Intelligent Hospital™ ICU/NICU Script 2015
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Table of Contents
To be integrated into Script ............................................................................................ Error! Bookmark not defined.
ICU1 CBORD Make it Easy for Employees to Spend with You ................................... Error! Bookmark not defined.
ICU2 Emanate Wireless: RTLS tag reporting location and usage on a smart phone Error! Bookmark not defined.
ICU3 AiRISTA - Asset Tracking.................................................................................... Error! Bookmark not defined.
Scenario .........................................................................................................................................................................3
ICU4 Staff Identification (TBD) .....................................................................................................................................3
ICU5 Network and Wireless Infrastructure (Extreme Networks) ................................................................................3
ICU6 Medical Device Connectivity (Cardiopulmonary, Nuvon, Sunquest) ..................................................................5
ICU7 Bedside Workstation / Tablet Authentication (HID Zebra) ................................... Error! Bookmark not defined.
ICU8 Hand Hygiene (Airista) ........................................................................................................................................6
ICU9 Bed/Nurse Call (Stryker / ASCOM) ....................................................................................................................6
ICU10 Alert Notification: (Vocera) ................................................................................................................................7
ICU11 Nursecall Communication & Workflow (ASCOM) .............................................................................................7
ICU12 Physiological Monitoring (Draeger)...................................................................................................................7
ICU13 Alarm Distribution / Management (ASCOM) ....................................................................................................8
ICU14 Data Distribution ................................................................................................................................................8
ICU15 Clinical Data View – EMR (Sunquest) ..............................................................................................................9
ICU16 Centrally Monitor Ventilated Patients (Cardiopulmonary) ............................................................................10
ICU17 Connectivity (Cardiopulmonary) .....................................................................................................................11
ICU18 Decision Support (Sunquest) ..........................................................................................................................12
ICU19 VOiP Communications (Vocera) ......................................................................................................................12
ICU20 RTLS Supply Management Automated Documentation (DeRoyal) ..................................................................12
ICU21 Labs Sample Collection (Sunquest, Zebra, Swisslog) ......................................................................................13
ICU22 Eliminating Transfusion Errors & Increasing Efficiencies (Sunquest, Zebra) ....................................................13
ICU23 Alarm Management (Cardiopulmonary, Vocera) ............................................... Error! Bookmark not defined.
ICU24 Staff Duress (TBD, ASCOM) .............................................................................................................................14
ICU25 Find Available Device (Ventilator) (Emanate Wireless) ...................................... Error! Bookmark not defined.
ICU26 Staff Workflow: (ASCOM) ................................................................................................................................14
ICU27 Mobile Med System-Remote Med Queuing App (Omnicell)...........................................................................15
ICU28 Advanced Infusion Pumps Medication Administration (Hospira) ....................................................................15
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ICU29 Remote Consultation (InTouch) ......................................................................................................................16
NICU .............................................................................................................................................................................17
NICU1 Security – Access Control (HID Global) ............................................................... Error! Bookmark not defined.
NICU2 Infant Security- (Stanley) .................................................................................................................................17
NICU3 Incubator (Drager) ...........................................................................................................................................18
NICU4 Medication Administration:.............................................................................................................................18
NICU5 Infusion Systems: (Carefusion) ......................................................................................................................21
NICU6 Medication Cabinet: (Carefusion) .................................................................................................................21
NICU7 Medication Delivery: (Carefusion) .................................................................... Error! Bookmark not defined.
NICU8 Find Available Infusion Pump: (Carefusion / Stanley) ...................................... Error! Bookmark not defined.
NICU9: Asset Management Visibility and Analytics: Increase Operational Efficiency, Patient Safety and Lower Costs
(STANLEY)
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Revised / Updated: Mar 25, 2015
Scenario
Patient Name:
Age:
MRN:
Status:
John Millhouse (Male)
32
Multiple Injuries from an Automobile Accident transferred from the
ED
NICU Patient
Baby Alice
Premature Birth transfer to the Neonatal ICU
Start:
(Actor 1, presses play on mp3 player, and starts by the bedside, Actor 2 starts
outside the door after everyone has entered the room. As soon as the script starts,
Actor 2 enters the room and walks to other side of the bed.)
ICU4 Staff Identification (Airista) Updated Mar 31
Hello, I would like to welcome everyone to the Intelligent Hospital™ Pavilion
developed by the Intelligent Health Association. This ICU demonstration will
address both critical manage of adults and neonatal patients.
