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MAKING SMART PUMPS SMARTER, MAKING IV THERAPY SAFER


thrombosis, myocardial infarction, stroke and pulmonary embolism may differ, even though alteplase is used in all.


Implementing a Guardrails® drug library data set in


a hospital is a challenge and requires coordinated project management. In a classic installation, the implementation team should have:


› An executive-level sponsor or local champion who can commit resources to the implementation process and escalate issues to support implementation and remove barriers


› A hospital project manager who coordinates the project. › A lead pharmacist who supports the development of the data set in consultation with clinicians


› A nursing education lead who coordinates competency- based education


› Nursing clinical leads from profi le (clinical) areas who provide input for profi le-specifi c confi gurations (such as air-in-line threshold and occlusion-pressure defaults), and the drug library. They also participate in testing and approval of the data set


› A senior anaesthetist to represent specialty needs of the anaesthesia department


› An IV therapy or specialist nurse to analyse likely impact on current IV practices


› A biomedical department lead who commits resources to maintaining the Guardrails®


software and to


ongoing upload of new data sets and CQI downloads. In some hospitals, there is also a commitment by biomedicine to use the facility’s wireless network to ‘asset track’ smart pumps. This can be helpful when new data sets are uploaded or for preventative maintenance, as each pump can be located via its tracking tag. Any pumps that have missed the latest data-set update can then be identifi ed.


Creating a Guardrails® DERS data set can be a diffi cult


and time-consuming process and often involves the resolution of confl icting ideas from stakeholders. But it is also a process of discovery and learning. It frequently leads to a rolling back of previous assumptions about current practices versus expected practice. Potentially unsafe workarounds used by clinicians, such as boluses being given by volume rather than by dose, or wards and units that run infusions at set rates for each patient without reference to, or knowledge of, dose or safe dosage, are commonly uncovered. It must be clear during this process that fi nding individuals to blame is not the object of the exercise. What is required is a collaboration that brings actual practice in line with best practice and creates systems that facilitate evidence-based practice in every situation.


24 CareFusion Supplement BJN July 2013


Hospitals that use an Executive Dashboard for daily review of activity and risk would generate a Pareto chart (Figure 1) showing the top 25 drugs or fl uids contributing to alerts. This chart allows pharmacists, risk managers and IV therapy nurses to concentrate their efforts to create safer systems or to target staff education around specifi cs rather than around general IV safety (Schneider, 2002).


For example, if a hospital identifi ed that vancomycin was involved in 30% of ‘good catches’ (where the system has prevented a dangerous administration from taking place) further analysis would be warranted. Profi le charts could pinpoint specifi c care areas with frequent near-error events. Reports can be of


› Implementing a drug library data set requires coordinated project management ‹


Extending smart pump potential: integration and review As discussed earlier, Guardrails®


CQI Reporter®


hard and soft limits


(the dosing rules) are only of value if they enhance patient safety, and what is perceived as occurring in a facility and what actually occurs is the perceived quality gap. The Guardrails®


is one


way of reviewing both ‘perceived versus reality’ and checking the effectiveness of the IV therapy rules.


Smart pumps record all patient events for extended periods of time and can transmit these data via networks to a central server. This provides a wealth of data, but Lee et al (2010) suggested that, currently, ‘there is negligible use or review of error logs in the healthcare sector’. The CQI Reporter®


uses fi elds of enquiry to


allow users to make sense of large volumes of data and sorts it into usable and easily accessible information. This increases the opportunities for using data to drive improvement and change. Having all infusion modalities on one Alaris®


platform (large volume pumps, syringe


drivers and patient-controlled analgesia pumps) and using a CareFusion Systems Manager to collect, compress and encrypt these data, avoids a common hospital problem of entrapment of data in multiple medical devices that cannot be accessed and integrated into quality reporting.


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