AN INTEGRATED APPROACH TO PRIORITIZE EFFECTIVE AND SAFE ALTERNATIVE INFUSION METHODS TO VOLUMETRIC...
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AN INTEGRATED APPROACH TO PRIORITIZE EFFECTIVE AND SAFE ALTERNATIVE INFUSION METHODS TO VOLUMETRIC INFUSION PUMPS AT CSSS DU LAC-DES-DEUX-MONTAGNES Gnahoua
AN INTEGRATED APPROACH TO PRIORITIZE EFFECTIVE AND SAFE
ALTERNATIVE INFUSION METHODS TO VOLUMETRIC INFUSION PUMPS AT CSSS
DU LAC-DES-DEUX-MONTAGNES Gnahoua Zoabli, P.Eng., M.Eng., Ph.D.
Chief of biomedical engineering depertment CSSS Du
Lac-Des-Deux-Montagnes www.zoabli.com Vancouver, May 21-23, 2014 1
Collaborators Sylvain Marcil 1, Liane Rouiller 1, Nathalie Bigras
1, Chantale Sguin 1, Nancy Chabot 1, France Granger 1, Arielle
Katia M. Bada 2, and Lucie Dugr 1 1 CSSS du Lac-des-Deux-Montagnes;
2 cole Polytechnique de Montral
Slide 2
O VERVIEW I.Summary of the problem II.Methodology III.Results
IV.Discussion V.Conclusion 2 Vancouver, May 21-23, 2014
Slide 3
3 Service du gnie biomdical Dveloppements en cours Plan
stratgique 2010-2015 Agrandissement du Bloc endoscopique (C)
Agrandissement de l urgence (E) 35 civires 4 salles de choc
Nouvelle Unit dophtalmologie (A) Mdecine nuclaire (M) Nouveau
Centre de tlnphrologie (M) Nouveau Centre dhmato-oncologie (M) 361
lits de courte dure 74+192 lits en hbergement 2 316 employs,
employes, 22 pharmaciens 257 mdecins 180 bnvoles moncsss.com
Slide 4
P ROBLEMATIC I.Issues regarding current models of volumetric
pumps - software francization of their new model - compliance to
Health Canada - availability estimated in 2015 (no replacement, no
new purchase) 4 Vancouver, May 21-23, 2014
Slide 5
O BJECTIVE Find a contingency plan allowing CSSS LDDM to
maintain an optimal intravenous therapy care to patients during
this period. Vancouver, May 21-23, 2014 5
Slide 6
1 (Need to )know actual clinical use of volumetric pumps 2
Consult the Guide for IV administration with associated clinical
surveillance (GIVACS) 3 (From the GIVACS) identify the medications
absolutely requiring a volumetric pump; 4 (From the GIVACS)
identify drugs that can be safely administrated with other
technological methods (gravity, mini-infusion pump, syringe pump,
ambulatory pump, patient controlled administration, injection); 5
Consult the collective directive for the installation of an
injection plug if the solute is prescribed in keep vein open (KVO)
infusion mode; 6 With a team of seven individuals, inventory of our
park of volumetric pumps in 30 min (consider the mobility of these
devices); 7 Prepare a consultation platform of the care units to
determine their effective infusion practice; Vancouver, May 21-23,
2014 6 M ETHODOLOGY
Slide 7
8 Collect data from these care units with the platform to get
an idea of the current medications administration practice and to
identify the gaps with the GIVACS; 9 From the information gathered,
identify in accordance with the pharmacy and the concerned nursing
units, how many volumetric pumps are used instead of the proper
infusion technique, according to the GIVACS instructions; 10 Based
on the number and frequency of medications used on each unit with
volumetric pumps, calculate a weighted Pump/Medication ratio to
take into consideration the actualized need of volumetric pumps on
each nursing unit; 11 This ratio will help determine for the
two-year period, if there are Too many, Acceptable or Less pumps on
the unit; 12 Submit a report of our consultations to a
Multidisciplinary Committee composed of clinical and medical
