Despite technology advances, adverse drug events (ADEs) continue to cause patient harm. Errors related to intravenous (IV) administration of high-risk medications are especially concerning. While intelligent infusion devices, barcode medication administration (BCMA) and electronic medical records (EMRs) can reduce medication errors, they are often used independently.
Use of standardized drug libraries in intelligent infusion device systems is critical to the safe administration of medications. Through these devices, the drug library provides a pre-established list of medications, concentrations and safe infusion rates. Despite extensive organizational efforts to develop these libraries, when these technology systems are used independently, compliance is problematic because nurses sometimes use the drug library incorrectly or bypass it altogether.
Lancaster General Health recognized the need to integrate these technologies into an IV interoperability system that connected:
• pharmacist assessment and validation of intravenous infusion orders followed by entry into the pharmacy information system
• automated population of required infusion parameters into the BCMA system by the pharmacy information system
• independent nurse verification of the medication order in the barcode system
• scanning of the patient wristband, IV medication and the intelligent infusion device
• confirmation of the intelligent infusion device parameters and initiation of the infusion
• communication to the EMR.
Over a 33-month period, the Lancaster General Clinical Medication Safety Committee participated in software design followed by evaluation, testing and validation of the BCMA and intelligent infusion device systems. This was followed by pilot testing, including staff education, in three telemetry units between July and November 2008. By July 2009, following implementation of the IV interoperability system in Lancaster General’s medical/surgical units, 392 patient beds had IV interoperability capabilities.
The IV interoperability system resulted in a 25- to 30-percent increase in drug library compliance in the telemetry areas and a 42-percent increase on the medical/surgical nursing units. As compliance to the IV interoperability software increased, the number of violations to the soft- and hard-dose limits that prompt the nurse to edit the pump settings decreased for both the telemetry and medical/surgical drug libraries, demonstrating an average reduction of 74 percent and 72 percent, respectively. There was also a 32-percent reduction in ADEs involving heparin and pump programming. Data from the pilot studies also indicate that nursing time for pump programming was reduced by almost 25 percent with the IV interoperability system as compared to the manual process. In addition, this system change has transformed the pharmacist’s role, involving the pharmacist directly in the process of administering IV medications.
This multidisciplinary team-driven IV medication infusion redesign at Lancaster General Health shows the medication safety benefits that can be achieved through interoperable technology solutions.
Multidisciplinary Team:
Amanda E. Prusch, Pharm.D., BCPS, Team Chair
Ryan Breznak, R.Ph.
Stephen T. Olin, M.D.
Richard D. Paoletti, M.B.A., R.Ph.
Jill A. Rebuck, Pharm.D., BCPS, FCCM, FCCP
Mark Ricketts
Surender Singh, M.D.
Dan Soukas
Tina M. Suess, R.N., B.S.N.
Elizabeth Thompson, R.N.
Starann D. Watts, R.N., B.S.N., CRNI