To be integrated into Script - ihassociation.orgihassociation.org/wordpress/.../ICU-Feb-26-2015.docx · Web viewInstitutional RFID systems provide the ability to locate the patient

Intelligent Hospital™ ICU/NICU Script 2015PLEASE EMAIL [email protected] with any suggested changes

Table of ContentsTo be integrated into Script.........................................................................................................................3

ICU1 CBORD Make it Easy for Employees to Spend with You.................................................................3

ICU2 Emanate Wireless: RTLS tag reporting location and usage on a smart phone...............................3

ICU3 AiRISTA - Asset Tracking.................................................................................................................4

Scenario.......................................................................................................................................................5

ICU4 Staff Identification (TBD)...................................................................................................................5

ICU5 Network and Wireless Infrastructure (Extreme Networks)...............................................................5

ICU6 Medical Device Connectivity (Cardiopulmonary, Nuvon, Sunquest).................................................6

ICU7 Bedside Workstation / Tablet (Zebra)...............................................................................................6

ICU8 Hand Hygiene (Airista)......................................................................................................................6

ICU9 Bed/Nurse Call (Stryker / ASCOM)...................................................................................................7

ICU10 Alert Notification: (Vocera)..............................................................................................................7

ICU11 Nursecall Communication & Workflow (ASCOM)............................................................................7

ICU12 Physiological Monitoring (Draeger).................................................................................................8

ICU13 Alarm Distribution / Management (ASCOM)...................................................................................8

ICU14 Data Distribution..............................................................................................................................9

ICU15 Clinical Data View – EMR (Sunquest).............................................................................................9

ICU16 Centrally Monitor Ventilated Patients (Cardiopulmonary).............................................................9

ICU17 Connectivity (Cardiopulmonary)...................................................................................................10

ICU18 Decision Support (Sunquest)........................................................................................................10

ICU19 VOiP Communications (Vocera)....................................................................................................11

ICU20 RTLS Supply Management Automated Documentation (DeRoyal).................................................11

ICU21 Labs Sample Collection (Sunquest, Zebra, Swisslog)....................................................................12

ICU22 Eliminating Transfusion Errors & Increasing Efficiencies (Sunquest, Zebra)...................................12

ICU23 Alarm Management (Cardiopulmonary, Vocera)..........................................................................12

ICU24 Staff Duress (TBD, ASCOM)...........................................................................................................13

ICU25 Find Available Device (Ventilator) (Emanate Wireless).................................................................13

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mailto:[email protected]


ICU26 Staff Workflow: (ASCOM)..............................................................................................................14

ICU27 Mobile Med System-Remote Med Queuing App (Omnicell).........................................................14

ICU28 Advanced Infusion Pumps Medication Administration (Hospira).................................................14

ICU29 Remote Consultation (InTouch)....................................................................................................15

NICU..........................................................................................................................................................15

NICU1 Security – Access Control (HID Global)......................................................................................16

NICU2 Infant Security- (Stanley)...............................................................................................................16

NICU3 Incubator (Drager).........................................................................................................................16

NICU4 Medication Administration:...........................................................................................................17

NICU5 Infusion Systems: (Carefusion).....................................................................................................17

NICU6 Medication Cabinet: (Carefusion)...............................................................................................18

NICU7 Medication Delivery: (Carefusion)...............................................................................................18

NICU8 Find Available Infusion Pump: (Carefusion / Stanley).................................................................19

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Revised / Updated: Feb 13, 2014

To be integrated into Script

ICU1 CBORD Make it Easy for Employees to Spend with You

This employee is about to go on break and she is ready for a pick-me-up. [Employee looks at her watch] She only has 15 minutes, and knows the lines at the coffee kiosk downstairs will be long right about now. [Employee gets out phone while monitor shows screen shots progressing through quick online order] Instead of wasting time in line, she gets out her phone and places a quick online order, paying at the end with her Intelligent Hospital ID badge -- the same one you received when you entered the Pavilion today. [Employee holds up badge] She will now have time to run to the restroom and return a few phone calls before heading down to the coffee kiosk, where she will skip the line entirely and pick up her coffee and scone. Then it’s back to work—refreshed, efficient, and on time. She loves the convenience of online ordering, and hospital administrators love giving their employees a strong incentive to do business with them instead of heading off campus. [Employee leaves to go on break] (Employee looks at watch.Employee gets out phone while monitor shows screen shots progressing through quick online order. Employee holds up ID badge. Employee leaves to go on break at end.)

