1. 1 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Lee Memorial Health System Smart Pump PI Team Smart Pump Loading Dose Feature Amiodarone IV FM# 2775 Rev. 05/13 December 21, 2015

2. 2 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Smart Pump Loading Dose Feature FM# 2775 Rev. 05/13 Rationale and Benefits of this feature: The Loading Dose feature in the Smart Pumps can accurately deliver a pre-programmed loading dose from an IV infusion with just the push of a button. Utilizing this feature will: o Decrease the number of times IV lines are accessed, reducing risk of infection o Decrease workload for nurses because a separate loading dose does not have to be infused before starting the continuous infusion o Decrease workload for nurses because the pump can be pre-programmed, fewer pump entries are needed o Decrease workload for Pharmacy because a separate loading dose does not have to be compounded and delivered o Cost and labor savings for the Health System

3. 3 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System AMIODARONE Loadng Dose from the Pump – this will require separate orders for the bolus dose and the infusion The MAR – Pharmacy will enter separate orders on the MAR for the infusion and the loading dose. The infusion has a frequency of “Continuous ” The Loading Dose has a frequency of “Once” The Loading Dose order will Complete after it has been documented as “Given”

4. 4 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System MAR View with Details.

5. 5 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Loading Dose from the Pump – this will require separate orders for the bolus dose and the infusion. Scanning the bar code on the IV bag will bring up both the loading dose and the infusion orders. The infusion has a frequency of “Continuous” The Loading Dose has a frequency of “Once” The Infusion has an administered dose range The Loading Dose has a specific dose equal to the total load

6. 6 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Loading Dose from the Pump – this will require separate orders for the bolus dose and the infusion. Selecting the Loading dose opens the order details The Loading Dose details show that 150 mg will be administered over 10 min. and the volume infused will be 83.33 ml

7. 7 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Documenting the Infusion – Scanning the bag a second time brings up both orders again, but now you can see that the loading dose has been administered in the “Last Admin” column. Selecting the infusion order opens the order details section

8. 8 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Documenting the infusion – the dose range of 0.5 – 1 mg/min. defaults in, just as it does now. Enter the rate in the dose field. The system prompts the user to enter the actual rate (should always be 1 mg/min for the first 6 hrs.)

9. 9 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Documenting the infusion – Completed documentation Documenting the Loading Dose – the completed loading dose will drop to the Completed Medications section of the MAR

10. 10 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Programming the Pump Amiodarone – the pump has been programmed to deliver the loading dose plus the initial rate of 1mg/min. x 6 hrs. The Pump will then stop and alarm to alert the RN to change the rate to 0.5 mg/min. for the duration of the drip (x 24 hrs., or till DC’d by Physician). Load Volume = 84 ml (150 mg / 1.8 mg/ml) Initial infusion volume = 198 ml (33 ml/h x 6 hours) Total volume load + Initial 6 hr. infusion = 282 ml Pre-programming the “Volume to be Infused” (VTBI) to 282 ml will cause the pump to stop and alarm after the loading dose and initial 6 hr. infusion have completed Pump Entries for Amiodarone IV with Loading Dose: Care Area: Critical care “ICU Trial Amiodarone” Or “Amiodarone ICU Trial”

11. 11 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Programming the Pump - Amiodarone VTBI is pre-programmed to account for the load and 6 hour infusion at 1 mg/min. The option to deliver a loading dose appears when the drip is started.

12. 12 PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System Programming the Pump - Amiodarone Loading dose = 150 mg over 10 min. This is pre- programmed in the pump. After the Loading dose has completed the pump will automatically revert to the programmed rate of 1 mg/min Because of the pre-programmed VTBI, the pump will run for 6 hours at this rate After 6 hours, the pump will revert to 16.7 ml/hr. which has been set as the KVO rate for this pump entry. This is the correct rate to deliver 0.5 mg/min for the remainder of the infusion per the amiodarone order set. Using this rate as the KVO default will ensure that the patient continues to receive the med if the RN can’t get back timely to change the settings for the next phase of therapy. The pump will alarm because the VTBI will have to be reset in order to stop the pump from alarming.

13. 13 Questions? PATIENT SAFETY WORK PRODUCT—Created as part of LPSES - the LMHS Patient Safety Evaluation System We are Caring People, caring for People.