1
|
Ubanyionwu S, Khandekar D, Mara KC, Teaford H. Enterprise standardization and convergence of large-volume infusion pump drug libraries. Am J Health Syst Pharm 2023; 80:1743-1751. [PMID: 37527506 DOI: 10.1093/ajhp/zxad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE With the implementation of a new electronic health record (EHR) system across Mayo Clinic, a project was approved to standardize and converge 9 region-specific large-volume infusion pump (LVP) drug libraries for Baxter SIGMA Spectrum pumps. SUMMARY The objectives of the project were to (1) develop recommendations for identified variances in practice, (2) consolidate regional drug libraries into a converged enterprise library, (3) improve the drug library management process, and (4) maintain or exceed previous Dose Error Reduction System (DERS) compliance for infusions administered. Harmonization efforts with infusion pumps decreased the number of drug libraries maintained, reduced content maintenance time, and increased readiness for smart infusion pump-EHR interoperability. Seven of the 8 regions for which change in DERS compliance was assessed showed improved compliance relative to baseline in the 30-day postwashout period. Furthermore, when comparing pre- and postimplementation DERS compliance, the number of regions meeting the minimum compliance rate of 95% increased from 5 to 6 regions. CONCLUSION The project improved the drug library management process, allowed for DERS compliance to be accurately compared across regions, and ensured that patients across the enterprise receive the same standard of care with the administration of intravenous medications.
Collapse
Affiliation(s)
| | - Divya Khandekar
- Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Hilary Teaford
- Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
2
|
Transparency in Error Reporting. JOURNAL OF INFUSION NURSING 2022; 45:243-244. [PMID: 36112870 DOI: 10.1097/nan.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
3
|
The effects of using a micro-infusion pump without accompanying fluid at a low flow rate on patients undergoing cardiac surgery. Transpl Immunol 2022; 73:101611. [DOI: 10.1016/j.trim.2022.101611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
|
4
|
Perera UT, Heeney C, Sheikh A. Policy parameters for optimising hospital ePrescribing: An exploratory literature review of selected countries of the Organisation for Economic Co-operation and Development. Digit Health 2022; 8:20552076221085074. [PMID: 35340903 PMCID: PMC8941697 DOI: 10.1177/20552076221085074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Electronic prescribing systems offer considerable opportunities to enhance
the safety, effectiveness and efficiency of prescribing and medicines
management decisions but, despite considerable investments in health IT
infrastructure and healthcare professional training, realising these
benefits continues to prove challenging. How systems are customised and
configured to achieve optimal functionality is an increasing focus for
policymakers. We sought to develop an overview of the policy landscape
currently supporting optimisation of hospital ePrescribing systems in
economically developed countries with a view to deriving lessons for the
United Kingdom (UK). Methods We conducted a review of research literature and policy documents pertaining
to optimisation of ePrescribing within hospitals across Organisation for
Economic Co-operation and Development (OECD) countries on Embase, Medline,
National Institute for Health (NIH), Google Scholar databases from 2010 to
2020 and the websites of organisations with international and national
health policy interests in digital health and ePrescribing. We designed a
typology of policies targeting optimisation of ePrescribing systems that
provides an overview of evidence relating to the level at which policy is
set, the aims and the barriers encountered in enacting these policies. Results Our database searches retrieved 11 relevant articles and other web resources
mainly from North America and Western Europe. We identified very few
countries with a national level strategy for optimisation of ePrescribing in
hospitals. There were hotspots of digital maturity in relation to
ePrescribing at institutional, specialisation, regional and national levels
in the US and Europe. We noted that such countries with digital maturity
fostered innovations such as patient involvement. Conclusions We found that, whilst helpful to achieve certain aims, coordinated strategies
within and across countries for optimisation of ePrescribing systems are
rare, even in countries with well-established ePrescribing and digital
health infrastructures. There is at present little policy focus on
maximising the utility of ePrescribing systems.
