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MAKING SMART PUMPS SMARTER, MAKING IV THERAPY SAFER


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0 4115 2491 1351 1156 18% 11% 30% 33% 36% 38% 41% 43% 45% 47% 49% 50% 52% 53% 55% 56% 57% 59% 60% 61% 62% 63%


21% 25% 28% 1109


1041 1002 958 945 936 788 765 739 638 578 574 566 506 498 495 455 436 410 389 384


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Drug


Figure 1: Figure 1: Daily Pareto charts showing the top 25 drugs or fl uids contributing to alerts allow Pharmacists, Risk Managers and IV Therapy Nurses to target their activity and education.


signifi cant value when targeting education. Equally, closer analysis of the type of limit (soft or hard) being breached (Figure 2) may indicate an issue with the data set values for this drug (Fields and Peterman, 2005). There has been work examining the effectiveness of soft limits versus hard limits that suggests that soft advisory limits may be overridden without full review of the situation by clinicians (Graham et al, 2010). The removal of the soft limit and a ‘tightening’ of hard limits for dose, concentration and duration might be indicated for a drug that is showing a signifi cant number of overrides of soft limits.


Chronograms (Figure 3) can be of value to nurse managers because alert spikes in the chronogram may indicate higher risk periods at particular times of the day. Workfl ow changes may reduce these risk peaks. For example, IV medication administrations given at 11am might clash with medical rounds, pharmacy deliveries and preoperative patient preparation. Retiming of IV medications or redistribution of other tasks might be considered with CQI Reporter®


alerts data being used to


measure the effectiveness of changes. Use of CQI Reporter®


charts of clinician action by care


area will show how often clinicians are overriding infusion entries. A large number of overrides may indicate too many nuisance alerts or it may indicate there is a mismatch between clinical practice and the limits in the data set. In IV risk management, we are always interested in the relationship between the safety systems and policies used and what in reality is


occurring at the bedside. Being able to view clinician activity through clinician recorded programming and keystrokes can bring us closer to understanding the reality of practice. Thimbleby and Cairns (2010) suggested that data logs are ineffective if they only ‘record the result but not the user’s exact actions’. CQI Reporter allows us to infer the clinician’s intent through


BJN July 2013 CareFusion Supplement 25 Number of alerts 00:00 23:00 22:00 21:00 20:00


17:00 18:00 19:00


16:00 15:00 14:00 13:00 12:00


Figure 2: Profi le charts that pinpoint the type of limit (Soft or Hard) being breached may indicate an issue with the Data Set values for individual drugs


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Number of Alerts


..IVF Plain VANCOmycin magnesium sulfate propofol (DIPRIVAN) ..IVF POTASSIUM chloride HYDROmorphone PCA AMPicillin piperacillin/tazo .IVF + Additives heparin potassium chloride metronidazole .IVF + KCL morphine MAG sulfate RIDER levofloxacin cefTRIAXone HYDROmorphone Lactated Ringers ..maintenance IVF ceFAZolin azithromycin morphine PCA DOPamine


Cumulative Frequency of Alerts


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