Save time and money through pump consolidation

Cut back on stock and after-hours calls

If you’re using more than one brand of infusion pump, your agency’s supply room could probably stock a small hospital for several days. The problem is that much of that stock usually just gathers dust on the shelves, waiting to be used.

That may not be the only problem you create by using multiple brands of pumps. With managed care, there’s no guarantee your staff will be the only nurses visiting patients. Forcing other agency’s nurses to learn how to program several different brands of pumps can create obvious problems. Such dilemmas — and more — forced Genesys Medical Equipment Services Home Infusion in Flint, MI, to become more efficient in its own use of IV pumps.

It wasn’t long ago that Genesys, which provides home infusion to a diverse range of patient diagnoses from antibiotics to total parenteral nutrition (TPN) and pain management, was using several different pump models from three different manufacturers.

"Three years ago, we had so many different pumps that the nurses from the six or so skilled nursing agencies in our region who were actually using the pumps in patients’ homes were having a difficult time remembering the various idiosyncrasies and parameters from pump to pump," says Debbie Holman, RN, director of home infusion services for Genesys. "The nurses probably started to feel a little schizophrenic out there because they never knew what pump they would get."

As a result, Genesys’ after-hours, on-call pharmacist would typically receive two or three calls every night yielding simple questions on pump operations.

"The nurses couldn’t remember how to reprogram the pump, change the rate, or put in a new program," says Holman. "So a lot of our after-hour problem calls were on reprogramming the pumps."

The only solution Holman saw was to switch to one pump that could do all the various home infusion therapies provided by Genesys. It took some effort to resolve the confusion and to realize added benefits of switching to a single model pump, such as fewer after-hours troubleshooting calls and reduced expenses associated with pump rentals in tubing. Holman took the following steps to find the most suitable pump:

1. Shop around.

Holman started by collecting information on pumps that could provide antibiotics, TPN, and pain management therapies. After doing its homework, Genesys selected the Verifuse pump by I-Flow, which stood out because of its reprogramming capabilities. I-Flow allows Genesys to reprogram the pump using a touch-tone phone, which reduces nursing visits usually required for such services. (See Home Infusion Therapy Management, July 1997, p. 93, for story on the I-Flow pump’s capabilities.)

2. Test your findings.

Before finalizing the decision, Genesys tested the Verifuse brand pump for one month each on a TPN patient, a pain management patient, and an antibiotic patient.

"We were looking for the number of calls from nurses we got on the pump and what the feedback was from patients or caregivers," says Lucy Tyrer, RPh, director of pharmacy for Genesys. "We wanted to make sure no one hated the pump."

When the pump passed the test, it was just a matter of finalizing the switch over.

3. Make the switch.

Switching pumps wasn’t simply a matter of ordering new pumps and placing them in patient homes. First, patients were divided into two groups: long-term patients and short-term patients.

The first to receive the new pumps were patients receiving long-term infusions such as TPN, antibiotics, or hydration. For each long-term patient, a nurse brought the new pump, provided the patient and caregiver with training on the Verifuse, and collected the old pump. Short-term patients were allowed to complete their therapies on their old pumps.

"It didn’t make sense to go out and re-educate patients who may have had only a few days left on their therapy," says Holman. "So we left them on their old pump, and when their therapy was done, we sent the old pumps back."

Tyrer notes that sending the old pumps back to I-Flow as trade-ins were part of the negotiation process.

4. Provide training.

Genesys had a clinician from the pump’s manufacturer (I-Flow) provide three days of on-site instruction for all involved parties.

"We notified all the nursing agencies in our area and told them their nurses were welcome to come," says Holman. "We also provided it for our own home care and hospice nurses and pharmacists."

In addition to the hands-on training, I-Flow provided educational videos and operations manuals to all the nursing agency facilities, and each nurse received a quick-reference card and a clinician handbook.

Allow for plenty of training time

Not all agencies were able to attend the original three-day seminar held at the Genesys office. For the agencies that missed out, Holman worked with I-Flow’s sales representative to offer inservices at those agencies at a later date.

"It would have been easier if we knew more in advance we were going to [switch pumps] because we could have gotten to the external agencies faster," notes Holman. "You’re limited by their scheduling. In some instances, it was a month or two before they could coordinate this training with their own inservice schedule."

Tyrer notes that two full months would be optimum once you’ve selected the pump you’re going to use. Genesys gave itself just one month following the initial trial, which left some outside agencies unable to schedule an inservice on such short notice. For such agencies, Genesys offered one-on-one training to any nurse who would have to treat a patient who was hooked up to a Verifuse pump.

"We gave every nurse who hadn’t been trained on the pump a choice to receive one-on-one training in our office, their office, or at the patient’s home," says Holman. "We tried to make it as simple as possible."

Holman says the first benefit of the switch was almost immediate.

"We went down to getting just a couple of calls each week, so it was significant," she says. "We’re even to the point now that, because we work with our own skilled nursing agency, we get calls just a couple of times a month from them because the comfort level is there, and we do so much inservice and retraining." Inservice for the pump is provided on a quarterly basis.

Holman adds that the on-call pharmacist now has an easier time troubleshooting because there’s just one pump model to know.

Finally, the cost of upgrading was somewhat offset by the reduction in inventory needed.

"I don’t have as much product sitting on the shelves," says Holman. "I don’t have multiple types of sets on my shelf. I’ve gone from an inventory of 12 different sets to three."

Holman adds that there are additional cost savings in reduced rentals. Because the Verifuse pump meets all of Genesys’ infusion therapy needs, there’s no need to rent an extra pump for a specific therapy.