Collapse
Affiliation(s)
- Uditha T Perera
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Catherine Heeney
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| |
Collapse
|
5
|
Marwitz KK, Fritschle AC, Trivedi V, Covert ML, Walroth TA, DeLaurentis P, Saunders T, Walleser N, Fuller J, Degnan D. Investigating multiple sources of data for smart infusion pump and electronic health record interoperability. Am J Health Syst Pharm 2021; 77:1417-1423. [PMID: 32462189 DOI: 10.1093/ajhp/zxaa115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Infusion pump data, which describe compliance to dose-error reduction software among other metrics, are retrievable from infusion pump vendor software, electronic health record (EHR) systems, and regional and national data repositories such as the Regenstrief National Center for Medical Device Informatics (REMEDI). Smart infusion pump and EHR interoperability has added to the granularity and complexity of data collected, and clinicians are challenged with efficiently comprehending and interpreting the data and reports available. SUMMARY Collaborative partnerships between the Indianapolis Coalition for Patient Safety and the Regenstrief Center for Healthcare Engineering allowed for clinicians, informaticists, researchers, and engineers to compare the information gained and strengths of using smart infusion pumps, EHR, and REMEDI to assess hospital medication safety in a setting of interoperability. Seven reporting capabilities were used to compare available reports, and 2 hypothetical scenarios were developed to highlight these processes. Infusion pump vendor-provided software and reports were found to provide the most usable information for detailed infusion reporting, while the EHR was strongly usable for interoperability compliance and REMEDI excelled in benchmarking capabilities. CONCLUSION While infusion analytics needs may differ across health systems, a better understanding of the strengths of infusion pump data and EHR data may help provide structure and direction in the infusion analytics process. Infusion data repositories such as REMEDI are useful tools to obtain information in a way not delivered by smart pump data.
Collapse
Affiliation(s)
- Kathryn K Marwitz
- Manchester University College of Pharmacy, Natural, and Health Sciences, Fort Wayne, IN
| | | | | | | | | | - Poching DeLaurentis
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN
| | | | | | - James Fuller
- Indianapolis Coalition for Patient Safety, Inc., Indianapolis, IN
| | - Dan Degnan
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN
| |
Collapse
|
6
|
Implementation of Smart Infusion Pumps: A Scoping Review and Case Study Discussion of the Evidence of the Role of the Pharmacist. PHARMACY 2020; 8:pharmacy8040239. [PMID: 33339182 PMCID: PMC7768446 DOI: 10.3390/pharmacy8040239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022] Open
Abstract
“Smart” infusion pumps include built in drug error reduction software which uses a drug library. Studies have reported the drug library build should be undertaken by a multidisciplinary team, including a pharmacist; however, the extent or nature of the input required by the pharmacist for greatest benefit is unknown. This review aimed to identify key factors for the implementation of the smart infusion pumps, with a focus on the role of pharmacists and compare this to the experience from a case study. A literature review was conducted using Embase and Ovid Medline, and 13 eligible papers were found. Predominant themes relating to the pharmacist’s role and successful implementation of the smart infusion pumps were determined. Key factors for success included team involvement across the entire process from procurement, set-up through to implementation including risk assessment and device distribution, and training, which were comparable to the case study experience. Few studies described the extent or details of the pharmacist’s responsibilities.
Collapse
|
7
|
Vest TA, Gazda NP, Schenkat DH, Eckel SF. Practice-enhancing publications about the medication-use process in 2018. Am J Health Syst Pharm 2020; 77:759-770. [PMID: 32378716 DOI: 10.1093/ajhp/zxaa057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2018 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following steps: prescribing/transcribing, dispensing, administration, and monitoring. Articles that evaluated one of the steps were gauged for their usefulness toward daily practice change. SUMMARY A PubMed search was conducted in February 2019 for articles published in calendar year 2018 using targeted Medical Subject Headings (MeSH) keywords, targeted non-MeSH keywords, and the table of contents of selected pharmacy journals, providing a total of 43,977 articles. A thorough review identified 62 potentially significant articles: 9 for prescribing/transcribing, 12 for dispensing, 13 for administration, and 28 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why they are important within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing recent impactful contributions to the MUP literature. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of significant published studies can assist in changing practice at the institutional level.
