1. Wireless Smart Pump Updates: Exploring the Details
Dennis M. Killian, Pharm.D., Ph.D.
Pharmacy Director
Peninsula Regional Medical Center
Associate Professor
Pharmacy Practice and Administration
UMES School of Pharmacy

2. Disclosure
The views and opinions presented are entirely my own. They do not necessarily reflect the views of Peninsula Regional Medical Center or the University of Maryland Eastern Shore School of Pharmacy.
I have served as a speaker on behalf of Baxter Healthcare in regards to IV infusion devices and how to achieve a high level of drug library compliance.

3. Objectives
To discuss the a multitude of factors that impact the ability to efficiently publish wireless medication updates to smart pumps.

4. Peninsula Regional Medical Center
Peninsula Regional Medical Center is located in Salisbury, Maryland which is situated on the Eastern Shore of Maryland about 30 minutes west of the Atlantic Ocean. We are a 289-bed, level-2 trauma center. Key service lines include: cancer institute, heart & vascular institute, orthopedics, emergency and trauma medicine, and both women’s & children’s services.

5. Peninsula Regional Medical Center
Peninsula Regional has been named a top wired hospital, by the American Hospital Association, for 8 straight years.

6. Infusion Device Wireless Integration
Image:
Introduction:
Smartphone users can sympathize:
Operating System (OS) updates can be cumbersome and time consuming
Not enough space for update
Download takes a long time
Update requires power cycle (phone turns on and off)
The update doesn’t complete
Result: Frequently avoid and procrastinate doing updates as a result
Downside: Can’t take advantage of new OS features
Translates to Smart Pumps with drug library updates (move to next slide for drug library/DERS explanation)

7. Keeping your IV pumps up to date
Brief discussion about pushing out wireless updates and keeping your entire fleet of IV pumps up to date

8. Keeping your IV pumps up to date
Brief discussion about pushing out wireless updates and keeping your entire fleet of IV pumps up to date

9. Keeping your IV pumps up to date
Brief discussion about pushing out wireless updates and keeping your entire fleet of IV pumps up to date; we have 726 IV pumps

10. Infusion Device Wireless Integration
Talking Points:
Going back to the smartphone update example
Keeping drug libraries up-to-date is essential to reducing variability at the bedside and helping ensure clinicians can take advantage of this key safety feature.
Similar to smartphone updates, cumbersome drug library updates, prevent the drug library from being useful to clinicians. This is certainly something we experienced at our hospital prior to the implementation of the Sigma Spectrum Infusion System.

11. Infusion Device Wireless Integration
Wireless connectivity is more complex than simply connecting to “WiFi”
Bi-directional wireless integration is the goal
Drug library updates
Data from a central hosted server to the pumps
CQI data
Data from pumps to a central hosted server

12. WiFi for Smart Pumps From an IT Perspective
Radio Frequency
2.5 GHz
b, g, or n
b being the least preferable
5.0 GHz
a, n, or ac. 
5.0 GHz preferred since 2.5 GHz only provides for 3 non-overlapping channels where 5 GHz can support over 20 channels allowing for better performance and less interference.

13. WiFi for Smart Pumps From an IT Perspective
Wireless Security Protocol
Acceptable
WPA2 enterprise security
Best option
Extended Authentication Protocols (EAP) such as PEAP (username/password) or Transport Layer Security (TLS) which makes use of certificates.
Not preferred
Pre-shared Key (PSK) can be used but is not very scalable.  Changing the PSK would require having to change settings on all of the pumps and any other devices using that wireless network.