ICU2 Emanate Wireless: RTLS tag reporting location and usage on a smart phone

Introducing the most advanced WiFi RTLS tag ever. The PowerPath tag mounts on your asset in line with the AC power. It contains a rechargeable lifetime battery so once it’s mounted on the asset, you never need to replace it. The solution can assess the true utilization of your devices based on power consumption measured over time. This is valuable information as your determine your lease or rental budget for the next fiscal period! The tag has a low energy Bluetooth interface to connect with your mobile device. The PowerPath mobile application can help find the device within the last 30 feet. Note that the finder mode lists the devices within range. By selecting the device from the list, the tag will provide an audible and visual alert to quickly discern which device I’m looking for. (Point to the tag when the scrip begins. Point to the "utilization report" screen shot when highlighting true utilization. Point to the "finder mode" screen shot from the tablet" Push the button on smart phone or tablet to activate the tag. Tag blinks and beeps upon activation.)

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ICU3 AiRISTA - Asset Tracking

We can show the historical View of an Asset’s movement following an exposure outbreak. We can show the ability to track and trace asset location history in AiRISTA’s HVS Software Suite to prevent additional outbreaks within the hospital.

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Scenario

Patient Name: John Millhouse (Male) Age: 32 MRN:Status: Multiple Injuries from an Automobile Accident transferred from the

ED on Ventilation

NICU Patient Baby AlicePremature Birth transfer to the Neonatal ICU

Start:

(Actor 1, presses play on mp3 player, and starts by the bedside, Actor 2 starts outside the door after everyone has entered the room. As soon as the script starts, Actor 2 enters the room and walks to other side of the bed.)

ICU4 Staff Identification (TBD)

Hello, I would like to welcome everyone to the Intelligent Hospital™ Pavilion developed by the Intelligent Health Association. This ICU demonstration will address both critical manage of adults and neonatal patients.

As you can see, I am automatically identified as I enter the room as indicated on the large display. (Actor 2 points to large display when their picture pops up)

ICU5 Network and Wireless Infrastructure (Extreme Networks)

The Intelligent Hospital combines a robust network and wireless infrastructure, providing a seamless blend of multi-carrier cellular and Wi-Fi services. This enables real time operational intelligence from multiple RTLS / RFID and Wi-Fi systems applications as well as several modalities of communication and visualization providing rapid enterprise level interaction as observed on the large screen on a portable tablet or a hand held device. Actor 1 points to large display, Actor 2 holds up iPhone and HP tablet.)

We pick up the Scenario in the Intelligent Hospital ICU, where patient safety and continuity of care are paramount and great emphasis has been placed on asset, data and alarm management through multidisciplinary collaboration of the clinical staff,

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as well as informatics and biomedical engineering experts and a host of high tech venders. The ICU is cognizant of the recent Joint Commission Alarm Management National Patient Safety Goal and many of our solutions will help meet this goal.

The ICU has just received John Millhouse from the ED. He is a 32-year-old male patient who was one of the drivers from a car crash. He presented to the ED awake with multiple injuries, however he deteriorated and now requires critical care support including mechanical ventilatory support.