Collapse
Affiliation(s)
- Tyler A Vest
- Duke University Hospital, Durham, NC, and University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC
| | | | | | - Stephen F Eckel
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, and University of North Carolina Medical Center, Chapel Hill, NC
| |
Collapse
|
8
|
Melton KR, Timmons K, Walsh KE, Meinzen-Derr JK, Kirkendall E. Smart pumps improve medication safety but increase alert burden in neonatal care. BMC Med Inform Decis Mak 2019; 19:213. [PMID: 31699078 PMCID: PMC6836424 DOI: 10.1186/s12911-019-0945-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source of alert burden and alert fatigue in an intensive care environment. Methods Using smart pump records, over 370,000 infusion starts for continuously infused medications used in neonates and infants hospitalized in a level IV NICU from 2014 to 2016 were evaluated. Attempts to exceed preset soft and hard maximum limits, percent variance from those limits, and pump alert frequency, patterns and salience were evaluated. Results Smart pumps prevented 160 attempts to exceed the hard maximum limit for doses that were as high as 7–29 times the maximum dose and resulted in the reprogramming or cancellation of 2093 infusions after soft maximum alerts. While the overall alert burden from smart pumps for continuous infusions was not high, alerts clustered around specific patients and medications, and a small portion (17%) of infusions generated the majority of alerts. Soft maximum alerts were often overridden (79%), consistent with low alert salience. Conclusions Smart pumps have the ability to improve neonatal medication safety when compliance with dose error reducing software is high. Numerous attempts to administer high doses were intercepted by dosing alerts. Clustered alerts may generate a high alert burden and limit safety benefit by desensitizing providers to alerts. Future efforts should address ways to improve alert salience.
Collapse
Affiliation(s)
- Kristin R Melton
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Kristen Timmons
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathleen E Walsh
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jareen K Meinzen-Derr
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eric Kirkendall
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
9
|
DeLaurentis P, Walroth TA, Fritschle AC, Yu D, Hong JE, Yih Y, Fuller J. Stakeholder perceptions of smart infusion pumps and drug library updates: A multisite, interdisciplinary study. Am J Health Syst Pharm 2019; 76:1281-1287. [PMID: 31325354 PMCID: PMC6695576 DOI: 10.1093/ajhp/zxz135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Results of a questionnaire-based study to evaluate smart infusion pump end users' perceptions and understanding of the drug library update process are reported. METHODS The Indianapolis Coalition for Patient Safety, Inc., in partnership with the Regenstrief Center for Healthcare Engineering, conducted a 33-item electronic, cross-sectional survey across 5 Indiana health systems from May through November 2017. Interdisciplinary participants identified for survey distribution included nurses, pharmacists, biomedical engineers, administrators, and medication safety officers. The survey assessed the following domains: patient safety, the drug library update process, knowledge of drug libraries and the update process, and end-user perceptions. RESULTS A total of 778 submitted surveys were included in the data analysis, with a large majority of responses (90.2%) provided by nurses. The use of drug libraries for ensuring patient safety was deemed extremely important or important by 88% of respondents, but 36% indicated that they were unsure of whether drug libraries are updated on a routine basis in their health system. Approximately two-thirds agreed that the current update process improves quality of care (65.0%) and patient safety (68.1%). Moreover, 53.3% agreed that the current drug library update process was effective. However, less than 10% responded correctly when asked about the steps required to update the drug library. Furthermore, only 18% correctly indicated that when a pump is on it may not necessarily contain the most up-to-date version of the drug library. CONCLUSION A survey of 5 health systems in Indianapolis identified several end-user knowledge gaps related to smart pump drug library updates. The results suggest that these gaps were most likely due to a combination of the 2-step update process and the fact that the current drug library version is not easy to find and/or user-friendly and it is unclear when an update is pending.
