Clinical Skills Validation: Alaris Pump System These documents are intended for use by CW Nurse Clinical Leadership Team. The method used to implement the validation of the Alaris Pump System is unit specific. Yearly pump validation is required. Once validation has been completed, each nurse must sign up on the LearningHub in order to maintain her record. This document may be changed to meet the needs of each unit. Please ensure that you change the title if you change the document. What you may need in order to complete a validation 1. On-line Alaris resources: LearningHub Alaris Pump On-line Training CW intranet webpage http://infosource.cw.bc.ca/cw_ivpump/content/home.asp 2. Unit specific resources: Policies and Procedures related to IV pump infusions Pumps and tubing that your unit uses 1 Learning and Development Dept March 26, 2012
Learner assessment of readiness: Assesses self to be competent in foundational parenteral and infusion therapy. See CAPE tool Consistently exhibits ability to plan and deliver care for broad range of patients requiring parenteral and medication infusions via the Alaris Pump System Learning Activities: Review and complete Alaris skills validation tool Review policies and procedures related to Alaris pumps, medication administration and IV therapy. Care for a patient with an Alaris pump infusion and their family. Identify and review the Alaris pump resources on CW intranet http://infosource/cw_ivpump/content/hom e.asp Validation methods: Skill and knowledge demonstration through use of a case scenario or with the patient at the bedside. Knowledge Recognizes and describes when Alaris pump system is required o All parenteral infusions at BC Children s Hospital and BC Women s Hospital Recognizes when to use specific modules according to patient requirements, volume and medication (syringe, pump module, PCA) o Syringe module medications prepared by pharmacy with a volume of less than 50 cc (arrive in a syringe) o Pump Module all continuous and intermittent infusions of parenteral fluids (maintenance fluids, medications, blood or blood components) o PCA Module - Able to correctly use specific modules (Point of Care Unit,PCU or Brain), barcode, syringe, pump module (Programming both primary, secondary infusions and PCA) Understands elements of programming and the dose error reduction system: DERS (drug library) Identifies related policies and procedures for safe medication administration and use of Alaris Pump System Skill Identify all necessary equipment and supplies according to the type of infusion and patient (for your unit). Demonstrates (where applicable) set up of infusions for syringe, pump module, primary and secondary infusions and PCA. Demonstrate use of Alaris safety features including barcode technology and the DERS o Demonstrates A to M below: (also refer to quick reference guides on CW intranet webpage) 2 Learning and Development Dept March 26, 2012
A. Powering on the Pump Loading infusion set 1. Prime and load set into pump 2. Press system on button to power up Point of Care Unit (PCU or Brain ) 3. Selects new patient. Able to verbalize when it is appropriate not to do so. Yes (Erases history) No to change profile 4. Accept or change current profile. Profiles: Pediatric, Oncology, NICU, Critical Care/OR, Women s and ECLS. Clinician is able to verbalize that profiles are not to be used out of the designated care area. Yes confirms current profile No to change profile Press to confirm 5. Enters patient ID or scan patient ID band and press confirm. Able to verbalize where to find patient ID (7 digit MRN number). 6. Scan Clinician ID badge or manually enter. Press options, enter clinician ID and press confirm. 7. Select channel to be programmed. 8. Confirms current software version is running on the pump. In the upper left hand corner of the screen on the PCU. B. Programming a Primary Infusion on the Pump Module 1. Manually primes appropriate infusion set and loads pump module. 2. Selects channel by pressing Select Channel button on the channel to be programmed 3 Learning and Development Dept March 26, 2012
3. Scans barcode on medication label or Selects correct infusion type. Guardrails Drugs Guardrails IV Fluids Basic Infusion Only manually programs if there is no medication barcode or unable to scan the label. Basic infusion is only selected for those drugs or fluids not available in the drug library. 4. If manually programming pump, Confirms drug selection. 5. Enters Drug Amount, Diluents Volume and Patient s Weight then verifies correct parameters before selecting Next. 6. Enter Rate, VTBI or Dose then verifies correct parameters before pressing Start. C. Programming a Bolus Dose from a Continuous Infusion 1. Bolus dose can be programmed at the beginning or during and infusion. 2. Select Channel you wish to bolus from 3. Press the Bolus key at the bottom of the screen 4. Enter bolus dose to be given and enter patients weight if not already present. 5. Enter Duration of bolus or press Rapid Bolus to give bolus at Maximum safe rate possible. 6. Verify correct parameters and press Start. 7. Can articulate how to stop a bolus dose mod infusion. Press Channel Select Key, then press Stop Bolus key and verify that you want to stop the bolus. 4 Learning and Development Dept March 26, 2012