14. WiFi for Smart Pumps From an IT Perspective
Wireless Network
Wireless assessment
High availability
Uninterruptible power supply (UPS)
Redundancy
Wireless controllers
Power supplies
All areas covered by 2-3 access points
Security
Restrict network traffic to/from pump
Network port restrictions

15. Factors Influencing Drug Library Updates
EHR
Order Sets
CQI
Reports
EHR
Drug DB
IV Pump
Drug Library
User
Feedback and Practices
P&T
Many competing factors to keep your drug library up to date
Drug Shortages

16. Factors Influencing Drug Library Updates
EHR
Order Sets
CQI
Reports
EHR
Drug DB
IV Pump
Drug Library
User
Feedback and Practices
P&T
Many competing factors to keep your drug library up to date
Drug Shortages

17. Factors Influencing Drug Library Updates
EHR
Order Sets
CQI
Reports
EHR
Drug DB
IV Pump
Drug Library
User
Feedback and Practices
P&T
Many competing factors to keep your drug library up to date
Drug Shortages

18. Factors Influencing Drug Library Updates
EHR
Order Sets
CQI
Reports
EHR
Drug DB
IV Pump
Drug Library
User
Feedback and Practices
P&T
Many competing factors to keep your drug library up to date
Drug Shortages

19. Factors Influencing Drug Library Updates
EHR
Order Sets
CQI
Reports
EHR
Drug DB
IV Pump
Drug Library
User
Feedback and Practices
P&T
Many competing factors to keep your drug library up to date
Drug Shortages

20. Steps for Drug Library Updates
Modify the drug library
Finalize the drug library
Publish the drug library on the server
Push the drug library to the infusion devices
Monitor the progress of the library push

21. Steps for Drug Library Updates
Modify the drug library
Finalize the drug library
Publish the drug library on the server
Push the drug library to the infusion devices
Monitor the progress of the library push
Vendor-supplied software is used to perform the steps listed above. Steps 1 and 2 are usually performed via locally installed software that is only available to the infusion device administrator. Experience shows that steps 1 and 2 are similar among the various vendors.

22. Steps for Drug Library Updates
Modify the drug library
Finalize the drug library
Publish the drug library on the server
Push the drug library to the infusion devices
Monitor the progress of the library push
Steps 3 to 5 are typically performed on a local server that connects wirelessly to all the applicable infusion devices; implementation of these steps may vary widely among vendors. Some systems require significant manual intervention to ensure the library update is sent and the infusion devices are updated. Other systems automate the entire update process, ensuring efficient updates requiring minimal intervention.

23. Infusion Device Wireless Integration
Extensive Scheduling
Labor Intensive
1. Forced to move to semi-annual updates instead of quarterly updates
2. Frustration amongst staff due to change in drug library from pump to pump
3. Higher possibility of patient safety risk
Time Demands
Talking Points:
To conduct updates required extensive scheduling, it was very labor intensive, and demanded specific/dedicated attention from Pharmacy. Caused drug libraries to vary and be out-of-date.
Unable to do quarterly updates due to time commitment on my end and pump download time, moved to twice a year
This led to frustration on the nurse floor as drug libraries could differ from pump to pump
Finally, and probably our least favored consequence: opened up our hospital to higher possibility of patient safety risk
Different (outdated) Drug Libraries at the Bedside

24. Keys to Success Ensure all pumps are connected to a power source.
Software updates must not require any end user action.
Medication library must have the capability to be updated near real-time.
The entire pump fleet must be updated over a short period of time with minimal effort by the pump library administrator.
A reasonable expectation is that >90% of devices will receive the update within 1 day, and >95% of devices will receive the update in 2 to 3 days.
Add other keys to success that may not be on the slide
Some systems require continual pushes/monitoring; some do not

25. Infusion Device RTLS Integration
RTLS = real-time locating system
Peninsula Regional uses the Stanley Aeroscout system
Integration of Stanley w/Baxter Sigma occurred in early 2017
Sigma has an integrated RTLS tag in its battery module

26. Infusion Device RTLS Integration

27. Conclusions
Multiple variables impact the ability to efficiently publish medication library updates to your infusion device.
Collaborate with your IT department to optimize wireless hardware and parameters within your facility.
When researching infusion devices, be sure to investigate the efficiency of their system to receive wireless drug library updates.

28. References
Accessed: January 12, 2018
Accessed: January 12, 2018
Accessed: January 12, 2018