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Small Buttons, Large Consequences:

Programming Considerations for Smart

Pump Interoperability Implementation

Megan Holsopple, PharmD, BCPS

Medication Utilization Coordinator

Center for Medication Utilization

Froedtert & the Medical College of Wisconsin

Presentation Overview

• Review key considerations for smart pump

programming prior to interoperability

implementation

• Discuss considerations for data set

upgrades post-interoperability

2

Froedtert Health

Froedtert Hospital

585 inpatient beds

Infusion Clinic Services

Community Memorial Hospital

198 inpatient beds

Infusion Clinic Services

St. Joseph Hospital

70 inpatient beds

Infusion Clinic Services

Drexel Town Square

Primary Care

Urgent Care

Infusion Clinic Services

Moorland Reserve Health Center

Primary Care

Urgent Care / Emergency Department

Infusion Clinic Services

Town Hall Health Center

Primary Care

3

Froedtert’s Interoperability Journey

Project Timeline F

eb

rua

ry 2

01

6

Pro

ject K

ick-O

ff | T

ea

m M

ee

t n

’ Gre

ets

March 2016 – June 2016

Infusion Standardization

Smart pump profile condensing

Nursing Workflow Meetings

Connectivity Testing/Virtual Server Expansion

August 2016

Full Medication Testing

August – November 2016

Residual Medication Testing

Super-user training

Nursing education

November 2016

Implementation

De

ce

mb

er

20

16

– C

urr

en

t

Sm

art

Pu

mp

Ma

inte

na

nce

Re

po

rt E

va

lua

tio

n

April 2016

Targeted Medication

Testing

(20-30 medications)

Project Milestones

5

Baseline Requirements

• Barcode Medication Administration

• Smart Pumps

– Guardrails Editor® software upgrade

– Updated smart pump devices

• Servers and wireless connectivity

6

The Basics!

• Standardized infusion concentrations and

dosing units1,2

– No more than 2 concentrations if possible

– A single dosing unit for each medication

1. ASHP Standardize for Safety. https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/s4s-iv-adult-continuous-infusion-guiding-

principles.ashx?la=en. Accessed April 2, 2018.

2. ISMP’s Medication Safety Alert! Smart Pump Custom Concentrations Without Hard “Low Concentration” Alerts.

http://www.ismp.org/newsletters/acutecare/showarticle.asp?id=16 Accessed April 2, 2018. 7

Reviewed and aligned 270

continuous and intermittent

infusion concentrations!

Interoperability Groundwork

8

Pump and eHR Evaluation

Identifying eRX differences

at each hospital

Identifying any existing defaults:

1. Concentration

2. Base solution

3. Base Volume

4. Dosing Recommendations

5. Administration Practices

6. Compounding Practices

1

2 3

4

5

9

6

How Many Profiles Are in Your

Smart Pump? A. 3 – 5

B. 6 – 8

C. 9 – 12

D. More than 12

10

Out-of-Scope Areas

Pre-Interoperability

• 14 Total Profiles

Interoperability

• 7 Total Profiles

11

Smart Pump Profile Condensing

Pre-Interoperability

• 14 Total Profiles

Interoperability

• 7 Total Profiles

12

Interoperability Data Set Space

Available Programming

Space 14%

Programmed Space 86%

Figure 1. Pre-Interop Data Set (n=14 profiles)

Available Programming

Space 56%

Programmed Space 44%

Figure 2. Interoperability Data Set (n=7 profiles)

13

Profiles and Configurations

Interoperability

• 7 Total Profiles

14

Pump and eHR Interface

• Three requirements:

– Main ingredient dose, volume, and rate

– Identifier (ie, alias)

– Ability for medication to auto-insert a flowsheet

15

Pump and eHR Interface

• Three requirements:

– Main ingredient dose, volume, and rate

– Identifier (ie, alias)

– Ability for medication to auto-insert a flowsheet

16

Standardizing Alias Nomenclature

• Used first 3-5 letters of

medication name

• Identified standardized

concentration or dose

vs. a “wild-card” entry

• Denoted continuous “C” vs.

piggyback “PB” at the end

and used “BB” for bolus

from bag entries 17

Pump and eHR Interface

• Three requirements:

– Main ingredient dose, volume, and rate

– Identifier (ie, alias)

