Infusion Pumps: a structured approach to drug library optimizations3.amazonaws.com/rdcms-aami/files/production/public/File... · 2018-06-19 · DERS Compliance – May/June 2015 25

Infusion Pumps: a structured approach to drug library optimizationDennis M. Killian, Pharm.D., Ph.D.Pharmacy DirectorPeninsula Regional Medical Center

Associate ProfessorUMES School of Pharmacy

AAMI FoundationVision: Healthcare technology promotes positive patient and healthcare provider outcomes and causes no harm

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A Special Thanks

Thank You to Our Premiere Industry PartnersWithout the generous support of our industry partners, we would not be able to produce the many tools and deliverables created by the coalition to help you improve infusion therapy safety. The AAMI Foundation is managing all costs for the series. The seminar does not contain commercial content. PlatinumDiamond Gold

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Infusion Pumps: a structured approach to drug library optimization

Dennis M. Killian, Pharm.D., Ph.D.

Pharmacy Director

Peninsula Regional Medical Center

Associate Professor

UMES School of Pharmacy

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Disclosure

• The views and opinions presented are entirely my own. They do not necessarily reflect the views of Peninsula Regional Medical Center or the University of Maryland Eastern Shore School of Pharmacy.

• I have served as a speaker on behalf of Baxter Healthcare in regards to IV infusion devices and how to achieve a high level of drug library compliance.

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Learning Objectives

• Define Dose Error Reduction System (DERS) and identify key components of this vital smart pump safety software.

• Explain the purpose of Continuous Quality Improvement (CQI) reports and how to leverage this data to optimize smart pump safety features and identify near misses.

• Discuss wireless connectivity for infusion pumps and best demonstrated practices for publishing drug library updates.

• Identify scenarios where Clinical Conditions (Modifiers) can be used to help promote safe IV medication delivery.

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• 3000+ employees; 350+ physicians 21,000 admissions• 289 acute care, 28 nursery beds 95,000 ED visits• 30 pharmacists; 50 pharmacy technicians

www.peninsula.org

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Peninsula Regional Medical CenterAutomation Overview

• EPIC Electronic Health Record• Baxter SIGMA Spectrum Infusion System• KitCheck: passive RFID tagging of medications• ICU Medical Diana® oncology dose system• Omnicell MedCarousel: inventory management• Pearson Medical high speed oral unit dose

packagers• Baxter EXACTAMIX 2400 Compounder and

REPEATER Pump• Baxter DoseEdge Pharmacy Workflow Manager• Omnicell AcuDose, Anes-Rx, NarcStation• McKesson Horizon Platform: BCMA, CPOE

20162015

2012

2008

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• Intelligence, is essentially the medication or Drug Library and all the associated safety features with this software.

• We need to use the Drug Library as much as possible to help enhance infusion safety measures.

• Not using the Drug Library is comparable to the scarecrow not using his newfound intelligence.

What is the “Drug Library”?

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Infusion DevicesMarket Analysis

• KLAS– http://www.klasresearch.com/

– Feedback from healthcare professionals

– “Best in KLAS”

• ECRI– https://www.ecri.org/

– Evidence-based evaluations

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Infusion DevicePRMC Vendor Fair Scoring

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Infusion DevicePRMC Decision Matrix

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Infusion Pump Decision

• Which of the following can be used when deciding on an infusion device:

(select all that apply)

A. Decision Matrix

B. Market Intelligence (e.g., KLAS, ECRI)

C. Opinions from other facilities

D. Vendor Fair

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Infusion Pump Decision

• Which of the following is not a key driver for purchasing an infusion device?

A. Cost

B. Efficiency / Ease of Use

C. Safety Features

D. RTLS (Real-Time Location System) Integration

E. Wireless Integration

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Drug Library orDose Error Reduction System (DERS)

• Defaults to the drug library, not opt-in– Must opt-out of drug library, if needed– Helps to ensure a high level of drug library

compliance

• PRMC Drug Library Specifics:– Care Areas: 30

• ED, ICU, Cath Lab, Oncology etc.