As you can see, I am automatically identified as I enter the room by the RTLS Staff
Badges that I am wearing. (Actor 2 points to AiRISTA RTLS Badge). An enterprise
RTLS solution capable of staff identification and locating enables an organization to
automate processes and workflows improving the quality of patient care. (Actor 2:
Points to large display showing screenshot 1 “staff location”) Integration to existing
hospital systems such as Nurse Call, Single Sign On and Nurse
Rounding/Scheduling increases the efficiency of healthcare workers and their
managers. (Actor 2: Points to large display showing “Staff Rounding Report”)
Multiple dashboards and business analytics are present to assist in the management
of time consuming processes associated with staff management.
ICU 4: Passive RFID Zonal Tracking (Borda)
The Intelligent Hospital provides multiple levels of asset tracking functionality including
zonal tracking of assets with UHF Passive RFID. Every asset has a passive RFID tag attached
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on it with a unique ID. (Actor points to a device with UHF Passive RFID tag attached on it).
With this solution; Assets entering to a specific zone or leaving from a zone is detected and
a picture or a video is captured through an integration with CCTV systems when leaving a
critical zone. Zonal tracking can also be combined with real time rule engine so that any
biomedical device with an expired calibration date would create an alert as soon as the
device gets into the ICU room. (Actor, (1) points to the Borda Display (2) brings a mobile
biomedical device into the room and an alert condition will be shown on the Borda Display (3)
clicks on the alert to show the details)
ICU5 Network and Wireless Infrastructure (Extreme Networks)
The Intelligent Hospital combines a robust network and wireless infrastructure,
providing a seamless blend of multi-carrier cellular and Wi-Fi services. This enables
real time operational intelligence from multiple RTLS / RFID and Wi-Fi systems
applications as well as several modalities of communication and visualization
providing rapid enterprise level interaction as observed on the large screen on a
portable tablet or a hand held device. Actor 1 points to large display, Actor 2 holds
up iPhone and HP tablet.)
We pick up the Scenario in the Intelligent Hospital ICU, where patient safety and
continuity of care are paramount and great emphasis has been placed on asset, data
and alarm management through multidisciplinary collaboration of the clinical staff,
as well as informatics and biomedical engineering experts and a host of high tech
venders. The ICU is cognizant of the recent Joint Commission Alarm Management
National Patient Safety Goal and many of our solutions will help meet this goal.
ICU 1: Staff Management: (CBORD) Make it Easy for Employees to Spend with You
Within the ICU the high acuity of patients makes staff response patient paramount.
The high patient to staff ratio requires staff to manage time and breaks affectivity
and ensure that the proper coverage is provided. If a nurse needs to go on break
and only has 15 minutes, and knows the lines at the coffee kiosk downstairs will be
long right about now. [Employee gets out phone while monitor shows screen shots
progressing through quick online order] Instead of wasting time in line, she gets out
her phone and places a quick online order, paying at the end with her Intelligent
Hospital ID badge -- the same one you received when you entered the Pavilion
today. [Employee holds up badge] She will now have time to run to the restroom
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and return a few phone calls before heading down to the coffee kiosk, where she will
skip the line entirely and pick up her coffee and scone. She loves the convenience of
online ordering, and hospital administrator’s love giving their employees a strong
incentive to do business with them instead of heading off campus. [Employee leaves
to go on break] (Employee looks at watch.Employee gets out phone while monitor
shows screen shots progressing through quick online order. Employee holds up ID
badge. Employee leaves to go on break at end.)
The ICU has just received John Millhouse from the ED. He is a 32-year-old male
patient who was one of the drivers from a car crash. He presented to the ED awake
with multiple injuries, however he deteriorated and now requires critical care
support including mechanical ventilatory support.