ICU6 Medical Device Connectivity (Cardiopulmonary, Nuvon, Sunquest)

In this facility, continuity of care has been established through medical device connectivity enabling surveillance, monitoring, and documentation, even in transport. Institutional RFID systems provide the ability to locate the patient in route and at specific locations such as Radiology or Radiation Oncology. Aggregated clinical information coming into the EMR, Laboratory system and PACS is delivered to a hand held and available for review anywhere in the hospital. This increases patient safety, by allowing clinicians throughout the institution and at remote locations to access clinical information to support, monitor and communicate . [Hold up hand held device and point to shared monitor]

ICU7 Bedside Workstation / Tablet (Zebra)

This room is equipped with a bedside PC workstation which can be wall or cart mounted or a hand held tablet replacing the larger solutions. This PC or tablet is capable of running all the hospital applications and provides the clinician bedside access to the EMR, PACS, Lab information system, cardiology management data or medical history data. (Actor 2 picks up the tablet, Scrolls through the simulated data towards the crowd.) In addition the PC provides the capability to print and scan barcode labels, and can also be integrated with RFID reader. These integrations ensure patient centric identification and association of all devices, supplies, medications, samples and documentation is directly associated to the patient.

(Actor 1 Walks in at the start of the next paragraph, and immediately uses the hand washing dispenser)

ICU8 Hand Hygiene (Airista)

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Hand hygiene is significant for infection control, therefore The Joint Commission Standards require hospitals to assure and measure compliance. As you can see, the clinicians wash their hands as they enter the ICU. The clinician’s RTLS badge combined with the embedded module within the dispenser automatically identifies that the clinician washed their hands, upon entry to the ICU. (Point to RTLS Badge and Hand Washing Dispenser)This monitoring solution not only encourages hand hygiene compliance via reminders, but also provides business intelligence, metrics and analytics to administration or regulatory organizations. (Actor points to display showing hand hygiene statistics and analytics) The software application provides portal access allowing administration and leadership to evaluate hand hygiene over time demonstrating compliant entry into the ICU.

ICU9 Bed/Nurse Call (Stryker / ASCOM)

Typical of most high acuity patient environments, our patient lies in an instrumented smart bed giving a secure dynamic environment capable of monitoring patient weight, side rail status, wheels, and patient communications.(Actor points to the bed)

The bed integrates with a nurse call platform, providing patient to staff communications. Caregivers and staff wear a staff badges that use IR, ultrasound, or low frequency RF technology through receivers located throughout the hospital and patient rooms. (Actor1 puts down bed rails, and points to other actors ASCOM Device) (Actor 2 holds up ASCOM Device to the audience to show that it was alerted when the rails went down) . Calls and alerts such as bed exit or rails down can be immediately directed to the appropriate and available caregiver through the staff worn or handheld wireless device.

ICU10 Alert Notification: (Vocera)

In this case the rail down alert is sent to the primary caregiver (Actor 2) but she responds via her hand held device that she is unavailable which in turn transmits the alert to the secondary caregiver (Actor 1 then holds up the ( Vocera badge,) and shows that he got a call when Actor 2 could not respond) who accepts the alert and attends to the potential bed exit alarm situation. It is important to note that caregiver one is carrying an entirely different personal communication device than the secondary caregiver. (Vocera) (Actor 1 picks up the bed rails to cancel the alarm)

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ICU11 Nursecall Communication & Workflow (ASCOM)

The nurse call platform also server to enhance communications and workflows of the nursing staff. In this case the nurse observes that the patient’s IV appears to be tissuing and requires a new catheter at a new location. The staff member touches the “IV Team” touch point on the workflow station. The request is immediately sent to the appropriate group of staff via their wireless device. When a member of the team “accepts” the event using the soft key on the handset the rest of the team is notified that the request has been accepted saving steps. The staff member accepting the request has the option to speak back into the patient room to communicate with present staff prior to arrival.

ICU12 Physiological Monitoring (Draeger)

Within the ICU, Mr. Millhouse is placed on physiological monitoring as ordered by the physician. At the Intelligent Hospital™, physiological parameters are monitored by a high acuity networked monitoring platform. This provides real time measurement, visualization, archiving and dissemination of critical parameters to other middleware including the EMR, hand held devices and alarm management systems.