– Medication Entries: 411• All Care Area entries are linked to a master medication listing

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• Lower Hard Limit

• Lower Soft Limit

• Default Starting Rate*

• Upper Soft Limit

• Upper Hard Limit

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Key Factors for Peninsula Regional

• Clinical Advisories• Default Volume to be

Infused*• Dose Rate/Change

(Titration) limits*• Default Bolus amount

and time*

*Peninsula Regional identifiedthese as key factors for safe IV medication delivery

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• Ability to default the starting rate and volume to be infused (VTBI) for end users

– Improved standardization

– Removes guessing

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21 21


22 22

Drug Library SetupLinking Entries

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Drug Library Setup Question

• When establishing drug library parameters for an intermittent IV antibiotic (e.g., ampicillin), which of the following is the least important from a patient safety standpoint:

A. Default starting rateB. Volume to be infused (VTBI)C. Upper soft limitD. Lower hard limitE. Upper hard limit

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Continuous Quality Improvement (CQI)

Immediately After Implementation

May 2015

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Continuous Quality ImprovementDERS Compliance – May/June 2015

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0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

EP L

abCa

th L

abN

ICU

Peds

ED

4 So

uth

CDU

ICU ED

4 W

est

2 W

est

2 Ea

stEn

do/O

RU/S

DS

5 Ea

st B

PCU

Ane

sthe

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ICU

5 W

est

5 La

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DE

PACU

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lysi

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5 Ea

st A

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olog

y

DERS Mode

% D

ERS

Com

plia

nce

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Continuous Quality ImprovementDERS Compliance – May/June 2015

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0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

EP L

abCa

th L

abN

ICU

Peds

ED

4 So

uth

CDU

ICU ED

4 W

est

2 W

est

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do/O

RU/S

DS

5 Ea

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PCU

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3 La

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ICU

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5 La

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5 Ea

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DERS Mode

% D

ERS

Com

plia

nce

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Continuous Quality ImprovementSoft Limit Alerts

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0

100

200

300

400

500

600

700

800

900

OPI ED 4 South ICU 3 West

# of

Sof

t Lim

its E

xcee

ded

Top 5 Care Areas Exceeding Soft Limits

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Continuous Quality ImprovementSoft Limit Alerts

28

0100200300400500600700800900

1000

# of

Sof

t Lim

it Ex

ceed

ed

Top 10 Medications Exceeding Soft Limits

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Continuous Quality ImprovementHard Limit Alerts

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0

10

20

30

40

50

60

ED 3 West OPI 5 South 2 West

# of

Har

d Li

mtis

Att

empt

edTop 5 Care Areas Attempting Hard Limits

(Excluding IV fluids)

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30

0

10

20

30

40

50

60

70

80

90

# of

Har

d Li

mtis

Att

empt

ed

Top 10 Medications Attempting Hard Limits

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0

10

20

30

40

50

60

70

80

90

# of

Har

d Li

mtis

Att

empt

ed

Top 10 Medications Attempting Hard Limits


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Continuous Quality ImprovementAlert Optimization

• Gemba and discuss with key stakeholders– Outpatient infusion area

– ED

– Anesthesia

– Cath/EP Lab

– Labor & Delivery

– Clinical nurse specialists

• Discussion: current practice vs recommended practice

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A Few Months After Implementation

June/July 2015

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Continuous Quality ImprovementDERS Compliance – Before and After

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Continuous Quality ImprovementSoft/Hard Alerts – Before and After

85.7

12.1

2.2

95.8

2.9 1.30

10

20

30

40

50

60

70

80

90

100

normal soft limit hard limit

Perc

enta

ge

before after

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Continuous Quality ImprovementSoft/Hard Alerts – Before and After

85.7

12.1

2.2

95.8

2.9 1.30

10

20

30

40

50

60

70

80

90

100

normal soft limit hard limit

Perc

enta

ge

before after

40% Reduction

75% Reduction

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Current State

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Continuous Quality ImprovementDERS Compliance – Our Recent Data

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Continuous Quality ImprovementDERS Compliance – Feb17

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Peds

2 Ea

stED

-Ped

s4

Sout

h2

Wes

tD

ialy

sis

PACU

5 So

uth

3 Ea

st O

ncol

ogy

3 W

est

ICU

5 W

est

5 Ea

stCT

ICU ED

Endo

/ORU

/SD

S5

Layf

ield

EP L

ab3

Layf

ield

4 W

est

Ane

sthe

sia

PCU

Cath

Lab

MO

BN

ICU

OPI

Radi

olog

yTr

aini

ng U

se O

nly

DER

S Co

mpl

ianc

e (%

)

