It seems like just about every other conversation I have these days revolves around something to do with Smart Pump Programming and EHR integration, so I have no doubt this topic will be of interest to our blog readers.
The questions I receive vary greatly in concept and technical detail, but the general trend in interest in smart pump integration is lending itself to the notion (at least for my team) that 2015 will be the year of smart pump programming for many hospitals.
There are many aspects to this subject, but I’ll present the three most commonly asked questions. Understanding the answers to these questions will help you better assess the relevance and need of this technology for your own hospital environment.
- What exactly is smart pump programming?
- How will integrating smart pumps with our EHR impact clinician workflow?
- What are top benefits for smart pump to EHR integration?
What is Smart Pump Programming?
Smart Pump Programming is just what it sounds like - it's the automatic, electronic programming of the infusion order, which is passed from the EHR's pharmacy system to the smart pump. Without an automatic programming solution, infusion smart pumps themselves already provide a big step forward in patient safety for the hospital. This is because the pumps contain additional software called drug libraries, which help the clinician calculate appropriate dose and delivery rates. Integrating the smart pump to the hospital’s EHR — to bring pharmacy orders from the EHR to the pump automatically — adds that extra layer of safety by reducing the chance of error inherent in manual pump programming.
It’s also important to understand that there are two parts to smart pumps and EHR Integration. In one direction, orders are coming from the EHR and passed into the pump, and in the opposite direction infusion pump events are reported back to the EHR for patient charting:
- Smart Pump Programming — During administration, this is the electronic transfer of drug, dose, and rate information automatically from your hospital’s EHR to the smart pumps
- Auto-Documentation — During documentation, this is the electronic transfer of start times and stop times, as well as titration event data, from the smart pump automatically to the EHR
If you take away only one thing from this post, remember this: Simply installing smart pumps at your hospital doesn’t mean they’ll communicate with your EHR. You will need to have a conversation with your smart pump vendor about the capabilities of their pump devices to accept pharmacy orders electronically as well as their ability to send smart pump event data to the EHR. Find out if they have implemented this already with another hospital. Also, have the same conversation with your MDI solution vendor and find out what it would take to integrate pharmacy orders to and pump event data from the pump to the EHR.
What’s the impact to clinician workflow?
With a smart pump programming solution in place, here’s an example of what the clinician workflow would look like:
- Clinician logs into EHR and finds the patient's infusion order
- Clinician scans patient’s wristband to verify correct patient account number then selects desired medication order
- Clinician scans the medication barcode, which the system will verify against the order
- Once dose rate and unit are verified, the clinician then identifies which pump device to send the order to and then sends the medication order information to the smart pump by clicking a button
- Before administering the infusion order from the pump device, the clinician conducts a final “five-rights” verification of the medication order data displayed for the patient and then starts the pump
- As pump event data is recorded at the pump, this data automatically flows back to EHR behind the scenes to be saved to the patient’s chart
As you can see, the "Five Rights" are still in place and the clinician is still responsible for pressing the infusion start button at the pump to push the medication. But compare the new workflow with a smart pump programming solution to an existing workflow where the clinician has to manually enter the infusion order and you’ll see a very big solution advantage: the chance for error by manual entries at the pump has been eliminated with smart pump programming.
Why is this beneficial?
Automating the programming piece of the infusion pump has huge implications on clinician workflow in reduction of errors and adverse events. If you’re not familiar with the sobering statistics, the Association for the Advancement of Medical Instrumentation (AAMI) conducted a study in 2010 and found that between January 1, 2005 and December 31, 2009, more than 56,000 adverse events and 710 deaths associated with infusion pumps were reported to the FDA.1
We know firsthand that hospitals very much want to improve safety measures for their infusion medication administration. In December last year, Iatric Systems surveyed more than 4,000 CNOs about Medical Device Integration (MDI). The results of the survey indicate clearly that CNOs care first and foremost about patient safety. Here’s what they told us they want:
- 65% said reducing errors and adverse events is the #1 goal they wish to achieve by implementing MDI
- 44% said smart pumps would be their #1 choice if they could integrate only one medical device type with their hospital’s EHR
Here’s a link to the Executive Summary and complete list of questions and answers from the CNO Survey if you’re interested:
The second bullet is particularly interesting to me because historically, my conversations with hospitals have been nearly monopolized by the subject of integrating patient monitoring systems. Now everyone wants to talk about smart pump integration and I rarely go one day without discussing it! With that said, not too many hospitals have this solution in place today (check out a recent KLAS report explaining why), but the tide is turning particularly as other initiatives for Meaningful Use have been completed and hospitals gain a better understanding of how to cost-justify MDI projects. If this is a solution you feel would benefit your hospital environment, I would encourage you to have an open conversation with your other hospital stakeholders, device vendors, and integration solution vendors to determine the best solution fit for your hospital.
Please leave a comment if you’d like to learn more, or email me at [email protected].
- Infusing Patients Safely. 2010. http://s3.amazonaws.com/rdcms-aami/files/production/public/FileDownloads/Summits/AAMI_FDA_Summit_Report.pdf. Accessed April 14, 2015.