges, improved reliability of DDAVP response assessment, and likely decreased cost and burden to families.

Keywords

quality improvement

desmopressin challenge

DDAVP testing

von Willebrand disease

pediatric bleeding disorders

laboratory timing errors

Plan-Do-Study-Act

standardized order sets

clinical practice guideline

hemostasis team coordination