Infusion Management Implementation Karen Corrick, BSN, RN Great
River Medical Center Burlington, Iowa
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To describe Great River Medical Center and our journey to
integrate our BBraun Infusion pumps into our EHR Cerner Millenium.
To describe issues during the integration build. To describe
ongoing issues with system maintenance and nursing staff use.
Objectives
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GREAT RIVER MEDICAL CENTER
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GRMC is part of Great River Health Systems, a privately owned,
independent 378-bed regional, integrated health-care system which
covers a five county area with the main services in Des Moines
County, Iowa Acute Care Licensed Beds 213 All others are Long Term
Care Beds 165 Average Daily Census YTD for FY14 73.8 Emergency Dept
visits FY 2014: 32,157 Newborn deliveries FY14: 569 Inpatient
Admissions Adults and Children, FY 2014: 6,125 Outpatient
procedures FY14: 746,129 Pharmacy hours of operation 24/7 Medical
Staff Members 129 Number of GRHS employees 2,012 Great River Health
Systems Demographics
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Acute Inpatient & Outpatient Key Services OB/GYN
Orthopedics Spine Surgery Cardiology Interventional Cardiology
Behavioral Health Digestive Health Surgical Rehabilitation Hospice
Home Health Care Emergency Department
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Hospital-based Clinic Services Wound & Hyperbaric
Cardiology Cancer Care Business Health Rehab Center Wapello
Physical Therapy Pain Management
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BBraun Outlook 400 ES Cerner Millenium Integration
Device/Systems
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Team Effort
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Biomed Overview ICommand shows what devices are associated to
make sure data is flowing. Viewing tool to check what is running
and what is used to point devices to a non-prod domain. The
Millenium what the nurses and doctors use to see the actual data:
Anesthesia, Fetalink, Lab, CareAware/Iaware, Pharmacy dashboards
iBus is the main hub of data. iCommand is the first check. Multiple
domains 1 PROD and 1 NonProd
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BioMed Issues We were the test site for our BBraun Outlook 400
ES Infusion pumps with Cerner Millenium Needed another IP address
from Cerner Our Biomed department did not receive more than a few
minutes of training Pumps needed scanning barcodes. We had 2
different types of scanners and this caused issues in our testing.
Barcodes were built according to Cerner recommendations. Changes
being made by Cerner, without our knowledge, for their testing
purposes, caused issues
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Information System Overview Interface mapping Servers Back up
for Biomed and iCommand
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Infusion Pump Issues Bbraun pumps needed an update to help with
connectivity issues. All the pumps were assigned a static IP
address to prevent roaming, in addition, to the IP address Cerner
provided. Drug mapping file on each pump needs to be updated and
matched in iCommand. Process for keeping the drug library matching.
The drug file in iCommand updates all of the pumps.
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Nursing Informatics Issues Testing of the various continuous IV
medications administered by Nursing staff Many points in the
process where issues could occur Medications based on weight or age
needed extra testing IVPB testing versus continuous infusion
testing Medications without a diluent were an issue Premixed meds
were an issue Anesthesia medications after surgery continued into
ICU Rates and volume issues Workflows and various processes from
department to department: ED, PACU, ICU, Med/Surg areas Generic
access dashboards for iAware
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Staff like the functionality of making changes on the IV pump
setting, then having this change date/timed in their documentation.
They verify and sign. Staff like the Intake automatically
populating into their documentation.
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Current Nursing Issues Staff Buy in Staff knowledge of what to
do when part or all of the process isnt working (trouble shooting)
Inconsistencies with staff signing all documentation and making
sure they are signing in the correct place ICU/CCU is doing one
process, the Med/Surg areas are doing another process Anesthesia
issue with data flowing
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Lessons Learned Meet with all vendors/engineers together early
on. This will diminish finger pointing at others when something
isnt connecting. Have a mature EHR system prior to integration.
Building a system and integrating devices doesnt work. Pharmacy
involvement is key during the build, go live and ongoing
monitoring.
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Improved patient safety by: Medication scanning to set dosage
rates on the IV pump Medication scanning to improve patient
identification for high risk medications Pharmacy real-time
dashboard of IV medication use (DoseTrac) Forces upfront work to
review and maintain your IV pump drug library Key Clinical
Success