1. Infusion Management Implementation
Karen Corrick, BSN, RN
Great River Medical Center – Burlington, Iowa

2. Objectives
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.

3. GREAT RIVER MEDICAL CENTER

4. Great River Health Systems Demographics
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

5. 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

6. Hospital-based Clinic Services
Wound & Hyperbaric
Cardiology
Cancer Care
Business Health
Rehab Center
Wapello Physical Therapy
Pain Management

7. Integration Device/Systems
BBraun Outlook 400 ES
Cerner Millenium

8. Team Effort

9. Biomed Overview ICommand The Millenium iBus
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

10. 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

11. Information System Overview
Interface mapping
Servers
Back up for Biomed and iCommand

12. 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. 

13. 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

14. 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.

15. Current Nursing Issues
Staff ‘Buy in’
Staff knowledge of what to do when part or all of the process isn’t 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

16. Lessons Learned
Meet with all vendors/engineers together early on. This will diminish finger pointing at others when something isn’t connecting.
Have a mature EHR system prior to integration. Building a system and integrating devices doesn’t work.
Pharmacy involvement is key during the build, go live and ongoing monitoring.

17. Key Clinical Success 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

18. Questions???