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

2. 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

3. 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

4. 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

5. Process Improvement flowchart

6. 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.

7. 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

8. 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

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

10. Consistent limits if appropriate

11. Different concentration, different limits

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

13. Look for potential alarms
Soft limits report – double confirmation

14. Change in practice?? No change in pump library?

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

16. 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/ /16

17. Thank You
REMEDI Conference 2017