Here, Mr. Millhouse’s heart rate and ECG rhythms, blood pressure, and O2 saturation are continuously monitored and are also available on the central station as well as on mobile devices carried by nurses and doctors. (Actor Points to physiological monitor) This monitoring platform also integrates with the hospitals wireless WiFi network enabling continuous monitoring at all locations in the hospital, during transit, at Radiology or any testing or treatment location. Critical to the objectives of the National Patient safety goals is alarm management. The ICU uses a distributed alarm notification methodology, where in addition to annunciation at the central locations alarms and waveforms are delivered directly to the nurse at the point of care [ Hold up mobile device with alarm and waveform]

ICU13 Alarm Distribution / Management (ASCOM)

Emergency alarms such as physiological monitor V TACH alarms are dispatched to the assigned nurse and the supporting handset to enhance nursing response and optimize workflow. The hand set identifies the alarm type via the top display and the color bar

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indicates severity at a quick glance. The nurse is able to view the event (look at the wave file from the monitor that generated the alarm. Upon assessing the alarm she is able to accept the event and take care of it. She also has the option to select “Busy”, if unable to take this alarm, to have the alarm dispatched to the backup nurse. On the Unite View (shown on a wall mounted monitor) central dispatch can see what staff members have accepted or escalated the event.

ICU14 Data Distribution

The Intelligent Hospital utilizes a combined data distribution approach. This includes the delivery of information to a central location for continuous surveillance, directly to the point of care via hand held devices carried by the staff or to off-site clinicians via web based applications. The delivery of critical alarms or test results to the point of care, to selected team members, eliminates the need for bedside team members or lab tech’s to play phone tag especially when a critical result is being transmitted. Actor tbd

ICU15 Clinical Data View – EMR (Sunquest)

Flowsheets in the patient’s electronic medical record are automatically updated from bedside devices minute by minute. Critical data are trended and correlated with ventilator settings, arterial blood gases, Intake and output data, medication data and vital parameters over time through at the point of care. Correlating data allows physicians to see patterns and abnormalities or areas of concern, while viewing relationships between data. Show EMR w/ Clinical Data Viewer for Mr. Millhouse

Clinical Decision Support and knowledge based charting can be used when placing orders to manage conditions noted from the review of data in the ICU, helping to manage best practices for ICU Insulin Protocols, Sepsis Early Warning and Treatment, Pain Management, and Catheter related blood stream infections. [Show EMR w/ display of an ICU Insulin Protocol Order for Mr. Millhouse]

ICU16 Centrally Monitor Ventilated Patients (Cardiopulmonary)

Back to our case, our patient requires mechanical ventilation. He is placed a ventilator which is connected to the hospitals infrastructure using either hardwire or wireless solutions. In fact, all ventilated patients can be centrally or remotely monitored, such as on the Wall of Knowledge with alerts are delivered directly to

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the care provider at the point of care via a variety of hand held devices. This application also enables the hospital to dynamically monitor all ventilated patients independent of their location providing a virtual ventilator community and ensuring a standard level of safety across the facility.

As you can see in this acute care setting, patients are typically connected to a variety of devices in addition to physiological monitoring and ventilators; which includes pulse oximetry, intra-aortic balloon pumps, dialysis machines, cardiac output computers and infusion pumps. It is vital that data from these discrete devices and systems is time synchronized and available to share the information providing an enhanced and comprehensive view of the patient’s condition. However, for devices and data to integrate with other applications like alarm management or the EMR, the medical devices must additionally associated with the correct patient.

ICU17 Connectivity (Cardiopulmonary)

To provide this local and remote real time connectivity and surveillance a multiport bridge provides high-speed, high-fidelity data acquisition from all the devices (actor plug devices into MPB so they activate and display on the MPB screen as transmitting) Continuous acquisition of ICU monitored parameters from an array of devices along with additional functionality may include the integration of video, activity or temperature monitoring, using a wireless temperature transducer and/or accelerometer directly to the patient providing continuous patient body surface temperature. This combined real time data is displayed on a web-based clinical surveillance system (actor points to the patient data surveillance monitor in the room), which is also available via a web browser from any remote location

Actor disconnects the ventilator tube and generates an alarm on the ventilator, and points to the corresponding red cell on the Bernoulli screen) Actor plugs tube back in, and waits for alarm to correct itself on vent and on screen.As you can see in this acute care setting, patients are typically connected to a variety of devices. It is vital that data from these discrete devices and systems is time synchronized, associated to the correct patient and available to share the information providing an enhanced or more comprehensive view and interpretation of the patient status and condition.

