Category: Professional Posters
Purpose: Smart pump drug library use is associated with improved medication safety and lower potential for infusion errors. The safe guards will not be realized unless the drug library is used during infusion administration which is measured through the library compliance metric. Attaining and maintaining high library compliance requires education, training, and continuous monitoring efforts. ISMP has recommended that drug library compliance meet or exceed 95%. This report describes the results of a community hospital system’s actions to improve overall drug library compliance by decreasing the use of “No Drug Selected” with both manual programming and auto programming.
Methods: In 2018, a medical system initiative was launched to increase smart pump programming compliance in preparation for expansion of electronic health record (EHR) capabilities to include capture of infusion delivery detail. Historic analytic data demonstrated that the hospital system had less than 50% drug library compliance with manual programming and during the initial stages of interoperability. After an infusion pump update in 2017, smart pump programming compliance increased to approximately 70%. However smart pump safety features continued to be bypassed through utilization of a drug library entry called “No Drug Selected”. “No Drug Selected” lacks safety limits and exists to enable manual pump programming when interoperability is not available for a scheduled infusion.
Medical center resources were dedicated to initiate infusion system performance improvement. The infusion pump vendor was included in the process to bring data analytic resources and visibility to infusion pump utilization over time. Initiatives included making the “No Drug Selected” entry accessible through a search rather than at the top drug library location, refinement and alignment of the drug library to practice, and a system wide campaign to promote smart pump programming with interoperability and utilization of the drug library when manually programming. Analysis of infusion pump data from two study periods, May 2018 and April 2019, was undertaken and shared with health system leadership for evaluation.
Results: The initiative included 8 hospitals which share a common drug library with 15 clinical care areas. In May 2018, overall smart pump drug library compliance was 69.2% of 411,966 infusions. In April of 2019, the compliance had increased to 93.5% of 455,396 infusions. The compliance increase correlates to 140,462 additional infusions delivered within the protective limits of the drug library. In the 2018 study period, “No Drug Selected” was utilized in 30.8% of programs or 127,067 infusions. In 2019, the use of “No Drug Selected” decreased to 6.5% of programs or 29,541 infusions. In the 2019 study period, the range of compliance across the hospitals was 91.8% to 96.8%.
The largest gains in compliance from 2018 to 2019 were observed in Oncology (39.5% to 78.0%, +38.5%), MedSurg (63.0% to 96.3%, +33.3%), ED Adult (60.8% to 92.9%, +32.1%), and PCU (65.1% to 95.7%, +30.6%). The highest compliance rate in 2019 was in Anesthesia at 97.5%. The greatest increase in the number of compliant infusions was in the ICU which showed a 16.5% increase in compliance, from 79.3% to 95.8%, correlating to 28,368 additional infusions delivered within the protective limits of the drug library.
Conclusion: Drug library compliance during manual pump programming and smart pump programming with interoperability requires ongoing education, training, and accountability for success. This descriptive report presents the successful outcome associated with an effort across a health system to increase drug library compliance. The overall compliance gains seen in a one-year time frame demonstrate that broad improvements are possible across multiple facilities and care areas. These results also suggest that the ISMP recommended compliance targets of 95% during manual programming and smart pump programming with interoperability are attainable. Further studies are required to confirm and evaluate the clinical significance of these results.