ICU6 Medical Device Connectivity
(Cardiopulmonary, Nuvon,
Sunquest)
In this facility, continuity of care has been established through medical device
connectivity enabling surveillance, monitoring, and documentation, even in
transport. Institutional RFID systems provide the ability to locate the patient in
route and at specific locations such as Radiology or Radiation Oncology. Aggregated
clinical information coming into the EMR, Laboratory system and PACS is delivered
to a hand held and available for review anywhere in the hospital. This increases
patient safety, by allowing clinicians throughout the institution and at remote
locations to access clinical information to support, monitor and communicate. [Hold
up hand held device and point to shared monitor]
ICU 7 Bedside workstation/ Tablet authentication (HID, Zebra)
This room is equipped with a bedside PC workstation which can be wall or cart
mounted or a hand held tablet replacing the larger solutions. This PC or tablet is
capable of running all the hospital applications and provides the clinician bedside
access to the EMR, PACS, Lab information system, cardiology management data or
medical history data. Proving you are who you say you are, by utilizing One Time
Password security into cloud applications can be accomplished leveraging your ID
Badge and NFC communication protocol with a single tap of the card. The
innovative technology card both generates and sends a One Time Password without
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the inconvenience of re-entry. (Actor picks up the tablet and taps their ID badge to
the tablet – screen shot of the authentication application).
In addition the PC provides the capability to print and scan barcode labels, and can
also be integrated with RFID reader.
These integrations ensure patient centric
identification and association of all devices, supplies, medications, samples and
documentation is directly associated to the patient.
(Actor 1 Walks in at the start of the next paragraph, and immediately uses the hand
washing dispenser)
ICU8 Hand Hygiene (Airista) Updated Mar 31
Hello, I would like to welcome everyone to the Intelligent Hospital™ Pavilion
developed by the Intelligent Health Association. This ICU demonstration will
address both critical manage of adults and neonatal patients.
As you can see, I am automatically identified as I enter the room by the RTLS Staff
Badges that I am wearing. (Actor 2 points to AiRISTA RTLS Badge). An enterprise
RTLS solution capable of staff identification and locating enables an organization to
automate processes and workflows improving the quality of patient care. (Actor 2:
Points to large display showing screenshot 1 “staff location”) Integration to existing
hospital systems such as Nurse Call, Single Sign On and Nurse
Rounding/Scheduling increases the efficiency of healthcare workers and their
managers. (Actor 2: Points to large display showing “Staff Rounding Report”)
Multiple dashboards and business analytics are present to assist in the management
of time consuming processes associated with staff management.
ICU9 Bed/Nurse Call
(Stryker / ASCOM)
Typical of most high acuity patient environments, our patient lies in an
instrumented smart bed giving a secure dynamic environment capable of
monitoring patient weight, side rail status, wheels, and patient
communications.(Actor points to the bed)
The bed integrates with a nurse call platform, providing patient to staff
communications. Caregivers and staff wear staff badges that use IR, ultrasound, or
low frequency RF technology through receivers located throughout the hospital and
patient rooms. (Actor1 puts down bed rails, and points to other actors ASCOM
Device) (Actor 2 holds up ASCOM Device to the audience to show that it was alerted
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when the rails went down). Calls and alerts such as bed exit or rails down can be
immediately directed to the appropriate and available caregiver through the staff
worn or handheld wireless device.
ICU10 Alert Notification (Vocera ASCOM)
In this case the rail down condition is detected by the nurse call platform and the
alert is sent to the primary caregiver (Actor 2) but she responds via her Vocera
Badge (pushes a button on the Badge) that she is unavailable which in turn
transmits the alert to the secondary caregiver (Actor 1 then holds up the and shows
that he got a call when Actor 2 could not respond) who accepts the alert and attends
to the potential bed exit alarm situation. It is important to note that caregiver one is
carrying an entirely different personal communication device than the secondary
caregiver. (Vocera) (Actor 1 picks up the bed rails to cancel the alarm)
ICU11 Nursecall Communication & Workflow (ASCOM)
The nurse call platform also server to enhance communications and workflows of
the nursing staff. In this case the nurse observes that the patient’s IV appears to be
tissuing and requires a new catheter at a new location. The staff member touches
the “IV Team” touch point on the workflow station. The request is immediately sent
to the appropriate group of staff via their wireless device. When a member of the
team “accepts” the event using the soft key on the handset the rest of the team is
notified that the request has been accepted saving steps. The staff member
accepting the request has the option to speak back into the patient room to
communicate with present staff prior to arrival.
(Draeger)
ICU12 Physiological Monitoring
Mr. Millhouse is also placed on physiological monitoring as ordered by the
physician. At the Intelligent Hospital™, physiological parameters are monitored by a
high acuity networked monitoring platform. This provides real time measurement,
visualization, archiving and dissemination of critical parameters to other
middleware including the EMR, hand held devices and alarm management systems.
