Pursuing 100: MDL Creation Considerations Jason Demuth, PharmD, BCPS Senior Pharmacy Consultant REMEDI CONFERENCE 2017 Rosemont

Describe the process of analyzing pump programming practices Purpose Describe the process of analyzing pump programming practices Identify opportunities to improve compliance Identify opportunities to improve compliance, increase safety utilizing a properly constructed drug library Analyze appropriate review of library using CQI reports

MDL Creation Considerations If you don’t break a limit, you can’t track with CQI analytics For best results have limits on everything that is clinically meaningful Continuous Quality Improvement (CQI) insight supports high DERS compliance Examine by care area to determine where MDL updates or education could increase compliance

Frequency of reporting typically set by P&T committee CQI Reporting Frequency of reporting typically set by P&T committee Makeup of committee that examines and receives reports should reflect hospital Departments, pharmacy, nursing, medications safety committees, etc. Examine soon after go live (or major MDL update) to look for obvious issues Establish a normal cadence afterwards Monthly or quarterly are typical

Process Improvement flowchart

Understand how library is being used Review the Top Ten drugs most frequently programmed – identify “phantom” infusions. Review BASIC mode programming details to understand common dosing units used, common concentrations and doses programmed. This may help identify drug(s) that are not in the drug library or have concentrations that are not consistent with current practice. In addition to reviewing reports, one of the best ways to understand drug library gaps is to conduct targeted observation audits (drug rounds). Review soft/hard limit reports and identify Top Ten drugs with the most programming limit alerts and review common doses programmed against preconfigured safe dosing ranges.

Best Practices – Real hospital examples This is one CQI report from a typical hospital, approximately 300 pumps Typical hospital with issues presented that happen in many hospitals. CQI Workflow utilized: DERS compliance (95%) Soft Limit report Hard Limit report Pivot tables to filter more efficiently on reports

Soft Limits exceeded report look for things that actually happened May need to go back to original data set (filtered table) to determine date, care area, and access point if needed to follow up. Filter on specific drug, examine description for explanation of what was entered and where the limits were that triggered an alarm. Look at both total count, as well as critical medications. If it didn’t break a limit, you didn’t capture it

INSULIN DRIP – No hard upper limit Also a 999 units/hr entry. Separate pumps/days

Consistent limits if appropriate

Different concentration, different limits

Filter “Pullback” to see “near misses” Soft Limits exceeded report – filter “Pullback” Pivot table

Look for potential alarms Soft limits report – double confirmation

Change in practice?? No change in pump library?

Thank Goodness for hard limits Heparin 20 units/hr is common with change to smart pumps. Too many others to list!

Hard limits can help prevent mix ups with wt-based and non-wt based Baxter and Sigma Spectrum are trademarks of Baxter International Inc. USMP/361/16/0049 06/16

Thank You REMEDI Conference 2017