ICU18 Decision Support (Sunquest)

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Importantly, the real time collection and integration allows for active patient monitoring and alarm management and for fusion of this data with other EMR data elements to implement algorithms, and for data analytics and clinical decision support within the EMR or thru third-party venders to identify patients at risk for deterioration, and prevent adverse clinical events. Importantly, Clinical Decision Support can be utilized to monitor and track many Quality and Outcomes indicators helping to prevent, identify and reduce the numbers of adverse patient and reportable events. These include Catheter related blood stream infections and Urinary tract infections. Of note, in states like New York where sepsis management is mandated, the EMR, through logic modules can access data and identify patients at risk for sepsis, alert the providers, and direct them to management protocols.

Clinical Analytic Reports can trend compliance to Quality and Outcome Measures in real time. Actor: Show Facility Board, Clinical Summary View, and Clinical Analytics View, viewing multiple alerts

ICU19 VOiP Communications (Vocera)

The nurse just received a message over her VoIP phone that the intensivist will be coming to the unit to insert a central line in Mr. Millhouse for hemodynamic monitoring. Each staff member of the Intelligent Hospital carries a VoIP phone that enables direct staff-to-staff communications. The system integrates with the hospital phone systems and additionally enables incoming and outgoing calls directly to and from the care provider (Both Actors hold up the Vocera pendant)

ICU20 RTLS Supply Management Automated Documentation (DeRoyal)

Protocol dictates that the central line kit is set up and ready when the physician arrives. A nurse places the kit on a procedure tray, alongside the other supplies required to perform the procedure. The nurse realizes that particular items are not available in the ICU store room.

The Cloud based Continuum Safe will display applicable patient information from the ADT system on the screen. The nurse will open a supply needed for the patient and then simply toss the wrapper in the Safe. By doing this, the Safe captures usage for charging and verifies the item has not expired. The system also associates any relevant item information such as serial and lot number to the specific patient for documentation and traceability purposes. Because of the teamed approach to care in

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the ICU the same action may also be performed by other ancillary providers who care for the patient such as respiratory and radiology .The item usage may then be sent to the clinical record and/or financial system. (The nurse picks up a supply, opens the package, and tosses the wrapper into the Continuum Safe (bin). The nurse will then see the item is now displayed on the screen.

ICU21 Labs Sample Collection (Sunquest, Zebra, Swisslog)

Blood samples are also routinely collected for processing in the stat laboratory. Once the Nurse logs into the EMR they launch the collection application via any bedside device and scans the patient’s armband with existing orders appearing on screen. Selecting the appropriate orders and presses print labels. Labels print from mobile printer and are attached to containers. Nurse draws specimen from patient and fills containers. Nurse then concludes the session.

The nurse scans the sample and inserts it into the pneumatic tube carrier. The carrier is then inserted into the pneumatic tube system which automatically reads the RFID chip embedded in the carrier and tracks the sample throughout the transport. The entire transaction is tracked within the pneumatic tube station’s software, providing complete chain of custody, which monitors and confirms all sends, receives delays or missing carriers. The carrier arrival is silent, and laboratory staff is alerted via mobile device that the patients sample has arrived. [actor looks at cell phone or other mobile device screen].

(The Patient gets agitated) (Actor needs to manually trigger alarm on the ventilator disconnect tube)

ICU22 Eliminating Transfusion Errors & Increasing Efficiencies (Sunquest, Zebra)

Similarly if the patient requires a blood transfusion Patient is given a blood transfusion. The Transfusion Manager application uses the bedside barcode or RFID scanner to positively identify patient and ensure the correct blood is given to the patient. (Actor/Actress uses handheld device to scan patient ID and carries out positive patient identification. Using the same device, a unit of blood is scanned. The match is confirmed, and the patient is given the blood transfusion.)