Here, Mr. Millhouse’s heart rate and ECG rhythms, blood pressure, and O2
saturation are continuously monitored and are also available on the central station
as well as on mobile devices carried by nurses and doctors. (Actor Points to
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physiological monitor) This monitoring platform also integrates with the hospitals
wireless WiFi network enabling continuous monitoring at all locations in the
hospital, during transit, at Radiology or any testing or treatment location. Critical to
the objectives of the National Patient safety goals is alarm management. The ICU
uses a distributed alarm notification methodology, where in addition to
annunciation at the central locations alarms and waveforms are delivered directly to
the nurse at the point of care [ Hold up mobile device with alarm and waveform]
ICU13 Alarm Distribution / Management (ASCOM)
Emergency alarms such as physiological monitor VTACH alarms are dispatched to
the assigned nurse and the supporting handset to enhance nursing response and
optimize workflow. The hand set identifies the alarm type via the top display and
the color bar indicates severity at a quick glance. The nurse is able to view the event
(look at the wave file from the monitor that generated the alarm. Upon assessing
the alarm she is able to accept the event and take care of it. She also has the option
to select “Busy”, if unable to take this alarm, to have the alarm dispatched to the
backup nurse. On the Unite View (shown on a wall mounted monitor) central
dispatch can see what staff members have accepted or escalated the event.
ICU14 Data Distribution
The Intelligent Hospital utilizes a combined data distribution approach. This
includes the delivery of information to a central location (screen shot Draeger) for
continuous surveillance, directly to the point of care via hand held devices carried
by the staff or to off-site clinicians via web based applications. The delivery of
critical alarms or test results to the point of care, to selected team members,
eliminates the need for bedside team members or lab tech’s to play phone tag
especially when a critical result is being transmitted.
ICU14a: ICU for wearable alarm interface: (Cardiopulmonary)
For devices that have no visual or audible alarm capability such as a battery
operated wireless wearable patient monitor the system has FDA Class II clearance
and provides the primary alarm functionality. This system collects and relays the
real time data including alarms, settings, battery status and direct measurements
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generated by the patient monitor utilizing the hospital's wireless infrastructure
(Actor points to the mannequin).
The central monitoring station of the system is the primary alarm device displaying
and distributing the real time alarms and data to the clinical staff (Actor points to
the central monitoring nurse’s station displaying the alarms and real time data).
Alarms can also be transmitted to clinicians via any mobile devices available such as
smart phones or tablets. (Actor points to the tablet and smart phone displaying data
at the nurse’s station).
A complete set of data generated by each patient monitor is archived by the
Bernoulli system or forwarded to any EMR system where it can be stored and
analyzed.
ICU15 Clinical Data View – EMR (Sunquest)
Flow sheets in the patient’s electronic medical record are automatically updated
from bedside devices minute by minute. Critical data are trended and correlated
with ventilator settings, arterial blood gases, Intake and output data, medication
data and vital parameters over time through at the point of care. Correlating data
allows physicians to see patterns and abnormalities or areas of concern, while
viewing relationships between data. Show EMR w/ Clinical Data Viewer for Mr.
Millhouse
Clinical Decision Support and knowledge based charting can be used when placing
orders to manage conditions noted from the review of data in the ICU, helping to
manage best practices for ICU Insulin Protocols, Sepsis Early Warning and
Treatment, Pain Management, and Catheter related blood stream infections. [Show
EMR w/ display of an ICU Insulin Protocol Order for Mr. Millhouse]
ICU25 Find Available Device (Ventilator) (Emanate Wireless Mar 31
Returning to our case, our patient requires mechanical ventilation, the staff must
quickly locate an available ventilator. Using the RTLS system the nurse is able to
locate the nearest available clean ventilator. (Point to the tag upon starting the
script.) The inline power tag mounts directly on the pump in line with the AC power.
