Software Strategies: Hospital works hard to succeed using smart pumps
Hospital works hard to succeed using smart pumps
Staff buy-in has been arduous process
Installing new technology in any hospital is a difficult process, but for small hospitals, there are additional hurdles to overcome.
So when Angel Medical Center in Franklin, NC, implemented a plan to improve patient safety through technological solutions, the licensed 59-bed, rural hospital's director of pharmacy had her hands full.
The hospital had adopted a program called the Utilize Technology to Enhance Patient Safety Team, says Debra L. Cowan, PharmD, director of pharmacy for Angel Medical Center.
"The team is involved in administration, admissions, pharmacy, accounting, nursing, and all areas of the hospital," Cowan says.
One of the team's first decisions was to implement smart pumps and intelligent infusion devices, Cowan says.
"We have a multiyear plan to implement barcode technology, an electronic physician order entry, and an electronic integrated medical record," Cowan explains. "So a physician can go into the computer and have the nurses' note, lab results, X-rays, EKG machine output, and all of the information that is used to monitor patients — all on the same computer system."
The ultimate goal is to have all of the information readily available for physicians, she says.
"We're about halfway there at this point," Cowan says.
The first step in barcoding was to install smart pumps.
"When we were putting in the smart pumps we asked if we could take it one step further to have barcoding technology tied in with the smart pumps," Cowan says.
In the old system of IV pumps, the nurse would enter the amount of IV fluid and enter a rate per hour and then push a button to run it, she notes.
When the hospital made the change to the new technology, Cowan learned how inaccurate the old system had been.
"We found some hidden errors we didn't know were out there," Cowan notes. "Some nurses were using cheat sheets before they used the smart pumps."
The nursing director confiscated those sheets and gave them to Cowan, who was startled to discover that nurses had been programming the pumps with some incorrect information.
"I looked over those sheets, and some were flat-out wrong," she says. "Some were calculating doses of say morphine with a weight chart and a rate for the IV pump that was the wrong calculation."
Or the nurse was using a drug with a totally different solution than was standard, she adds.
"It was up to the nurse to install the correct medication and IV bag and rate," Cowan says. "With the smart pumps, if the nurse chooses a bag of heparin, for example, the machine knows how much medication is in the bag, and when the nurse puts in the rate, the computer checks to see if the rate is correct for this bag."
If the nurse accidentally punches in an extra zero in the rate, the smart pump knows it's incorrect and would sound an alarm until the nurse stops and puts in the correct rate.
Also, all of the operational information is documented, and Cowan can see a computer printout of all of the pumps' rates, whether alarms sounded, when nurses overrode the system, and how many mistakes occurred with each drug used.
"We can use this information to teach the nurse how many mistakes occurred with a particular drug," Cowan says. "The primary reason for having the smart pump is to prevent those errors."
The barcoding system enables supervisors to pinpoint where and to whom a particular medication is being administered, Cowan says.
"The nurse first scans the patient's wrist band, and then scans the bag of IV fluid," she says. "If there's a mismatch, the device sounds an alarm."
As with any technological change, there can be human engineering problems.
"It can be circumvented if the nurse doesn't scan the barcode," Cowan says. "Some nurses don't adapt to change as well and won't scan it."
The nurse might have had trouble with the barcode scanner, perhaps holding it at an incorrect distance, she says.
"It's easy to learn, but if nurses have trouble the first few times of scanning, some will throw up their hands and say, 'I'm never going to try it again,'" Cowan says.
So the hospital set up a performance improvement process to obtain nursing compliance with the new technology.
"It's easy to track because we can see how many bags identifying patients are recorded in the software," Cowan says.
The chief nursing officer then sends out warnings by e-mail to nurses who've not complied with using the device.
Also, the hospital surveyed nursing staff to see what their concerns were. They found that some felt the pharmacy department had installed barcodes in a way that made them wrinkled and difficult to scan, Cowan says.
In a survey of nurses, the reasons for not using the technology were found to be due to a lack of user knowledge, pharmacy and label problems, and attitudes/habit/culture issues, Cowan says.
Some nurses would say they were just used to doing it the same old way and forgot, she adds.
"We've had additional education for nurses on how to use barcode technology, and we've made changes on the barcode printing on labels to make it easier to use," Cowan says.
The IV pump company's trainers were asked to return, and all nurses were asked to attend.
"We sent the trainers to individual departments to catch as much of the staff as they could," Cowan says. "So, they did training on the spot and helped them use the pumps as they worked with patients, walking them through the steps."
Initially the nursing compliance with the smart pumps was only 15%, but the additional hands-on training sessions and other efforts have helped to increase it, Cowan says.
Perhaps the most effective strategy was having the chief nursing officer send a memo to all nurses, telling them that the hospital had invested a lot of money in the new technology with the purpose of improving safety and helping patients, Cowan says.
"She said that people needed to participate and help to make sure their patient care was safer, utilizing the full potential of it, or else we should have just saved our money," she adds.
Also, hospital supervisors have informed nurses in a general way of some nursing mistakes that would have been prevented through use of the new technology, including drugs going to the wrong patient, Cowan says.
"That was a powerful converter of people," she says. "The nurse involved with the mistake has turned over a new leaf and has been a very powerful advocate of the new technology, pushing it with other nurses and being a person they go to if they need help figuring out something."
As part of the ongoing technology compliance effort, the hospital has made these changes:
- The hospital lists medication errors that are prevented in quarterly, staff newsletters;
- Pharmacy adjusted the drug library to match the dosage ranges programmed in the pumps to the hospital's standard practice so there would be fewer false alarms;
- Managers identified the nurse super-users, who had adapted to the new technology better than others, and encouraged them to be the point persons if other nurses had problems with the technology.
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