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ICU23 Alarm Management (Cardiopulmonary, Vocera)

As a result of the ventilator failure the patient becomes immediately agitated. As observed the disconnect triggers a variety of alarms throughout the hospital. Data may be delivered and viewed in any telemedicine location using a wide range of fixed viewers or any mobile communication device. Shown here, by way of a non-limiting example, a clinician disconnects a ventilator, which triggers an alarm that is sent to a VoIP badge to indicate a potentially dangerous risk condition has arisen with a patient. (CPC) (Actor 1 disconnects ventilator tube or triggers an alarm on the ventilator. Vocera badge on Actor 2 activates to indicate an alarm has been sent with applicable message.) (Actor 1 then holds up iPhone and points out the red icon for the ventilator at the bottom of the patient shield.)

ICU24 Staff Duress (TBD, ASCOM)

The patient continues to become increasingly agitated. He is tachycardic with a decreased pulse, and the nurse finds it necessary to request assistance in the management of the patient. Since she is busy trying to keep the patient claim and in bed she uses the event buttons on the RTLS tag generate an alert defined as staff duress or assistance required. This is event is globally visible on the RTLS map and can be annunciated in a variety of ways.

ICU25 Find Available Device (Ventilator) (Emanate Wireless)

In addition the staff must quickly locate a replacement ventilator. Using the RTLS system the nurse is able to locate the nearest available clean ventilator. The PowerPath tag mounts directly on the pump in line with the AC power. It contains a rechargeable lifetime battery so once it’s mounted on the asset, you never need to replace it. The solution can assess the true utilization of your devices based on power consumption as measured over time. This is valuable information as your determine your par requirements and requirements for purchase, leasing or rental budget for the next fiscal period. The tag has a low energy Bluetooth interface to connect with your mobile device. The PowerPath mobile application can help find the device within the last 30 feet. Note that the finder mode lists all the ventilators within range. By selecting the device from the list, the tag will provide an audible and visual alert to quickly discern which device I’m looking for. (Point to the tag upon starting the script. Point to the utilization report on the monitor when highlighting reporting power consumption. Point to "finder mode" screen shot when talking about mobile application. Push button on mobile device to have tag blink and flash)

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Not only does a real time operational intelligence system enable us to find the right piece of equipment for the patient improving safety, knowing the location and status of our medical equipment helps save substantial dollars by right-sizing inventory to optimal levels.

ICU26 Staff Workflow: (ASCOM)

Once the patient is restored on ventilation, the nurse must contact the attending physician directly, through the attending physician button on the workflow console (Actor closest to the nurse call system presses the attending physician button)The physician responds directly to the nurses hand held device, and after evaluating patient orders prescribes additional medications to be delivered.

ICU27 Mobile Med System-Remote Med Queuing App (Omnicell)

(Actor 1 will perform steps as they are listed in the script on the Omnicell medication cabinet)

Your final opportunity to ensure medication safety is at the point of administration. The nurse goes to the automated dispensing cabinet to withdraw the medications. The nurse confirms patient identification, using the RFID or barcode wristband, and using the bedside medication tracking system checks physician medication orders . The mobile mediation system streamlines medication tracking and transport by communicating seamlessly with the Automated Dispensing Cabinets. Clinicians are able to capture patient information from these dispensing systems, eliminating redundant data entry, allowing them to stock their system in advance with the patient specific ordered medications.

ICU28 Advanced Infusion Pumps Medication Administration (Hospira)

The Intelligent Hospital has deployed an advanced infusion system operating wirelessly and with interoperability to the EMR system. CPOE and BCMA provide tremendous value in patient medication safety. But they are not enough. This Infusion pump has onboard

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safety software that can serve as the last line of defense for the patient to guard against an incorrect dose or type-o during infusion setup.

