Category: Professional Posters
Purpose: Describe the process to implement smart pump–electronic health record (EHR) interoperability technology throughout a multi-facility community health system to improve intravenous (IV) medication safety and efficiency from its original 17 step manual process to seven steps with auto-programming.
Methods: It is critical to first identify stakeholders and develop a project plan. We identified the stakeholders to be EHR and pump vendors, nursing, pharmacy, information services, biomedical, facilities, cardiopulmonary, finance, and leadership. Next, we evaluated our current state – wireless network, technology usage and barcode compliance, nursing workflows, computerized provider order entry (CPOE), and pump drug library settings. Then, an extensive review of every IV medication build with all corresponding dosing options occurred followed by testing across the interface from the EHR order to the pump library. Areas and patient situations that will not use interoperability were labeled as out of scope and defined.
Nursing workflows and drug library clinical care areas were explored by stakeholders from nursing, an EHR Clinical Documentation Analyst, and the Pharmacy Integration Nurse. After build was complete and standard workflows defined, extensive testing was conducted throughout the EHR and the pump drug library in a distinct test environment. Testing was conducted by EHR analysts and pharmacists and repeated by bedside nurses. Testers reviewed auto-programming, EHR and intake flowsheet documentation, and popup alerts or error messages prior to go-live. Problems were corrected in real time or tracked to be included as points for end user education.
The final step was to complete a thorough Failure Modes Effects Analysis with key stakeholders where follow up was assigned to address identified concerns.
Results: An IV Pump Steering Committee was formed and met weekly with subgroup meetings, tasks, and assignments occurring in between. Unique patient care drug libraries were reduced from 22 to 9. Three rounds of testing were completed on 1400+ medication orders ensuring the order auto-programs the pump, closes without alerts, and documents rate, dose, and volumes correctly to the EHR. Seven key nursing units were identified to guide standard workflows. Seven out of scope units and six out of scope patient care situations were defined. Eighteen nursing workflows were standardized across eight facilities and more than 50 departments. Over 5500 nurses were trained over 10-weeks using a multimodal training approach, including a terminology e-learning and instructor led classes. The 2-hour class sessions included an interoperability overview, 1-2-minute demonstrations workflow videos created by our team, followed by hands on exercises. Individualized educations were also created for out-of-scope areas, pharmacy, and providers. The project was completed in 18-months from kick-off to successful go-live.
Conclusion: Assessment of current state technology should start early. A multidisciplinary approach is critical to ensure all aspects of the project are aligned. A dedicated resource to serve as a liaison among the stakeholders with existing knowledge of pharmacy and nursing is invaluable. Collaborating with the EHR, facilities, and biomedical will minimize delays. Implementation will not be without challenges and delays and is achievable within a reasonable timeframe. Following up with ongoing communications that are identified by end users, event review analysis, and proactive assessment of data allows the system and end user experience to continuously improve.