1. Improving Medication Safety: Closing the Loop with Smart Infusion Systems and EHR Interoperability
Presented by:
Tim Vanderveen, PharmD, MS

2. © 2012 CareFusion Corporation or one of its subsidiaries
© 2012 CareFusion Corporation or one of its subsidiaries. All rights reserved. FOR INTERNAL USE ONLY

5. Insights from the Sharp End of IV Medication Errors
Objectives: To determine actual type, frequency and severity of medication errors associated with IV pumps
Findings: 426 medications being infused (8hr. assessment)
285 (67%) had one or more error
Identified 389 errors in 426 infusions
Of those, 37 were rate errors (3 programming errors)
1 serious/life-threatening error
Conclusion: Complexity of IV therapy requires an integrated approach
CareFusion Foundation is supporting AAMI/Dr David Bates to repeat study in 10 hospitals
Husch et al. QHC.BMJ.journals.com 12 April, 2005
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

6. Medication and Dose Infusing via IV pump
Error Examples
Medication and Dose Infusing via IV pump
Medical Record Order
Heparin infusing at 200 u/hr
Order was 1200 u/hr
Hydromorphone 2mg every 15 minutes prn
No new order upon transfer to ICU in medical record
Amiodarone 0.5mg/minute
Order written 5 days prior: Amiodarone 1mg/min x 6 hours then 0.5mg/min x 18 hours
Hydromorphone 0.5mg every 15 minutes prn
Hydromorphone 0.2mg/mL
@ 1 mg every 15minutes
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

7. University of Wisconsin Pediatrics ICU Study
30-bed Pediatric ICU Unit
Compare CPOE Orders to Smart Pump Programming
296 drug infusions and 231 fluid infusions observed
24% of drug infusions and 42% of fluid infusions had discrepancies
Anti-infectives, concentrated electrolytes and anticoagulants had highest frequency of discrepancies
Qual Saf Health Care 2010;19(Suppl 3):i31ei35.doi: /qshc
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

8. 2013 Repeat of Northwestern Study
31%
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9. Guardrails® Safety Software
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10. Guardrails® Safety Software: More than dose limits
Max and Min Dose Limits
Patient / Area Specific Drug Libraries
Channel Specific Drug Display
Backward Compatible
Clinical Advisories
SE Picture
Occlusion
Pressure Limits
Patient / Area Performance Limits
Maximum
Weight Limits
Guardrails Event Log
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

11. In the First Decade, Infusion Pumps Have:
Fostered development of drug dose limits
Configured pumps to match applications
Uncovered high degree of variation in infusion practices
Documented many “good catches”
Identified human factors issues/opportunities
Provided a “treasure trove” of infusion data
Promoted wireless connectivity/server applications
Been limited to drug/therapy/patient type
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

12. Smart Infusion Pumps Have Not:
Typically assigned to specific patients
Been aware of intended therapy
Prevented drug mix-ups, incorrect library selection
Recorded identity of caregiver/ reason for overrides of limits
Populated infusion records
Maximized value of bar code medication administration systems
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

13. Connection Technology to Improve Patient Safety
CPOE initiates med order
Pharmacy verifies med order
EMR schedules med order and automatically updates automated dispensing cabinets (ADC)
Medications IV compounded and/or removed from ADC
BCMA 5-rights at the bedside for non-IV pump medications.
IV pump auto-programming 5-rights integrated with BCMA
IV pump status automatically populates EMR
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

14. Scan the patient identification band
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15. Scan the medication bag or syringe
© 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved.

16. Scan the pump
© 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved.

17. Confirm and start
© 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved.

18. Benefits of a Closed-Loop IV Medication Safety System
Reduction in IV programming errors
More accurate and timely documentation
Reduction in alarms and alerts
Promotes a new level of standardization; helps eliminate error prone variation from policies and procedures
Provides remote viewing of infusion status directly to clinicians
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

19. Key Lessons Learned with EMR Interoperability
Requires collaboration between vendors and multidisciplinary hospital staff
Scope and go-live strategy must be determined upfront
An in-depth assessment of the current state is imperative
Must achieve 100% match between orders, formularies, and databases
Technology workflows and actual practice must be harmonized
Testing and retesting are required to identify potential failure points
Comprehensive training, go-live, and post implementation support are critical success factors
Interoperability requires a continuous improvement mentality
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

20. Infusing Patients Safely: Our Future Vision
Infusion pumps will be associated with both patients and caregivers
Image recognition (bar code, RFID tags) will be required to identify the IV drug/concentration being infused
Critical and/or missing lab values that impact IV infusions will be immediately communicated to the appropriate caregiver
All patients receiving high risk IV medications will be continuously monitored with appropriate vital sign monitoring
Critical infusion (and physiological) alarms associated with high risk IV infusions will be immediately presented to the appropriate caregiver
© 2015 CareFusion Corporation or one of its affiliates. All rights reserved.

21. Questions

22. Thank you