2011 QUALITY IMPROVEMENT INITIATIVES
Clinical Improvement Project:
Time Frame: January 2011 and ongoing
To improve patient safety and quality of care, Grace Cottage Hospital (GCH) purchased and implemented a Hospira automated intravenous (IV) infusion pump system with complementary specialized software. By implementing this intelligent infusion technology, Grace Cottage Hospital (GCH) can ensure safer and more efficient IV medication and fluid administration.
Medicated intravenous infusions are critical in addressing emergency situations. Approximately 800 GCH ER patients, or about one-third of our entire ER volume, receive IVs, which need to be carefully titrated according to the patient’s response. Such is the case with those suffering from heart attacks, strokes, multiple trauma, internal bleeding, diabetic shock/coma or septic shock from an infection in the bloodstream. Nurses need to act quickly in these situations, and the increased complexity of medications may impact the timely response of medication administration. These types of medicated infusions are usually dosed in milligrams of medication per kilograms of body weight. In addition to checking for medication allergies, nurses must convert patient weights to kilograms to verify weight-based dosage and calculate how fast or slow to run the IV to deliver “x” milligrams of the drug per kilogram of weight per minute. The Hospira system’s software does the calculations for the nurse. In addition, the software contains a customized drug library with both hard and soft pre-set upper and lower rate and dose limits. The pump will alert the nurse if he/she has programmed it to deliver the medication at a rate or dose that is out of range. The nurse can override the soft limit, but cannot override the hard limit. However, it should be noted that IV infusions can still be infused using the Hospira pump without using the drug library’s safety features; the nurse can simply by-pass the drug library and just program the pump to run at a specific rate.
The Hospira software has several reports it can generate from the data it collects each time one of the pumps are utilized. Reports will contain information on staff compliance with using the drug library; the number of pump alerts, including the specific reason for each alert; and every over-ride of soft limits.
Our previous IV pumps only allowed the nurse to set a flow rate. All of the math needed to be manually calculated by the nurse and/or pharmacist prior to administration. In a critical patient scenario, the nurse is under stress and the potential for human error is greater. The medication administration process can be further complicated when patients need multiple medications administered intravenously either simultaneously or sequentially.
Our expectation for our staff was to initially attain a minimum of 75% compliance with the use of the drug library for all infusions. Hospira’s nationwide experience with new user initial compliance has been under 50%. The reason for this is the user’s ability to by-pass this feature and the temptation to do so for uncomplicated or non-medicated infusions, as it is faster and easier. During the training with our staff we stressed the importance of using the drug library and its ability to catch potential medication errors. We also made our expectation of their compliance clear. When we ran out first report in January, we were pleased to note that our compliance rate was 81.5% for the first 60 days of use. Fourteen potential medication errors were caught and corrected due to pump alerts.