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UI Hospitals and Clinics Smart Pumps Project Reduces Errors

University of Iowa Hospitals and Clinics’ new pump-EMR integration has resulted in a significant decrease in manual pump programming and increase in compliance.

IN FEBRUARY 2014, University of Iowa Hospitals and Clinics (UI Hospitals and Clinics) in Iowa City began electronically integrating its intravenous (IV) infusion pumps and electronic medical record (EMR).

The primary goal? Increase patient safety by preempting inaccurate manual keypad entries when programming infusions at the pump. Studies have shown that IV medication errors are associated with a high likelihood of patient harm compared with other routes of administration.[i]

A Huge Patient Safety Win

“Anytime you can automate a process, you remove the potential for human error,” said Jeff Killeen, Pharm.D., manager of pharmacy informatics with UI Hospitals and Clinics.

“Integrating our pumps with the EMR closes the gap between what happens after the prescriber orders a medication and what happens at the infusion pump,” he noted, adding that an additional goal was to prevent transcription errors that can occur when pumps are programmed manually. “Eliminating that source of mistakes is a huge patient safety win for any organization.”

Jeff Killeen, Pharm.D.

Pharmacists still verify the IV medication orders after they are entered into the EMR but now, the order is confirmed by a nurse and sent wirelessly to the pump. The nurse then verifies the medication details on the pump and starts the infusion, which documents the entire process and updates the EMR. This completes the data loop.

“The process is safer for the patient. The fact that there is less manual programming of the pump means there are far fewer chances for errors,” said Pamela Kunert, MSN, RN-BC, nurse practice leader in nursing informatics at UI Hospitals and Clinics. She added that in cases of downtime, manual programming is still used.

Increasing Compliance, Reducing Workarounds

The 700+ bed academic medical center (which includes a 190-bed children’s hospital) has steadily rolled out the pump-EMR integration across the entire health system. By early June, the initiative will be complete, according to Chief Pharmacy Officer Mike Brownlee, Pharm.D., M.S., FASHP.

Dr. Brownlee has already documented a significant decrease in manual pump programming as well as a jump in compliance from 86 percent to 92 percent for staying within upper and lower pump “guardrail” limits.

“That doesn’t sound like a big increase, but when you’re making hospital-wide changes like this, even a one percent increase in compliance is difficult to achieve,” said Dr. Brownlee.

Because infusion pumps are usually operated in isolation and manual keypad entry remains an enduring source of miscues, uncertainty about which drug and what dose a patient actually receives has been a nagging concern, added Alison Woods, Pharm.D., director of ASHP’s Section of Pharmacy Informatics and Technology.

Often, in fact, the pharmacist doesn’t find out for quite some time that a nurse has keyed in order information incorrectly or overridden safety stop “guardrails” on a pump.

“Pump integration creates much-needed transparency for all healthcare providers in the loop because now everyone knows with confidence what’s being administered, at what dose, and at what rate of delivery,” she said.

“That transparency creates an environment that no longer relies on reacting to mistakes and fixing problems retroactively after a patient has been harmed. This use of smart technology creates an efficient and safer patient care environment.”

Improved Efficiency Leads to Fewer Errors

The new system’s impact on pharmacist workflow has been very positive, according to Dr. Killeen.

“Before we had pump integration, the pharmacist had to manually check on factors such as infusion rates, current dose, and duration of infusion. Often this meant they had to physically check the pump itself,” he said. “If anything, the change has made our pharmacy team’s work easier because all of that information is tracked and displayed automatically in nearly real time within our EMR.”

…Nurses don’t have to worry about keypad entry errors. So, when an alert on the pump does occur, they know it’s something they need to pay attention to.

Dr. Killeen also noted that pump integration has meant a substantial reduction in the number of safety alerts, which has led to a corresponding drop in manual workarounds on the nursing administration side.

“When the order parameters are properly set up through the EMR with corresponding configuration in your smart pump library and pump integration is used, nurses don’t have to worry about keypad entry errors,” he said. “So, when an alert on the pump does occur, they know it’s something they need to pay attention to.”

Gaining Buy-In from Stakeholders

The sizeable benefits created by the pump-EMR integration didn’t come easily, according to Dr. Killeen, who emphasized the enormous amount of resources and resolve required to plan and execute the project.

“This type of system-wide project isn’t something to approach lightly,” he said. “It’s not something you can lump in and implement with other day-to-day changes.

“For such a large project to succeed, you must determine well ahead of time the resources you’ll need to carry it out and make sure they will be available.”

It took several pharmacists and pharmacy technicians six to nine months of very time-intensive work throughout planning and roll out along with countless hours spent by nursing staff, he said.

Dr. Killeen also underscored the importance of support from institutional leadership and from every area affected by the project.

“I wouldn’t even think about doing this if we didn’t have backing from at the very least the chief nursing officer, the chief pharmacy officer, and the chief medical officer,” he said. “Take your time and do it right; once you do, it’s definitely worth it.”

–By Steve Frandzel

[i] Proceedings of a Summit on Preventing Patient Harm and Death from IV Medication Errors. American Journal of Health System Pharmacy, Dec 15, 2008;65:2367-2379.