directorates, and purchasing services. Vancouver, May 21-23, 2014 7
M ETHODOLOGY (C ONT D )
Slide 8
S OME ILLUSTRATIONS Vancouver, May 21-23, 2014 8
Slide 9
C ONSULTATION OF THE MEDICATION ADMINISTRATION GUIDE The
medication administration guide is developed by the pharmacy to
associate each drug to be administered by IV to the suitable
infusion technique. Vancouver, May 21-23, 2014 9 NameAdministration
mode Side Effects
Slide 10
M EDICATION S URVEY QUESTIONNAIRE / U NIT Vancouver, May 21-23,
2014 10 Recommended mode is not Volumetric pump Actually used with
Volumetric pump ? How often ? Mini-infusion pump is
recommended
Slide 11
RESULTS Vancouver, May 21-23, 2014 11
Slide 12
I NVENTORY OF THE VOLUMETRIC PUMPS May 21, 2013 from 2:00 PM to
2:30 PM 27 volumetric pumps missing Vancouver, May 21-23, 2014
12
Slide 13
O UR CURRENT PRACTICE IN IV THERAPY Drugs administered by
Volumetric pumps are mainly used in critical care units. Vancouver,
May 21-23, 2014 13
Slide 14
IV T ECHNOLOGY S ELECTION D ECISION T REE In collaboration with
the managers of medical care units and pharmacy, a decision tree
has been developed Vancouver, May 21-23, 2014 14 Objective: To
determine the recommended infusion technology
Slide 15
Vancouver, May 21-23, 2014 15
Slide 16
W EIGHTED P UMP /M EDICATION RATIO Vancouver, May 21-23, 2014
16
Slide 17
Vancouver, May 21-23, 2014 17 W EIGHTED P UMP /M EDICATION
RATIO
Slide 18
1 Improved collaboration between units regarding volumetric
pumps 2 Some counter-effects between OR and MED-SURG. 3 Revised
complementary need according to the decision tree and the actual
needs for volumetric pumps Vancouver, May 21-23, 2014 18 D
ISCUSSION
Slide 19
4 Solute drop calculation is forgotten provide drops
calculation strips and support the nursing personnel to master the
bases of gravity infusion practice 5 Medical history of patient is
risky renal failure, cardiac history, chronic obstructive pulmonary
disease, degenerative disease, etc. 6 Reduced Nurse-to-patient
ration during night shift. Vancouver, May 21-23, 2014 19 M AIN
REASONS OF V OLUMETRIC PUMPS OVERUSE
Slide 20
ADDITIONAL NEEDS FOR VOLUMETRIC PUMPS (April 1, 2014)
Vancouver, May 21-23, 2014 20 May 21, 2013
Slide 21
1 This study brought together all local expertise in
intravenous therapy to establish a contingency plan based on
current best practices in IV therapy 2 The decision tree is planned
to be part of the continuing education of nurses to maintain IV
best practices standards at CSSS LDDM 4 Another CSSS which
benefited from our approach has told us about its successful
application 5 We share our experience, hoping it will help to
better manage the two-year waiting in other Quebec CSSS and
hospitals across Canada 6 The success of this approach requires
that any volumetric pump transferred with a patient to another care
unit will return to its original unit. This remains a perpetual
challenge with infusion pumps in any hospital. Vancouver, May
21-23, 2014 21 C ONCLUSION
Slide 22
We thank the following members of the multidisciplinary team
and managers whose involvement has led to develop the decision tree
for IV therapy at CSSS LDDM. Medical units Michelle Dufour, Jacob
Lalanne, and Nathalie Comtois Surgery Mlissa Pag, and Jocelyne
Sanscartier Counselors in nursing Chantal Laperriere, and Dany
Maheux. Their contribution has helped make more realistic the
application of this IV therapy decision tree, facilitating thus its
clinical acceptability. Vancouver, May 21-23, 2014 22 A
CKNOWLEDGMENTS