Post on 27-Jun-2015
description
Does one dataset suit all?Smart infusion pump implementation in a
cross-campus collaboration
2nd Annual EMM Conference
25 March 2013
Belinda Johnston: Dir. of Pharmacy, St Vincent’s Private Hospital
Maureen Heywood: eMedicines Management Pharmacist ,St Vincent’s Public Hospital
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Why New Pumps?
� Old pumps dying - no longer supported with service or parts
� Increasing patient acuity and shorter lengths of stay required adequate equipment to meet demands
� SMART Pump initiation a recommendation of CEC MSSA (Medication Safety Self Assessment) – SVH and SVPH 2011
� SVMHS ITSC infrastructure supports use of wireless technology
� Fits SVMHS campus e-medicines vision
� Reporting and Continuous Quality Improvement capability
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Are IV Meds infused safely? - Evidence
•Prof J Westbrook et al administration errors study¹
• Nearly 70% of all intravenous medication administered had at least one clinical error and 25.5% of these were serious.
• Wrong rate was the most frequent error type
• UK and German observational studies suggest 49% and 48% overall error rates
•Prof J Westbrook et al interruptions study²
•Nurse experience level provided no protection against making a clinical error
•Error severity increased with interruption frequency
•Wrong IV administration rate was the second most frequent clinical error with 35.7% of these errors rated as being of major severity
1. Westbrook JL, Rob MI, Woods A, Parry D. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf 2011;20:1027-1034
2. Westbrook JI, Woods A, Rob MI, Dunsmuir WT, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med. 2010 Apr 26;170(8):683-90.
What is a SMART PUMP? (1)
Dose error reduction software -Guardrails®
Locally defined drug dataset of meds, IV fluids and blood products
Sophisticated dose / rate / concentration expressions:
g, mg, mcg, nanogramweight-based BSA-basedconcentrations
PCA specific doses / boluses
CQI – Continuous Quality Improvement tool for reporting records any breaching of limits- Nurse education- Dataset improvement
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What is a SMART PUMP? (2)
Each hospital defines “clinical area” Profiles
Each profile is populated with appropriate drugs in a library where doses, concentrations, rates, soft and hard min/max limits are coded
Advisories
Therapies
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Cross campus private / public collaboration
The Mater SV Private SV Public
Beds 216 270 350
Medication charts Paper Paper Electronic -MedChart®
Prescribers VMO VMO JMO
Drug Protocols Own + similar Similar (co-located) Similar (co-located)
Initial dataset From scratch From Mater From Private
Implementation Date June 2010 Sept 2011 Feb 2012
Dataset Team Nurse led; VMO andPharmacist input; Nurse and Exec sign-off
Nurse led; VMO input; Pharmacist and Exec sign-off
Pharmacist and nurse led; MO input; Pharmacist and Exec sign-off
Dataset Development 16 weeks 16 weeks 16 weeks
Number of Brains / Modules / PCA
85 / 100 / ? 150 / 220 / 60 270 / 450 / 25
Timeline
Jun 10
Mater go-live
Jun 11
Private dataset
build
Sept 11
Private go-live
78 drugs / 5 fluids
Nov 11 Public datasetbuild
Feb 12 Public go-live
155 drugs /
32 fluids
May12 Private
CQI
Nov 12 Private updated Dataset
139 drugs /
39 fluids
Mar 13 Public CQI
report
Mar 13 Public
Dataset
183 drugs / 32 fluids
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Challenges (1)
1. Vendor contract – signed before implementation teams in place -worked backwards from end date to extremely tight deadlines
2. Almost nil implementation resources allocated
3. 20 character drug name limit
4. Drugs and fluids are separate
5. Rounding / Weaning doses
6. Physical weight of pump – adapt process of patient transfer
1. No ability to stretch timelines meant decisions HAD to be made and acted upon immediately – no SHOWSTOPPERS allowed!
2. SVPH had 0.2FTE data entry nurseSVH pulled 1.5FTE Pcists from eMMSand ward workAll nursing, medical and senior pharmacist review / signoff at both sites squeezed on top of daily duties
3. ACSQHC recommendations for no abbreviations and use of “mcg” impossible to adhere to in a number of circumstances
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Challenges (2) - but collaboration ensured outcomes
PRIVATEDid not attempt to create a complete drug
library due to timelines – knew public was about to start its implementation so mutual agreement to let public try and sort the tricky drugs
NO dataset updates whilst public was developing theirs
Tested wireless connectivity
Biomedical engineering input:configured wirelessmaintenance program
Identified policies needing change
PUBLICHow to NOT corrupt / edit / delete private profiles whilst adding public ones on the same dataset – lots of trust, strict rules.
