1. © Aurora Health Care, Inc. Alaris Pump Compliance Julie L. Kindsfater (Puotinen) October 2013

2. © Aurora Health Care, Inc. Aurora Health Care Private, non-profit 15 hospitals 159 clinic sites 30,000 caregivers 1.2 million patients

3. © Aurora Health Care, Inc. AHC compliance – IPI chart January – August 2013

4. © Aurora Health Care, Inc. AHC compliance by profile August 2013

5. © Aurora Health Care, Inc. Achieving high compliance – set high expectations Set an objective goal and incorporate into your institution's safety goals –E.g. compliance at least 90% in all profiles –Supported by hospital, nursing, and safety leadership –Communicated to and understood by staff –Achievable with your data set

6. © Aurora Health Care, Inc. Achieving high compliance - accountability Define accountable parties and process to respond to compliance data System Alaris analytics team –Nurse representative from each site, drug policy, risk management –Review system data, share lessons learned, review library change requests, discuss system-level issues Site-based Alaris analytics teams –Nurse (from system committee), pharmacy, quality, risk –Review site data, create and implement site action plan for performance improvement, identify issues to forward to system team –Compliance data sent to team members and site Chief Nurse Officer

7. © Aurora Health Care, Inc. Achieving high compliance – data set Standard concentrations Drug names match eMAR entry Entries accommodate clinical practice and order sets Provide additional tools as needed Solicit feedback –E.g. Alaris email for library questions/issues

8. © Aurora Health Care, Inc.

9. Dashboard – v.1 February 2011

10. © Aurora Health Care, Inc. Dasboard – v.2 February 2012

11. © Aurora Health Care, Inc.

12. Dashboard v.4 Q2 2013

13. © Aurora Health Care, Inc. Addressing low compliance Investigate –Identify root causes/contributing factors –Solicit feedback –Compliance rounds Engage accountable parties Re-educate –What and why

14. © Aurora Health Care, Inc.

15. AHC compliance by profile August 2013

16. © Aurora Health Care, Inc. AHC – pediatric profile Discussed with nursing practice council and pediatric nursing groups Clarified profile name and moved to 1 st screen Revised fluid build Re-educated nurses on rationale for using library entries and age definitions Monitored and reinforced

17. © Aurora Health Care, Inc. Improving compliance – optimization Drug# Alerts% alerts overridden Proposal Blood products33987%Change soft min from 25 mL/hr to 10 mL/hr Propofol ANESTH23299%Change anesthesia alert limit to 150 mcg/kg/min Irinotecan20794%Change duration soft min to 80 min (i.e. distinguish from default of 90 min) Vasopressin ANESTH28199%Change anesthesia alert limit to 0.4 units/min Sodium chloride 3%91100%Change soft max from 35 to 50 mL/hr Etoposide92100%Change duration soft max from 90 min to 12 hours PCA lockout49100%Change PCA lockout soft max from 20 min to 30 min AHC - minor changes should eliminate 17% of all Guardrail alerts (white noise)

18. © Aurora Health Care, Inc. Concerns and lessons learned at other organizations?