Achieving compliance with The Joint Commission’s Sentinel Event Alert on optimizing smart infusion pump safety with DERS.
Part One: Recommendations 1 and 2
Ivyruth Andreica PharmD, BSN, FISMP, Clinical and Medication Safety Pharmacist, Ivenix, Inc.
The Joint Commission recently issued a Sentinel Event Alert regarding optimizing smart infusion pump safety with dose error reduction software (DERS).1 Currently, DERS is the standard of care for ensuring healthcare organizations safely administer IV infusions1. Best practices state that healthcare organizations should have Dose Error Reduction Software (DERS) compliance goals of at least 95% or better.2 However, many healthcare organizations implementing infusion technology do not realize all of the benefits of smart infusion pumps.
In this four-part series, we will examine each of the recommendations identified in “Sentinel Event Alert 63: Optimizing Smart Infusion Pump Safety with DERS” made by The Joint Commission. We will also share how the Ivenix Infusion System supports hospitals in improving patient safety by addressing the challenges presented by these recommendations.
Leadership assigns responsibility by identifying a multidisciplinary project team or department (such as the pharmacy and therapeutic committee) responsible for smart infusion pump interoperability, including DERS, the oversight of drug library revisions or additions, infusion protocols, smart infusion pump maintenance, and related issues1.
Smart pump infusion technology is more successful when multidisciplinary teams collaborate and work together. For example, during drug library creation, health systems with a group of pharmacists or smaller hospitals with only one pharmacist will gather a project team with representatives from each department or unit to gain consensus for infusion pump safety configurations. Because these settings may be different for each department, it is critical to ensure that respective departments contribute and approve the infusion pump safety configurations. This process is time-consuming and requires aligned coordination of each attendee’s time, participation from a representative from each department, and traditionally is done using paper worksheets. These printed worksheets are often distributed, completed, and collected during each meeting. Values like DERS limits, the audio volume level of alarms, the occlusion pressure setting, and air-in-line alarm thresholds are just a few examples of the customization a department representative is asked to decide.
The Ivenix Infusate Library Manager supports collaboration across hospital and health system infusion therapy committees in real-time via a secure browser-based data repository. Once the drug library editors add content, they can add notes viewable across the project team. In addition, drug library editors can transition infusates into a draft state for reviewers to evaluate and comment on the content.
Changes are made in the draft state, team reviewers can test the draft settings on a web-based pump simulator, and changes can be sent to the Ivenix Infusion System Large Volume Pumps (LVP) as they are approved.
Traditional processes require in-person or virtual meetings and a line-by-line discussion of the build of a drug library. Ivenix evaluated these processes and created new tools for multidisciplinary collaboration on interoperability, DERS, drug library oversight, infusion protocols, and the total cost of ownership associated with infusion technology. This evaluation revealed a strong need for a system of systems approach to problem-solving. As a result, Ivenix implemented a data-driven design and released to market the Ivenix Infusion System.
The nurses, doctors, pharmacists, and engineers at Ivenix built the Ivenix Infusion System to support nursing and patient safety collaboration between pharmacists, informaticists, and biomedical engineering. This software-based tool supports the rapid build and collaborative revision of the drug library and pump settings, rapid adoption tools for expediting smart pump auto-programming, and reduction of the total cost of ownership attributed to infusion pump maintenance. In addition, biomedical engineers experience advantages from predictive maintenance reporting, no device calibrations, and exceptional battery life.
Read more about Analyzing the actual total cost of ownership (TCO) for a hospital infusion pump
Define a process to create, test, regularly engage with, and maintain a drug library1.
Hospitals we have spoken with have shared their concerns about being overburdened with the upkeep and maintenance of technology in their facilities. In many cases, drug libraries are not maintained when infusion pump technology is implemented because updating the drug library is too challenging to perform frequently. Traditional processes for updating drug libraries are often reliant on the power-off and power-on sequence of the infusion pump and the reset of the pump to a “New Patient” status. In nearly all cases, the clinician is expected to wait for the update process to execute. This update process is traditionally accomplished by wireless transmission of the drug library as a complete file. This file is then applied to the pump in a rip and replace fashion and requires the clinician to wait for the update to complete while viewing a “please standby” message.
At Ivenix, we view this rip and replace process as equivalent to asking an airline pilot to wait while a new map is loaded into the onboard navigation system. Delays like this are not practical. In a modern hospital environment, we consider this kind of delay unacceptable and a contributor to the underutilization of DERS.
The Ivenix Infusion System is built to meet hospital infusion therapy needs by eliminating pain points that often lead to clinicians underutilizing DERS. Recent studies identified drug library update delays of up to 6 months.3,4 Over 30% of infusions were infused with outdated drug libraries.3,4 And over 22% of alerts were unnecessary.3,4 The clinician experience when using an outdated drug library can be negatively impacted by the alert fatigue resulting from avoidable alerts. The Ivenix pump workflow defaults the clinician prompts to the drug library. Automating this process ensures drug library compliance is high.
Wirelessly sending updates to the pumps is accomplished in near real-time to the entire fleet. Drug library updates are sent and applied to individual limit configuration items quickening the update process. The update of the pumps is immediate, taking only minutes to be applied. If an infusate with a change is running, the change is applied after the infusion is completed. This rapid drug library update capability minimizes the chances of a clinician infusing with the wrong DERS or without DERS protection at all. The drug updates sent to the pump are immediately available, do not interrupt actively running infusions, and do not require clinician acknowledgment or a pump power off. This lack of reliance on user interaction to trigger the drug library update allows nurses and pharmacists to focus on patient care.
Read more about the Prevalence of wireless smart-pump drug library update delays.
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1. The Joint Commission. Optimizing Smart Infusion Pump Safety with DERS. Sentinel Event Alert. 4-14; 2021; Issue 63
2. Institute for Safe Medication Practices. Guidelines for optimizing safe implementation and use of smart infusion pumps. 2020
3. DeLaurentis P, Hsu KY, Bitan Y. Prevalence of wireless smart-pump drug library update delays. Am J Health Syst Pharm 2018;75(15):1140-1144
4. DeLaurentis PC, Hsu KY, De la Armenta AI, Bitan Y. Investigating Delays in Updates to Infusion Pump Drug Limit Libraries. AMIA Annu Symp Proc. 2017 Feb 10; 2016: 490-495