It contains a rechargeable lifetime battery so once it’s mounted on the asset; you
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never need to replace it. The solution can assess the true utilization of your devices
based on power consumption as measured over time. (Point to the utilization report
on the monitor when highlighting reporting power consumption.) This is valuable
information as your determine your par requirements and requirements for
purchase, leasing or rental budget for the next fiscal period. The tag has a low
energy Bluetooth interface to connect with your mobile device. The PowerPath
mobile application can help find the device within the last 30 feet. (Point to "finder
mode" screen shot when talking about mobile application.) Note that the finder mode
lists all the ventilators within range. By selecting the device from the list, the tag
will provide an audible and visual alert to quickly discern which device I’m looking
for. (Push button on mobile device to have tag blink and flash)
ICU16 Centrally Monitored Ventilated Patients
(Cardiopulmonary)
He is placed a ventilator which is connected to the hospitals infrastructure using
either hardwire or wireless solutions. In fact, all ventilated patients can be centrally
or remotely monitored with alerts delivered directly to the care provider at the
point of care via a variety of hand held devices. This application also enables the
hospital to dynamically monitor all ventilated patients independent of their location
providing a virtual ventilator community and ensuring a standard level of safety
across the facility.
ICU 16b Analytics (Cardiopulmonary) ** Updated Mar 17
The platform provides a series of comprehensive reporting and analytic tools that
function to provide hospital subscribers with reports detailing operation within
their health system. This platform summarizes and de-identifies high-fidelity, realtime data from the enterprise wide system where subscribers can generate reports
at the click of a button. Subscribers can generate automated reports ranging from
alarms trending over time to bed occupancy to average length of patient stay, even
including alarm limit reduction analytics, and compare them across their health
system. (CPC)
ICU 16a Hemodialysis Systems (BBraun) ** Updated Mar 6
In the event this patient required additional support such as hemodialysis The
automated systems provides self test and recirculation or standby mode, simplifying
set up time enabling rapid deployments and eliminating the chance for errors. To
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prepare a patient for dialysis treatment, the Dialog+ is setup with the connection of
the concentrate, (actor point to the Solcart cartridge), patient bloodlines connected
to the dialyzer and primed, (actor point to the bloodline tubing, dialyzer and saline
bag), and confirm system is ready for final testing and initializing hemodialysis
treatment.
The system provides a wide range of clinical options with the ability to profile every
major parameter (UF, conductivity, temperature, heparin, dialysate flow, and its
wide range of parameter settings, tailoring the treatment to the patient’s needs.
With the Online information, trends and treatment parameters, therapy profiles can
be viewed and changed at any time during the treatment to provide enhanced
flexibility and better manage clinical outcomes and treatment anomalies for the
patient
As you can see in this acute care setting, patients are typically connected to a variety
of devices in addition to physiological monitoring and ventilators; which includes
pulse oximetry, intra-aortic balloon pumps, dialysis machines, cardiac output
computers, infusion pumps and hemodialysis.
ICU17 Connectivity (Cardiopulmonary)
It is vital that data from these discrete devices and systems is time synchronized
and available to share the information providing an enhanced and comprehensive
view of the patient’s condition. However, for devices and data to integrate with
other applications like alarm management or the EMR, the medical devices must
additionally associated with the correct patient.
To provide this local and remote real time connectivity and surveillance a multiport
bridge provides high-speed, high-fidelity data acquisition from all the devices (actor
plug devices into MPB so they activate and display on the MPB screen as
transmitting) Continuous acquisition of ICU monitored parameters from an array of
devices along with additional functionality may include the integration of video,
activity or temperature monitoring, using a wireless temperature transducer and/or
accelerometer directly to the patient providing continuous patient body surface
temperature. This combined real time data is displayed on a web-based clinical
surveillance system (actor points to the patient data surveillance monitor in the
room), which is also available via a web browser from any remote location
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ICU23 Alarm Management (Cardiopulmonary)
As a result of the ventilator failure the patient becomes immediately agitated. As
observed the disconnect triggers a variety of alarms throughout the hospital. Data
may be delivered and viewed in any telemedicine location using a wide range of
fixed viewers or any mobile communication device. Shown here, by way of a nonlimiting example, a clinician disconnects a ventilator, which triggers an alarm that is
sent to a VoIP badge to indicate a potentially dangerous risk condition has arisen
with a patient. (CPC) (Actor 1 disconnects ventilator tube or triggers an alarm on the
ventilator. Vocera badge on Actor 2 activates to indicate an alarm has been sent with
applicable message.) (Actor 1 then holds up iPhone and points out the red icon for
the ventilator at the bottom of the patient shield.)
