Infusion Management Implementation Karen Corrick, BSN, RN Great River Medical Center – Burlington, Iowa

Objectives To describe Great River Medical Center and our journey to integrate our BBraun Infusion pumps into our EHR – Cerner Millenium. To describe issues during the integration build. To describe ongoing issues with system maintenance and nursing staff use.

GREAT RIVER MEDICAL CENTER

Great River Health Systems Demographics GRMC is part of Great River Health Systems, a privately owned, independent 378-bed regional, integrated health-care system which covers a five county area with the main services in Des Moines County, Iowa Acute Care Licensed Beds – 213 All others are Long Term Care Beds – 165 Average Daily Census – YTD for FY14 – 73.8 Emergency Dept visits – FY 2014: 32,157 Newborn deliveries – FY14: 569 Inpatient Admissions – Adults and Children, FY 2014: 6,125 Outpatient procedures – FY14: 746,129 Pharmacy hours of operation – 24/7 Medical Staff Members – 129 Number of GRHS employees – 2,012

Acute Inpatient & Outpatient Key Services OB/GYN Orthopedics Spine Surgery Cardiology Interventional Cardiology Behavioral Health Digestive Health Surgical Rehabilitation Hospice Home Health Care Emergency Department

Hospital-based Clinic Services Wound & Hyperbaric Cardiology Cancer Care Business Health Rehab Center Wapello Physical Therapy Pain Management

Integration Device/Systems BBraun Outlook 400 ES Cerner Millenium

Team Effort

Biomed Overview ICommand The Millenium iBus shows what devices are associated to make sure data is flowing.  Viewing tool to check what is running and what is used to point devices to a non-prod domain. The Millenium what the nurses and doctors use to see the actual data: Anesthesia, Fetalink, Lab, CareAware/Iaware, Pharmacy dashboards iBus is the main hub of data.  iCommand is the first check. Multiple domains – 1 PROD and 1 NonProd

BioMed Issues We were the test site for our BBraun Outlook 400 ES Infusion pumps with Cerner Millenium Needed another IP address from Cerner Our Biomed department did not receive more than a few minutes of training Pumps needed scanning barcodes.  We had 2 different types of scanners and this caused issues in our testing.  Barcodes were built according to Cerner recommendations.  Changes being made by Cerner, without our knowledge, for their testing purposes, caused issues

Information System Overview Interface mapping Servers Back up for Biomed and iCommand

Infusion Pump Issues Bbraun pumps needed an update to help with connectivity issues.   All the pumps were assigned a static IP address to prevent roaming, in addition, to the IP address Cerner provided.  Drug mapping file on each pump needs to be updated and matched in iCommand.  Process for keeping the drug library matching. The drug file in iCommand updates all of the pumps. 

Nursing Informatics Issues Testing of the various continuous IV medications administered by Nursing staff Many points in the process where issues could occur Medications based on weight or age needed extra testing IVPB testing versus continuous infusion testing Medications without a diluent were an issue Premixed meds were an issue Anesthesia medications after surgery continued into ICU Rates and volume issues Workflows and various processes from department to department: ED, PACU, ICU, Med/Surg areas Generic access dashboards for iAware

Staff like the functionality of making changes on the IV pump setting, then having this change date/timed in their documentation. They verify and sign. Staff like the Intake automatically populating into their documentation.

Current Nursing Issues Staff ‘Buy in’ Staff knowledge of what to do when part or all of the process isn’t working (trouble shooting) Inconsistencies with staff signing all documentation and making sure they are signing in the correct place ICU/CCU is doing one process, the Med/Surg areas are doing another process Anesthesia issue with data flowing

Lessons Learned Meet with all vendors/engineers together early on. This will diminish finger pointing at others when something isn’t connecting. Have a mature EHR system prior to integration. Building a system and integrating devices doesn’t work. Pharmacy involvement is key during the build, go live and ongoing monitoring.

Key Clinical Success Improved patient safety by: Medication scanning to set dosage rates on the IV pump Medication scanning to improve patient identification for high risk medications Pharmacy real-time dashboard of IV medication use (DoseTrac) Forces upfront work to review and maintain your IV pump drug library

Questions???