Upload
others
View
9
Download
0
Embed Size (px)
Citation preview
IV Interoperability:Smart Pump and BCMA Integration
Amanda Prusch, PharmD, BCPSMedication Safety Specialist
Tina Suess, RN, BSNSystem Administrator
October 5, 2010
Lancaster General Hospital Profile
640-bed acute care hospital serving as keystone of health system
Intelligent Infusion Device ProfileNumber of Devices = 846Number of Lines = 2632
Challenges of Manual Pump programming
• Manual input process
• User must opt in to safety features
• Complex workflow on limited real estate
• Limited drug library size
• Pump setting are influenced by user
• Disconnect between what occurs on the pump and medical record
• Process totally owned by the nurse
Demonstration of Manual Pump Programming
Manual Program
• Scan patient• Scan medication and complete required fields• Manually document in eMAR• Program pump:
• Select CCA• Select line• Press Drug List• Scroll to find medication• Press Standard Program• Select dosing units• Enter concentration (3 steps), weight, dose, VTBI• Press Start• Select Yes to confirm
Objectives of IV Interoperability Purpose: Improve medication safety through the integration of emerging technologies and decrease error potential in the medication administration process
Objectives:1. Demonstrate integration between the medication order and the IV pump setting
2. Decrease opportunities for error through automation
3. Assure drug library is utilized correctly
4. Reduce the number of times the pump is reprogrammed “edited”
5. Ascertain valuable, comprehensive IV medication administration data
6. Streamline workflow
7. Real-time, complete patient-specific documentation of the IV administration
Data Flow
Demonstration of IV Interoperability
Manual Program
• Scan patient• Scan medication and complete required fields
• Manually document in eMAR• Program pump:
• Select CCA• Select line• Press Drug List• Scroll to find medication• Press Standard Program• Select dosing units• Enter concentration (3
steps), weight, dose, VTBI• Press Start• Select Yes to confirm
IV Interoperability
• Select CCA• Scan patient• Scan medication and complete required fields
• Scan pump channel• Press Start• Select Yes to confirm• Press OK to document in eMAR
Streamlined Workflow… 17 Steps down to 7
Order crosses into BCMA; nurse verifies order against original
provider order
Nurse Confirms Infusion and
Starts IID
Pharmacist provides clinical assessment of IV order;
Profiles rate/dose into Rx IS
5 right checking occurs with a bar-
code scan of patient ID and IV medication.
Wireless upload of infusion parameters to IID occur;
electronically matching to drug library
Current Infusion data to MedNet Server and BPOC for eMAR documentation
System setting determines if the nurse is presented with the
interoperability pathway.Nurse scans channel bar-code through which the
drug will be infused
Required infusion parameters (dose/rate,
volume, duration, weight) are populated by the Rx IS
to the BCMA
Clinical workflow
Rx IS: pharmacy information system; IID: intelligent infusion device; BCMA : barcode medication adminstration
Smart Pump Warning within the EMAR
ValidationJuly 2008
• Time & Motion Study• Comparing interoperability to manual process
• 19 nurses participated• 12 different scenarios: performed both manually/IV interoperability
• Exercising all BCMA and IID functionality
• Observation = valuable insight • wrong rates entered• wrong drug entered• wrong weight entered• wrong volume entered
• 24.8% reduction in nursing time
Comparison: Manual versus IV Interoperability Challenges of Manual Pump
ProgrammingAdvantages of IV Interoperability
Manual input process Pump programming parameters (dose/rate, weight, volume to be infused) populated by order
User must opt into safety features Magically occurs; guarantees correct medication is selected
Complex workflow on limited real estate
Streamlined workflowNurse must focus on one IV taskPump alerts display on computer screen
Limited drug library size Can program rate and volume to be infused off the order for medications NOT in the drug library
Pump settings are influenced by the user
Standardization is introduced; pump is programmed according to order
Disconnect between what occurs on the pump and medical record
Pump settings are documented in the medical record
Process totally owned by the nurse Pump is populated with clinically appropriate, evidence-based, safe infusion rates as profiled by pharmacist
IV Interoperability…Multidisciplinary • Pharmacists
• Pre-intelligent infusion pumps: • Few pharmacists understood IV pumps or nursing IV administration at the bedside
• Introduction of intelligent infusion devices:• Concerns over pump “limits”, rate/dose, dosing units in the pump• Begin understanding basics surrounding IV pumps
• Still most continuous IV medications were processed using the standard default of “titrate”
• Limited their clinical assessment of the infusion rate / dose• Lent insufficient guidance/support for nursing
• Information Services• Wireless network
• Biomedical Engineering• Device maintenance• Pump bar-coding
Conclusion• IV Interoperability is …
• Cutting edge technology• Still evolving• Interdependent / multidisciplinary• Eliminating the human variables • The next step in IV medication safety
• Requires collaboration between pump vendors and EMAR/HIS solutions• Requires a “full court press” by all
• Barriers must be eliminated• Government regulations
• Balance between quality assurance and technology advancements• Intellectual properties