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Continuous Quality ImprovementDERS Compliance – Feb17

75.4%

89.3% 92.7% 94.1% 94.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Peds 2 East ED-Peds 4 South 2 West

DER

S Co

mpl

ianc

e (%

)

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Hard/Soft AlertsFeb 2017

• Total program events– 17,474

• Soft alerts– 894 (5%)

• Reprogram: 11%

• Continue: 89%

• Hard alerts– 231 (1.3%)

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Continuous Quality Improvement

• Which of the following is not a positive benefit from interpreting CQI data:

A. Review drug library compliance

B. Obtain user satisfaction

C. Review soft limit overrides

D. Review hard limit attempts

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Infusion DeviceWireless Integration

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Labor Intensive

Extensive Scheduling

Time Demands

Different (outdated) Drug Libraries at the

Bedside

1. Forced to move to semi-annual updates instead of quarterly updates

2. Frustration amongst staff due to change in drug library from pump to pump

3. Higher possibility of patient safety risk

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• Wireless connectivity is more complex than simply connecting to “WiFi”

• Bi-directional wireless integration is the goal

– Drug library updates

• Data from a central hosted server to the pumps

– CQI data

• Data from pumps to a central hosted server

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• Medication library updates• Can initiate an update to the medication library in a few minutes

• Majority of pumps receive the update in less than 10 minutes

• No end user intervention required for the update to occur

• No pump “down time” required

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Server 726 Pumps

802.11

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Infusion DeviceRTLS Integration

• RTLS = real-time locating system

• PRMC uses the Stanley Aeroscout system

• Integration of Stanley w/Baxter Sigma occurred in early 2017

• Sigma has an integrated RTLS tag in its battery module

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Infusion DeviceRTLS Integration

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Clinical Conditions(Modifiers)

• Drug library build team

– Vendor, pharmacists, nurses, physicians

• Post-live = multi-disciplinary team

– P&T committee, CP&S

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PromptSelect Drug

Drug 1

Drug 2

Drug 3

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• Which of the following situations could benefit from the use of a clinical condition? (Select all that apply)

A. Vasopressin dosing for two different indicationsB. Propofol dosing for both bolus and infusionC. Multi-step infusion (e.g., IVIG)D. A medication that requires a 0.22-

micron filter

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Continuous Quality ImprovementDERS Compliance – Benchmarking

• Regenstrief Center for Healthcare Engineering– Catalyzecare.org– Purdue University

• Performs benchmarking for compliance data• Data analysis for alerts• Contact: Richard Zink ([email protected])

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Data from: Regenstrief Center for Healthcare Engineering,Infusion Pump Informatics

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Infusion Pumps & EMR Integration

• Peninsula Regional has migrated to the EPIC EMR in November 2016.

• Our plan is to integrate our infusion pumps with the new EMR system as part of optimization.

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Conclusions

• Implement a structured approach when deciding on an infusion device.

• Default starting rates, VTBI etc. whenever possible to improve standardization.

• Leverage CQI data in coordination with gemba to optimize DERS compliance and minimize unnecessary soft and hard limit alerts.

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Conclusions

• Leverage wireless connectivity to efficiently publish drug library updates with minimal disruption to end users.

• Use clinical conditions (modifiers) in key situations to improve IV medication safety and streamline user interaction with an IV infusion device.

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References

1. https://catalyzecare.org/remedi (accessed: 15-April-2017)

2. http://www.klasresearch.com/ (accessed: 15-April-2017)

3. http://www.ecri.org (accessed: 15-April-2017)

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Future/Ongoing Initiatives9/25/2013 65

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Thank You to Our Premiere Industry PartnersWithout the generous support of our industry partners, we would not be able to produce the many tools and deliverables created by the coalition to help you improve infusion therapy safety. The AAMI Foundation is managing all costs for the series. The seminar does not contain commercial content. PlatinumDiamond Gold

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Documents

Infusion Pumps: a structured approach to drug library optimizations3.amazonaws.com/rdcms-aami/files/production/public/File... · 2018-06-19 · DERS Compliance – May/June 2015 25