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Creating an Innovative IV Delivery System

THE STAFF AT WOMEN & CHILDREN’S HOSPITAL OF BUFFALO knows the value of speaking up. When it became evident that a new smart pump that Kaleida Health had introduced for use in its five-hospital system wouldn’t serve the needs of  Women & Children’s diverse population, the staff took its concerns to the administration. The result is an intravenous (IV) medication delivery system with a 99 percent compliance rate and real evidence of prevented errors. The system is so innovative that it won an ASHP Foundation Award for Excellence in Medication-Use Safety.

Kelly A. Michienzi, Pharm.D.

Preventing Workarounds

The smart pump Kaleida had originally intended to use wasn’t flexible enough for use with pediatric patients in particular, said Kelly A. Michienzi, Pharm.D., clinical pharmacy coordinator and co-chair of the hospital’s Pediatric Pharmacy & Therapeutics Sub-Committee.

“As we got deep into the software, we saw that it didn’t have proper dosing categories for pediatrics,” she said. “We knew it would produce too many workarounds.”

Rather than spend the money on a pump the staff likely would not use efficiently, the hospital gave the subcommittee permission to look into alternatives and develop an IV medication delivery system and training program. The staff recruited a multidisciplinary team for the task, including pharmacists, nurse educators, biomedical engineers, physicians, information technologists, and a toxicologist.

The team had several criteria for the new IV medication delivery system: It had to provide flexibility in dosing, include a customized drug library, and use

Michael Kalita, R.Ph., M.B.A.

wireless technology. At the time, the pump vendor was beta testing the Symbiq, and the team agreed to look at it.

“We saw immediately that the features were better for our needs. For example, it had a color monitor that was three or four times the size of the [originally proposed] pump, which is important for ICU physicians and staff running a code at the head of the bed,” said Michael Kalita, R.Ph., M.B.A., pharmacy director.

The more that staff members worked with the pump, the more ideas they had for fine-tuning its features, and soon the team’s feedback became integral to the pump manufacturer’s development efforts.

Collaborating for Safety

Michienzi said that input from the nurses who would be using the pump at bedside was critical, especially when the staff members loaded the library data into the pumps during pre-implementation testing.

“We asked them what they would do as well as what they weren’t supposed to do but might [given the pump’s features at the time], so we could try to find ways to prevent workarounds,” she said. “We asked nurses who have been here for 20 years, and we just kept playing with it until we got a library that everyone was comfortable with. It was a very informal failure mode and effects analysis.”

“You can’t have pharmacists build a drug library without nurse involvement,” said Kalita. “Nurses think about drugs differently than pharmacists, and you have to meet in the middle and come up with a system that works at the bedside.”

The team also developed a comprehensive training and education program that includes classroom education and hands-on training with the pumps.

Achieving Impressive Compliance

It wasn’t long before the effort put into developing the system bore fruit. During the first year of implementation, the number of preventable errors dropped 50 percent. Reports generated through the pump’s wireless technology attest to its 99 percent compliance rate.

The ASHP Foundation recognized the team’s efforts by awarding it the 2009 Award for Excellence in Medication-Use Safety. “What made this so impressive is that the pharmacist-led team had gone down a path to incorporate a smart pump as part of an IV medication system, found it wasn’t working, pulled a team together, and went to the administration,” said Foundation Executive Vice President Stephen J. Allen, M.S., FASHP. “At first, the technology was going to shape the care system, but the team said that the care system needs to shape the proper application of technology.”

The result is better care for patients, Allen added. “When you involve the people who will use a technology in making decisions about it, it yields improved quality and safety. The real change is evident at bedside.” Michael Kalita, R.Ph., M.B.A.