Jennifer Biltoft, Pharm.D., BCPS, Lonnye Finneman, Pharm.D., Kelley Curtis, B.S., Pharm.D., M.B.A., Cindy James, Pharm.D., Leigh Scherer, CPhT, Joan Thullbery, R.N., B.S.N., SCL Epic-Alaris Interoperability Team
St. Vincent Healthcare, Billings, Montana (SCL Health System, Denver, Colorado)
Computerized smart pumps with dose-error-reduction software (DERS) help avert potentially serious intravenous (i.v.) medication errors. Nonetheless, a 2005 study found that 67% of 426 in-process i.v. infusions had one or more discrepancies, including potentially fatal errors. The ECRI Institute found that smart pump-EMR interoperability, which makes it possible for infusion pump programming to be checked against medication orders, could have prevented 75% of the pump-related medication safety issues analyzed from their database. Pharmacists at this hospital led an innovative program to implement smart pump-EMR interoperability for both large-volume and syringe infusions. The purpose of the program was three-fold: to improve i.v. infusion medication safety; to improve the accuracy, timeliness, and efficiency of i.v. infusion documentation; and to increase revenue in outpatient areas through improved i.v. infusion documentation.
Interoperability allows prescriber-ordered, pharmacist-reviewed infusion parameters to be sent wirelessly from the EMR to the infusion device, reducing opportunities for manual programming errors, and thereby, improving medication safety. Pre-populating the smart pump also forces the infusion to use DERS, so that 100% of pre-populated infusions, and any subsequent titrations, are protected by the pump's safety software. Time-stamped infusion data from (dose, rate, and volume infused) are sent back to the EMR for validation and documentation, and subsequently, used to improve care and charge capture.
On May 13, 2014, smart pump-EMR interoperability was implemented on all care units except the NICU and procedural areas. Interoperability reduced the number of clinician key strokes needed to program each infusion from 15 to 2 (86%), thereby greatly decreasing opportunities for error. From January 2014 to February 2015, average monthly pump alerts and overridden alerts decreased 22% and 20.5%, respectively. Infusions reprogrammed in response to an alert and cancelled infusions decreased by 19% and 33%, respectively. The percent of infusions programmed with DERS increased from a monthly average of 91.76% to 94.38%. Compliance in using interoperability averaged 70% to 80%, and patient identification entry compliance improved from 35.54% to 80.96%. Lastly, improved infusion documentation decreased outpatient lost charges, due to missing start/stop time data, from $980,000 to $610,000. This almost 40% improvement equates to $370,000 in incremental revenue for the institution.
This innovative program highlights pharmacists' leading role in the successful implementation of smart pump-EMR interoperability. The program met its objectives by improving i.v. infusion medication safety, documentation, and outpatient infusion charge capture. The program also highlighted "financial stewardship" as an important part of pharmacy practice in today's healthcare environment.
- Williams C, Maddox RR. Implementation of an i.v. medication safety system. Am J Health-Syst Pharm. 2005; 62:530-6.
- Maddox R, Danello S, Williams GK et al. Intravenous infusion safety initiative: collaboration, evidence-based best practices and "smart" technology help avert high-risk adverse drug events and improve patient outcomes. In: Advances in Patient Safety: New Directions and Alternative Approaches, Vol. 4, Washington: Agency for Healthcare Research and Quality; 2008:143-56.
- Husch M, Sullivan C, Rooney D et al. Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Qual Saf Health Care.2005; 14:80-6.
- ECRI Guidance article: Infusion pump integration. Health Devices. 2013; 42:210-21.