ICU18 Decision Support (Sunquest)
Importantly, the real time collection and integration allows for active patient
monitoring and alarm management and for fusion of this data with other EMR data
elements to implement algorithms, and for data analytics and clinical decision
support within the EMR or thru third-party venders to identify patients at risk for
deterioration, and prevent adverse clinical events. Importantly, Clinical Decision
Support can be utilized to monitor and track many Quality and Outcomes indicators
helping to prevent, identify and reduce the numbers of adverse patient and
reportable events.
Actor: Show Facility Board, Clinical Summary View, and Clinical Analytics View,
viewing multiple alerts
ICU19 VOiP Communications (Vocera) Updated Mar 28
The nurse just received a message over her VoIP phone that the intensivist will be
coming to the unit to insert a central line in Mr. Millhouse for hemodynamic
monitoring. Each staff member of the Intelligent Hospital wears a Hands-Free
communication Badge that enables staff-to-staff communications, as well as
notifications from critical clinical systems and the hospital’s phone system. (Both
Actors hold up the Vocera Badge)
ICU20 Supply Management Automated Documentation (DeRoyal) **
Updated Mar 4
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Protocol dictates that the central line kit is set up and ready when the physician
arrives. A nurse places the kit on a procedure tray, alongside the other supplies
required to perform the procedure.
The Cloud based Continuum Safe will display applicable patient information from
the ADT system on the screen. The nurse will open a supply needed for the patient
and then simply toss the wrapper in the Safe. By doing this, the Safe captures usage
for charging and verifies the item has not expired. The system also associates any
relevant item information such as serial and lot number to the specific patient for
documentation and traceability purposes. Because of the teamed approach to care
in the ICU the same action may also be performed by other ancillary providers who
care for the patient such as respiratory and radiology .The item usage may then be
sent to the clinical record and/or financial system. (The nurse picks up a supply,
opens the package, and tosses the wrapper into the Continuum Safe (bin). The nurse
will then see the item is now displayed on the screen.
ICU21 Labs Sample Collection
(Sunquest, Zebra)
Blood samples are also routinely collected for processing in the stat laboratory.
Once the Nurse logs into the EMR, they scan the patient’s armband to electronically
confirm positive patient identification and view existing orders in real time for that
patient using Collection Manager on their handheld device.
The Nurse selects the appropriate orders and prints the labels from a mobile printer
in the patient’s room. The nurse then attaches the labels to the containers, collects
the specimens from the patient and places them in the labeled containers, all at the
patient’s bedside to prevent the chance of mislabeling or losing the specimen before
leaving the room.
The nurse scans the sample and inserts it into the pneumatic tube carrier. The
carrier is then inserted into the pneumatic tube system which automatically reads
the RFID chip embedded in the carrier and tracks the sample throughout the
transport. The entire transaction is tracked within the pneumatic tube station’s
software, providing complete chain of custody, which monitors and confirms all
sends, receives delays or missing carriers.
ICU22 Eliminating Transfusion Errors & Increasing Efficiencies
(Sunquest, Zebra)
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If a patient requires a blood transfusion, the caregiver uses Transfusion Manager on
the same handheld device to positively identify the patient by scanning their
armband.
The caregiver scans the unit of blood to electronically confirm the right blood is
going to the right patient. This electronic verification saves time by eliminating the
need for a second nurse verifier, and can save money by replacing secondary blood
bank wristbands. Once the patient and blood unit are positively matched, the
caregiver can proceed with the transfusion. If there is not a match, the system will
give a hard stop, preventing a mis-transfusion from occurring.
(Actor/Actress uses handheld device to scan patient ID and carries out positive
patient identification. Using the same device, a unit of blood is scanned. The match
is confirmed, and the patient is given the blood transfusion.)
ICU24 Staff Duress (Stanley, ASCOM)
The patient continues to become increasingly agitated. He is tachycardic with a
decreased pulse, and the nurse finds it necessary to request assistance in the
management of the patient. Since she is busy trying to keep the patient claim and in
bed she uses the event buttons on the RTLS tag generate an alert defined as staff
duress or assistance required. This is event is globally visible on the RTLS map and
can be annunciated in a variety of ways.
ICU26 Staff Workflow: (ASCOM)
Once the patient is restored on ventilation, the nurse must contact the attending physician
directly, through the attending physician button on the workflow console (Actor
closest to the nurse call system presses the attending physician button)The
physician responds directly to the nurses hand held device, and after evaluating
patient orders prescribes additional medications to be delivered.