Our patient's physician has ordered a Dopamine IV infusion with a concentration of 400 mg / 250 mL and a Dose of 5 mcg/kg/min. To ensure the complete 5 Rights administration of this powerful medication the nurse first scans the patient wristband with the clinical vendor's Barcode Medication Administration device to verify his identity, then, using the same device, scans the bar-coded IV medication, and finally scans a permanent barcode on the IV pump. These actions associate the patient, the IV medication and the infusion pump, and automatically program the IV pump to the pharmacy verified, physician order. The nurse then verifies the order, as displayed on the pump, and starts the device. With IV pump integration, not only is the device Auto-Programmed, but Auto Documentation to the patient's eMAR and I&O Flowsheet become a seamless by-product of the administration; all enhancing patient safety, improved outcomes, and workflow efficiency. (Actor will read script and where indicated will use the wireless handheld Barcode Medication Administration prop to scan the patient's wristband, scan the barcode of the IV medication bag hanging on the IV pole, and then scan the barcode on the pump. Upon scanning the pump (final step) the provided screen shot of the IV pump delivering the Dopamine medication should appear on the room's monitor.)

(Intouch robot moves to bedside)

ICU29 Remote Consultation (InTouch)

As the patient develops new problems, the nurse accesses the remote clinician. The robot is sent to the patient’s bedside, providing support to the ICU nurse for clinical inquiry. The robot remotely examines the patient, actor with stethoscope and sono probe and the remote doctor views bedside monitoring devices and the EMR. The intensivist decides to coordinate the care plan with the pharmacists and pulmonologist. In addition the patient’s family is remotely connected to receive updates and review the new care plan.

NICU

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[Actor moves to the NICU part of the room] Premature and newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained health care professionals to provide specialized care for the tiniest patients.

Within the Pediatric are of the hospital infant security is of paramount importance to all hospital operations. Hospital accreditation Standards defines patient abduction or a pediatric discharge to the wrong parent as a sentinel event.

NICU1 Security – Access Control (HID Global)

NICU2 Infant Security- (Stanley)

To ensure infant safety, the clinician has attached an active RFID security bracelet on her ankle. As a result, Molly’s bracelet is matched with the Mother Samantha, who also has an active RFID bracelet on her wrist. This establishes a dynamic association that continuously tracks in the system. Unauthorized attempts of removing the tag cause an alarm to sound. If the nurse accidentally brings the wrong infant to the wrong mother, the nurse would be silently warned of the mistake, avoiding potentially hazardous and costly issues. As proper association is reestablished, a green lamp confirms the correct match, along with a button-push on the mother’s bracelet. This test can be performed at anytime during the stay. A green/red indication will also appear on the infant’s bracelet. Should an attempt to remove the infant from the unit without an authorized escort, an alarm will sound notifying the staff. The same alarm may be used to prevent mothers from inadvertently taking the wrong baby from the nursery, and possibly nursing someone else’s child. These types of association and coupled exit alarms may be used for infant protection, elopement prevention in the case of dementia patients, and mitigating asset shrinkage.

NICU3 Incubator (Drager)

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These infants or preterm births are housed in an environmentally controlled incubator. These systems Oxygenation, through oxygen supplementation by head hood or nasal cannula, or even continuous positive airway pressure (CPAP) or mechanical ventilation. Patient observation of modern neonatal intensive care involves sophisticated measurement of temperature, respiration, cardiac function, oxygenation, and brain activity, and includes protection from cold temperature, infection, noise, drafts and excess handling: The incubator provides provisions for nutrition via an intravenous catheter or NG tube, administration of medications and maintaining fluid balance by providing fluid and keeping a high air humidity to prevent too great a loss from skin and respiratory evaporation.

NICU4 Medication Administration:

Patients in the NICU are very susceptible to medication issues. In premature infants, the immaturity of developing body systems affects the absorption, distribution, metabolism, and excretion of drugs and therefore an exponential risk for medication errors is present Medications are universally weight-based, requiring calculations for each dose. NICU patients often have long hospital stays, which increases their exposure to medications and medication errors.

NICU5 Infusion Systems: (Carefusion)

Syringe pumps are most commonly used in NICU and with anesthesia. These environments often require the precise delivery of very concentrated drugs or antibiotics. In NICUs, they are also used for enteral feedings.

The modular infusion system supports the Syringe module that is part of a comprehensive IV medication safety system with a common user interface shared across multiple infusion modalities.