Constant consultation with private ensured needs of both managed (eg: profile names changed to allow easy identification of private vs public)
Haematology / Oncology profile a must have –hardest – varied dose ranges – good outcome was public could be copied to private
Aimed for shared Critical Care profile but due to different PCA’s had to have separate
Solved some of the tricky drugs
Incredible Feedback
SVH learned from SVPH and adopted tactics:
1. Staff Engagement
• Outstanding involvement by Clinical Nurse Educators• Rallied their nursing colleagues• Pro-active responses and “gathering of info”• Engaged medical input
2. Ward feedback books idea
• SVPH - QA senior – visited the wards collecting data requests• SVH – Clinical Resource Unit Snr Nurse walked wards and
collected A4 feedback forms
3. Staff encouraged to actively contact dataset team
4. Monthly meetings
5. Alaris® vendor (Carefusion) feedback sought
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FIRSTS!
SVPH - First wireless pump implementation in Australia (Sept 11)
Second multi-site dataset
BUT first multi-site dataset where the 2 hospitals had their own and separate profiles all on the same dataset
(Private has 5 / Public has 4)
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Challenging high-risk drugs
Tirofiban
This
translates to
This
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What to consider with eMMS(MedChart®) and Alaris® pumps
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Compliance Audits - results
Private Dec 2011
PrivateAug 2012
Private Diff
Public Apr 2012
Public Oct 2012
Public Diff
PCU correctprofile
88% 88% - 90% 96% 6%
Patient ID 0% 0% - 52% 42% 10%
IV Fluids via Guardrails
72% 51% 21% 90% 86% 4%
IV Fluids avail in dataset
100% 100% - 100% 100% -
IV Drugs via Guardrails
88% 67% 21% 95% 94% 1%
IV Drugs avail in dataset
88% 93% 5% 100% 100% -
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Alaris® Infusion Analytics Review -CQI
Private Public
Severe harm averted (potential ADE’s)
29 205
Potential cost saving $254,000 $1.79 million
Total good catches 20 142
Total override alerts 5490 9528
Top 5 overrides NoradrenalinePropofolMaintenanceSod NitroprussideGlyceryl trinitrate
NoradrenalinePropofol – continuousMidazolamPropofol - bolusMorphine(+Midazolam)
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Issues requiring immediate action
� Wireless- blackspots in HOAC- for
the initial 3 uploads had to move
pumps out into corridor for dataset
to upload
� Windows 7 PC upgrade – Alaris®
incompatible – still awaiting patch
(had to keep an old version PC in
XP)
� Power boards in pumps had to be
replaced due to international recall
– took weeks / months
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Drug not in my pump – was yesterday!Where is MY pump?
Image caption here
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The FUTURE
Aligning MedChart® complex infusion orders with Alaris® “smartpump” drug library
Further collaboration on possible amalgamation of profiles for SVH and SVPH dataset (eg: critical care)
??does one dataset work to include Mater and St Joseph’s
Future electronic interfaces (eMMS to infusion pumps)
Disaster Plan and Recovery Testing
Thank You
Does one dataset suit all?Smart infusion pump implementation in a cross-campus collaboration
2nd Annual EMM Conference
25 March 2013
Belinda Johnston: Dir. of Pharmacy, St Vincent’s Private Hospital
Maureen Heywood: eMedicines Management Pharmacist ,St Vincent’s Public Hospital
Dataset
Private Public
Dataset 5 profiles crit caremedsurgcard medsurgOncologytraining
4 profiles crit caregeneralhem_oncologytraining
Trust Pharmacist updates only private ?Governance
Pharmacist updates only public
??? Agree -Rx Agree - Rx &EMM
Review When
CQI reports annually Ongoing-
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If you have a resource you can rapidly respond
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PUBLIC First x…?? months
Dataset wireless updates ~ 2 weekly – how many b/w golive and now
New drugs added 28 (8 in 1st week)
Limits changed 21 drugs (26 changes)
Concentrations 5
Name changes or advisory addition
8
Improved compliance
Improved patient safety
Discussion; of Public having ability to provide updates
Set and Forget??
If you create an entry in the smartpump must also do in eMMS - resource must be trained in both