D. Programming a Secondary Infusion (Piggyback Method) 1. Demonstrates set up of secondary medication set. Ensures secondary set is set at the correct height above the primary infusion (9 ½ above the primary container). 2. Press Select Channel Key 3. Press Secondary Key 4. Scan barcode on medication label or select drug to be infused from the drug library. Confirm drug selection. 5. Verifies drug information or enters drug information into the drug library, then presses the Next key. 6. To program a medication infusion followed by flushing with primary solution. Calculate rate (volume to be infused time in hours fractions = rate) and Enter amount. Enter VTBI (Volume of drug nearest whole number + dilutent + 25 ml) Verify secondary clamp is open. Press Start. 7. To program a medication infusion followed by flushing with 25 ml of Normal Saline or D5W. Calculate rate (volume of the drug to the nearest number + diluents) and Duration of infusion. Verifies secondary clamp is open. Press Start. When secondary bag is empty removes med bag and attaches 25 ml flush bag of NS or D5W. Presses Channel Select and Secondary med key, press Restore and Change VTBI to 25 ml. Press Start. 5 Learning and Development Dept March 26, 2012
E. Programming a Primary Infusion or Intermittent Medication using Syringe Module 1. Manually primes appropriate infusion set and loads pump module. Uses pressure sensing disk as per unit s. 2. Scans barcode on medication label or Selects correct infusion type. Guardrails Drugs Guardrails IV Fluids Basic Information Provides rational for choice. Only manually programs if there is no medication barcode or unable to scan the label. Basic information is only selected for those drugs or fluids not available in the drug library. 3. Seclects channel by pressing the Select Channel button on the channel to be programmed. 4. If manually programming pump, Confirms drug selection. 5. Enters Drug Amount, Diluents Volume and Patient s Weight then verifies correct parameters before selecting Next. 6. Enter Rate, VTBI or Dose then verifies correct parameters before pressing Start. 7. Flushing post medication infusion per unit policy. F. Programming a PCA Pump (See PCA module pocket guide) G. Changing a syringe on a continuous infusion. 1. Selects channel by pressing the Select Channel button. 6 Learning and Development Dept March 26, 2012
2. Presses Pause Key 3. Clamp tubing, remove and disconnect old syringe, attach new syringe and installs it in the syringe driver. 4. Confirm syringe size. H. Demonstrates Delay Infusion Option. 1. Selects Press Delay Options key. 2. Chooses appropriate option Pause Delay For (enters number of minutes, up to 120 minutes) Delay Until (confirms current time is correct and then enters time of day infusion is to be initiated, up to 23 hours and 59 minutes) 3. Prior to confirming Delay for or Delay until, a call back can be programmed. Before gives an alert when delay period is complete After gives an alert when delayed infusion has completed Before and After gives an alert when delay period is complete and infusion needs to be initiated and when delayed infusion is completed. 4. Press Confirm. 5. Respond to callback Before callback Press Channel Select and then the Start key or press Restart key. After callback press Confirm key 7 Learning and Development Dept March 26, 2012
Before and After callback Respond as indicated above. I. Demonstrates Turning Off the Pump and Safe Unloading of IV Set. 1. Stops infusion before removing set. 2. Removes set prior to turning Off the pump. 3. Turns off the pump. 4. Explains rationale for turning off the pump between patient: Ensures that appropriate library is selected and confirmed for each new patient, when pump is turned on it asks if this is a new patient and then asks for library to be selected/confirmed. J. Demonstrates Turning Off the Pump and Safe Unloading of IV Set. 1. Explains the drug library (dataset) update procedure. Turn all pumps in their area on to wirelessly receive the new drug library. In areas with no (or spotty) wireless coverage, the PCUs (brains) will have to be exchanged. Biomedical Engineering will coordinate with clinical staff in these areas over the following two weeks (Sunny Hill, Canuck Place, Women s Health Centre and Mental Health, NICU). Once the new dataset has been uploaded, the new drug library is activated by: turning the pump Off, then ON and selecting New Patient. 2. Explains how to identify that the pump has the current dataset. Current dataset name can be found under the Drug Library Updates tab on the Alaris/Solis Pumps link on infosource. The most current version will be the most recent date listed. By clicking on the date details of changes/updates to the library and to the current name will be found. 8 Learning and Development Dept March 26, 2012