These advanced infusion pumps are integrated with the EHR, which creates an integrated system connecting the infusion administration workflow to the pharmacy validated order. By adding the barcode scanning of the infusion pump, you create an association between the patient, the pump and the EHR. With this integrated system, the ordered infusion settings automatically populate on the pump screen, eliminating manual programming steps and decreasing opportunities for error. Running infusion status sent to the EHR allows for more timely, accurate and complete clinical documentation in addition to enabling infusion surveillance for

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nursing and pharmacy.)(Actor picks up handheld device, points to barcode on Alaris System pump, pushes left side button to scan)

NICU6 Medication Cabinet: (Carefusion)

NICU7 Medication Delivery: (Carefusion)

The nurse receiving this [xxxx] intravenous medication will now get it ready for administration using a smart pump like this. What makes this pump smart is that it has an electronic brain that contains a library of drugs with individual maximum & minimum dosing limits and safety parameters. These limits help prevent programming errors which can lead to over and under dosing of the medication. [Nurse Actor scans the barcode on the patient wristband, drug label, and syringe module][Screen Shots: workflow: scanning of wristband, scanning of drug label, scanning of syringe module]

The Intelligent Hospital has deployed a wireless system enabling the pumps to communicate with the hospitals electronic medical record. As soon as the nurse scans the barcodes on: the patient ID band, medication, and on the syringe pump an association is established which pre-populates the order for this [xxxx] drug on the pump with the exact dose and rate that the physician ordered. The nurse simply verifies the order, eliminating the need for manual programming, decreasing an opportunity for error. This is especially important in the NICU where the sickest and most vulnerable patients are.[Nurse Actor loads the syringe, verifies the parameters, presses NEXT, finishes verification and presses START.][Screen Shots: verification of parameters on pump, pressing NEXT / START]

The association between the smart pump and EMR system is bi-directional, which allows all of the infusion status information to flow back to the EMR. Every titration, pause, start and stop is recorded in near real-time. This provides a single reliable record to increase accuracy and timeliness of infusion documentation. The nurse simply verifies the data being sent by the pump, and if appropriate, completes the documentation by accepting it.

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[Nurse Actor stands at the workstation on wheels as if typing in documentation. Monitor shows a close up of the pump screen with I&O flowsheet receiving documentation messages.][Screen Shots: EMR documentation, data feed going into EMR.]

NICU8 Find Available Infusion Pump: (Carefusion / Stanley)

The nurse is ready to start an infusion, but the clean equipment room is empty. Because our Intelligent Hospital has deployed a wireless system allowing the RFID tags on the pump to communicate to a tracking system, the nurse can use “Find near me” features on mobile devices to find the nearest available pump to their specific location. (Stanley Healthcare)[Actor nurse picks up the iPhone and executes a search (iPhone 6Plus so the screen can be seen by the audience).][Screen Shot: iPhone - search]

There are no locally available pumps so the nurse submits a request through the Asset Management system. This sends a request to Central Supply and simultaneously to the technician, generating equipment orders for delivery of the asset to the patient room. [Actor central supply goes across the room and brings the pump to the bedside][Screen Shot: iPhone – request for pump]

(Alaris) With integration between RTLS and the infusion system, biomed has optimized the distribution of infusion devices. This is enabled by having visibility into the status of every infusion device – whether it is currently infusing and how frequently it has been used. This information then enables the hospital to allocate the optimal number of infusion modules, like pumps, syringes and PCA modules to the care areas with the highest historical usage.[Screen Shot: iPhone – request for pump]

This concludes the demonstration within the ICU, which highlighted how the integration of different technologies and applications to enhance patient care and safety, optimize staff workflow, meet Joint Commission and statewide mandates and assist the inventory and supply management. Please visit the other rooms in the

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Intelligent Hospital™ to find out how the other patients fair, pick up an ICU Tour Handout visit our sponsors in the Pavilion kiosks to learn more about these dynamic technologies.

Thank you.

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Documents

To be integrated into Script - ihassociation.orgihassociation.org/wordpress/.../ICU-Feb-26-2015.docx · Web viewInstitutional RFID systems provide the ability to locate the patient