– Ability for medication to auto-insert a flowsheet

eHR

generating

values flowsheets

18

Project Timeline F

eb

rua

ry 2

01

6

Pro

ject K

ick-O

ff | T

ea

m M

ee

t n

’ Gre

ets

March 2016 – June 2016

Infusion Standardization

Smart pump profile condensing

Nursing Workflow Meetings

Connectivity Testing/Virtual Server Expansion

August 2016

Full Medication Testing

August – November 2016

Residual Medication Testing

Super-user training

Nursing education

November 2016

Implementation

De

ce

mb

er

20

16

– C

urr

en

t

Sm

art

Pu

mp

Ma

inte

na

nce

Re

po

rt E

va

lua

tio

n

April 2016

Targeted Medication

Testing

(20-30 medications)

Project Milestones

19

Sample Testing Example

20

Troubleshooting

21

Clinical Advisory Use

• Combination medication infusions

– Example: VD-PACE (cisplatin, etoposide,

cyclophosphamide)

22

Blacklisted Medications

• Will not prompt the nurse to scan the

pump when selected for administration

• Blacklisted medications:

– Investigational medications

– Patient-controlled analgesia

– Technology limitations

• Penicillin dosing and concentration in million units

in the eHR and units in smart pump

• Blood factor products

• Immune globulin titratable infusions

23

Project Timeline F

eb

rua

ry 2

01

6

Pro

ject K

ick-O

ff | T

ea

m M

ee

t n

’ Gre

ets

March 2016 – June 2016

Infusion Standardization

Smart pump profile condensing

Nursing Workflow Meetings

Connectivity Testing/Virtual Server Expansion

August 2016

Full Medication Testing

August – November 2016

Residual Medication Testing

Super-user training

Nursing education

November 2016

Implementation

De

ce

mb

er

20

16

– C

urr

en

t

Sm

art

Pu

mp

Ma

inte

na

nce

Re

po

rt E

va

lua

tio

n

April 2016

Targeted Medication

Testing

(20-30 medications)

Project Milestones

24

Data Evaluation

• Available data

– eHR

– Smart pump

– Staff feedback

• Data presentation

– PDF

– Raw

– Verbal

25

Pump Near Miss Report

26

Compliance

• Ability to drill down

– Area

– Clinician

– Medication

– Number of attempts

27

Near Miss Report Details

28

Compliance

• Goal of 90% compliance using smart pumps

• Update drug libraries based on reports

29

How often do you implement

smart pump changes?

A. Monthly

B. Quarterly

C. Semi-Annually

D. Annually

E. No established frequency

30

Data Set Transfer Frequency

Monthly Upgrade Advantages

• Accountability process with

compliance report

evaluation

• Addressing pump and eHR

mismatches

• Ability to address shortage

issues and new formulary

medications

Monthly Upgrade Disadvantages

• Multiple circulating datasets

being used in patient care

• Maintenance of smart pump

data set

Monthly following interoperability through August 2017 the

changed to bimonthly

31

0.32%

0.81%

98.87%

0.34%

100.00% 99.66%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Feb. 2018 Update Dec. 2017 Update Oct. 2017 Uptake

Perc

en

t o

f P

um

ps

Bimonthly Update

Dec-17

Oct-17

Aug-17

Jul-17

Mar-17

32

290

348 383 398 406 422

448 461

223

320 337 351 357 366 376 393

548

665

744 771

790 827

850 869

0

100

200

300

400

500

600

700

800

900

1000

Day 0(data setpush day)

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

To

tal

Nu

mb

er

of

Ala

ris

Pu

mp

s (

n=

10

92)

Oct-17Dec-17Feb-18

33

Internal Resources

34

Conclusions

• Infusion alignment and standardization of

concentrations will help streamline

interoperability work

• Standardized nomenclature for alias

assignment will help make interpretation of

interface failures easier

• Test, test, and test some more!

35

Future Vision…

• Optimization of smart pump

reporting tools

• Out-of-scope areas that

implement BCMA will adopt

interoperability technology

• The same smart pump

technology will be utilized across

the Froedtert enterprise

36

Acknowledgements

Project Management Office

• Lisa Vance Coss

• Nanda Kothinti

Pharmacy and Nursing Informatics

• Brian Dekarske

• Kaleb Fitch

• Lisa Knoebel

• Matt Selsing

• Jody Thompson-King

• Carlos Ortiz

• Tina Wagner

• Amy Wolf

Nursing

• Rose Gaskell

• All super-users!

FMLH Dept. of Pharmacy

• Kristin Hanson

• Shannon Werner

Biomed

• Jovo Acamovic

• Jon Mackay

Vendor Support

• BD

• EPIC

37

Small Buttons, Large Consequences:

Programming Considerations for Smart

Pump Interoperability Implementation

Megan Holsopple, PharmD, BCPS

Medication Utilization Coordinator

Center for Medication Utilization

Megan.Holsopple@froedtert.com