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