Learning Assessment and Activities Clinical Skills Validation: Alaris Pump System Validation KEY Demonstrated o Link http://infosource/cw_ivpump/content/home.asp Locates the current dataset name on the PCU screen (upper left hand corner) o Current dataset name: K. Auto ID (Barcode) Module 1. Demonstrates scanning barcode on the clinician ID, patient ID and medication label. Press Scan/Cancel key on Alaris Auto ID, module or scan button on hand held module. Hold barcode to be scaned at level of plug in port for handheld scanner about 2 to 3 fingers away from the auto ID module under the beam of light. Beam of light should center over barcode. Ensures label to be scanned is as flat as possible and minimizes movement of hand holding label to be scanned. If scan is successful an audible beep will be heard and information will be displayed on the PC unit screen. 2. Provides rational for using the Auto ID module versus manually programming the pump: Provides an extra layer of safety ensuring that the correct strength and drug is selected from the library. Using the Auto ID module pre programs the pump, by selecting the drug and concentration decreasing the programming steps for the clinician. L. Hard and Soft Limits 1. Explains the difference between a soft and hard limit: A soft limit can be overridden 9 Learning and Development Dept March 26, 2012
and a hard limit cannot. 2. Can explain the process when triggering a soft or hard limit. 1. re check programming of the pump 2. re check clinical checks 3. consult with colleagues (Nursing, pharmacy, physician) Obtain new orders if indicated. 3. Demonstrates how to override a soft limit: Must double check and ensure the dose is appropriate before proceeding, select OK M. Trouble shooting Alarms 1. Defines and describes how to troubleshoot the following alarms: See Pump Module and Syringe Module Quick Reference Guides on CW intranet webpage. a) Accumulated air in line b) Air in Line c) Channel disconnect d) Check IV Set e) Occluded Fluid Side/Empty Container f) Occluded Patient Side g) Partial Occlusion Patient Side h) Pump Chamber Blocked i) Restart Channel j) Safety Clamp Open Close Door k) Check Syringe l) Syringe Empty m) Hardware Detected Error/System Error/Syringe Calibration Required/Syringe driver Head Error. Demonstrates patient IV site assessment related to Alaris pump system patient safety 10 Learning and Development Dept March 26, 2012
Learning Assessment and Activities Clinical Skills Validation: Alaris Pump System Validation KEY (site to source check or bag, pump, baby check; incorporating infiltration and phlebitis scales where applicable). Demonstrated Demonstrates accurate documentation related to IV medication and IV therapy. See relevant policies and procedures for your unit. Primary nurse responsibilities EACH SHIFT Checks type of line, type of infusion and seven rights(9 NICU) according to Policy and Procedure Ensures pump programmed with correct profile, patient MRN, weight Assesses infusion and patient every hour (bag,pump,baby check NICU) Documents intake and output per policy and totals every 12 hours Provides patient and family safety teaching Clinical Decision Making Responds to alarms and recognizes alterations in Alaris pump system functions by giving patient specific examples. Recognizes and addresses alterations in fluid dynamics and safety by giving patient specific examples. Recognizes infiltration and phlebitis scoring system and identifies course of action if scores > 0 Identify and locate support and resources to troubleshoot pump system malfunction and patient care issues Patient Family Considerations When required educates and supports patient and family around medications and safe pump use o Addresses questions and concerns from patient and family o Describes reason for infusion, what alarms indicate, to avoid tampering and 11 Learning and Development Dept March 26, 2012
when to call for help. Date: Additional comments/feedback Validated by: 12 Learning and Development Dept March 26, 2012