IV Interoperability: Smart Pump and BCMA Integration
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1 IV Interoperability: Smart Pump and BCMA Integration Amanda Prusch, PharmD, BCPS Medication Safety Specialist Tina Suess, RN, BSN System Administrator October 5, 2010
2 Lancaster General Hospital Profile 640-bed acute care hospital serving as keystone of health system Intelligent Infusion Device Profile Number of Devices = 846 Number of Lines = 2632
3 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
4 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
5 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
6 Data Flow
7 Demonstration of IV Interoperability Streamlined Workflow 17 Steps down to 7 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
8 Clinical workflow Current Infusion data to MedNet Server and BPOC for emar documentation Pharmacist provides clinical assessment of IV order; Profiles rate/dose into Rx IS Nurse Confirms Infusion and Starts IID Order crosses into BCMA; nurse verifies order against original provider order Wireless upload of infusion parameters to IID occur; electronically matching to drug library 5 right checking occurs with a barcode scan of patient ID and IV medication. Required infusion parameters (dose/rate, volume, duration, weight) are populated by the Rx IS to the BCMA Nurse scans channel bar-code through which the drug will be infused System setting determines if the nurse is presented with the interoperability pathway. Rx IS: pharmacy information system; IID: intelligent infusion device; BCMA : barcode medication adminstration
9 Smart Pump Warning within the EMAR
10 Validation July 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
11 Comparison: Manual versus IV Interoperability Challenges of Manual Pump Programming Manual input process Advantages of IV Interoperability Pump programming parameters (dose/rate, weight, volume to be infused) populated by order User must opt into safety features Complex workflow on limited real estate Limited drug library size Magically occurs; guarantees correct medication is selected Streamlined workflow Nurse must focus on one IV task Pump alerts display on computer screen 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 Disconnect between what occurs on the pump and medical record Process totally owned by the nurse Standardization is introduced; pump is programmed according to order Pump settings are documented in the medical record Pump is populated with clinically appropriate, evidencebased, safe infusion rates as profiled by pharmacist
12 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
13 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
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