Collapse
Affiliation(s)
- Poching DeLaurentis
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN
| | | | | | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN
| | - Jee Eun Hong
- School of Industrial Engineering, Purdue University, West Lafayette, IN
| | - Yuehwern Yih
- School of Industrial Engineering and Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN
| | - James Fuller
- Indianapolis Coalition for Patient Safety, Inc., Indianapolis, IN
| |
Collapse
|
10
|
Marwitz KK, Giuliano KK, Su WT, Degnan D, Zink RJ, DeLaurentis P. High-alert medication administration and intravenous smart pumps: A descriptive analysis of clinical practice. Res Social Adm Pharm 2019; 15:889-894. [PMID: 30827935 DOI: 10.1016/j.sapharm.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/16/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Institute for Safe Medication Practices (ISMP) describes high alert medications (HAM) as medications that represent a heightened risk of patient harm when used in error. IV smart pumps with dose error reduction systems (DERS) were created to help address medication administration errors. Compliance with DERS provides a measure of how accurately a hospital uses smart pump technology to reduce IV medication error. OBJECTIVE The primary purpose of this research was to use the REMEDI dataset, an aggregate, multi-hospital database inclusive of smart pump analytics, to improve the current understanding of clinical practices for IV HAM administration. METHODS Descriptive analyses and analysis of variance (ANOVA) were used to test for differences in the mean DERS alert override rate, and mean DERS alert override to reprogram ratio between non-HAM and HAM overall, by hospital system, and by pump type. RESULTS High mean override rates for non-HAM (73.8%) and HAM (75.8%) and high override to reprogram ratios for both non-HAM (7.30) and HAM (9.92) were seen. No significant differences were found in override rates (p = 0.23) and override to reprogram ratios (p = 0.06) between non-HAM and HAM. By hospital system, significant variability in override rates and override to reprogram ratios were seen. By pump type, there were no significant differences in the mean override rates (Baxter: p = 0.09; BD p = 0.34; ICU Medical p = 0.18) and the mean override to reprogram ratios (Baxter p = 0.84; BD p = 0.03; ICU Medical p = 0.63) between non-HAM and HAM. CONCLUSIONS These findings indicate that the majority of alerts generated are bypassed by clinicians at the point of care, a symptom of alert fatigue. Given the potential for significant patient harm with HAM and the high DERS alert override rates that routinely occur during IV medication administration, this study provides further support for clinician-driven IV smart pump innovation to improve alert fatigue.
Collapse
Affiliation(s)
- Kathryn K Marwitz
- Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN, 47907, USA.
| | - Karen K Giuliano
- Bouvé College of Health Sciences, 360 Huntington Avenue, Boston, MA, 02115, USA.
| | - Wan-Ting Su
- Center for Bioinformatics and Department of Public Health Science, Henry Ford Health System, One Ford Place, Detroit, MI, 48202, USA.
| | - Dan Degnan
- Professional Programs Laboratory, Clinical Assistant Professor of Pharmacy Practice (Courtesy), Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN, 47907, USA.
| | - Richard J Zink
- Regenstrief Center for Healthcare Engineering, Purdue University, Gerald D. and Edna E. Mann Hall, Suite 225, 203 S. Martin Jischke Drive, West Lafayette, IN, 47907-2057, USA.
| | - Poching DeLaurentis
- Regenstrief Center for Healthcare Engineering, Purdue University, Gerald D. and Edna E. Mann Hall, Suite 225, 203 S. Martin Jischke Drive, West Lafayette, IN, 47907-2057, USA.
| |
Collapse
|