ICU 26a: ePrescribing HID
According to DEA requirements, to write a schedule II-V prescription on-line the
physician needs to be identity proofed and bound to a certified credential. Within
the EHR module, two factors of authentication must be presented. You need to
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prove you are who you say you are. The prescriber can do any one of the following
supported methods:
[Actor#1: Holds up ID Badge, inserts it into desktop reader, types four digit PIN 1234]
Insert their ID credential for presentation of their digital certificate, and add PIN.
[Slide 2: Screen shot: Identity accepted]
OR, the prescriber can initiate a One-Time-Password from the certified credential,
types in six numbers. 123456
[Actor#1: Holds up ID Badge, types six digit PIN 123456]
[Slide 3: Screen shot: Identity accepted]
OR, the prescriber can use a biometric that matches the issuer profile.
[Actor#1: Holds places index finger on the sensor]
[Slide 4: Screen shot: Identity accepted]
[Slide 5: Prescription successfully sent to the Pharmacy]
Again, any ONE of these three authentication methods meets DEA requirements.
Two-factor authentication when E-Prescribing for all drugs increases security and
improves both the physician and patient’s experience.
ICU27 Mobile Med System-Remote Med Queuing App (Omnicell)
** Updated Mar 4, Mar 20
The Nurse remotely accesses the electronic medical record on the Mobile
Medication System. From here, she can review the medications currently ordered
for the patient and with a few clicks, can easily queue up medications for the patient.
When the nurse logs into the automated dispensing cabinet, she is immediately
presented with the option to remove that very same medication that was just
queued up. This connected system between the bedside mobile workstation and
the medication cabinet increases nurse efficiency and reduces time spent away from
the patient.
ICU28 Advanced Infusion Pumps Medication Administration
(Hospira)
The Intelligent Hospital has deployed an advanced infusion system operating
wirelessly and with interoperability to the EMR system. CPOE and BCMA provide
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tremendous value in patient medication safety. But they are not enough. This
Infusion pump has onboard safety software, including drug-specific hard and soft
dose limits, that can serve as a final line of defense for the patient by guarding
against an incorrect dose or type-o during infusion setup.
Our patient's physician has ordered a Dopamine IV infusion with a concentration of
400 mg / 250 mL and a Dose of 5 mcg/kg/min. To ensure the complete 5 Rights
administration of this powerful medication the nurse first scans the patient
wristband with the clinical vendor's Barcode Medication Administration device to
verify his identity, then, using the same device, scans the bar-coded IV medication,
and finally scans a permanent barcode on the IV pump.
(Where indicated by script, Actor will use the wireless handheld Barcode Medication
Administration prop to scan the patient's wristband, scan the barcode of the IV
medication bag hanging on the IV pole, and then scan the barcode on the pump.)
These actions associate the patient, the IV medication and the infusion pump, and
automatically program the IV pump to the pharmacy verified, physician order. The
nurse then verifies the order, as displayed on the pump, and starts the device.
(Actor mocks veryifying the onscreen order by tracing it with their finger, the mocks
pressing Start button on device – do not actually press)
With IV pump integration, not only is the device automatically programmed, but
infusion data is automatically documented to the patient's eMAR and I&O Flow
sheet. This combination of Auto-programming and Auto-documentation strengthens
the clinician’s ability to enhance patient safety, improve outcomes, and spend more
time with patients thanks to a more efficient workflow
(Intouch robot moves to bedside)
ICU29 Remote Consultation (InTouch)
As the patient develops new problems, the nurse accesses the remote clinician. The
robot is sent to the patient’s bedside, providing support to the ICU nurse for clinical
inquiry. The robot remotely examines the patient, actor with stethoscope and sono
probe and the remote doctor views bedside monitoring devices and the EMR. The
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intensivist decides to coordinate the care plan with the pharmacists and
pulmonologist. In addition the patient’s family is remotely connected to receive
updates and review the new care plan.
NICU - PICU
[Actor moves to the NICU part of the room] Managing critically ill pediatric or
newborns requires a specialized intensive care facilities design focusing on the
issues common to critically ill infants, children and teenagers. Premature and
newborn babies who need intensive medical attention are often admitted into a
special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU
combines advanced technology and trained health care professionals to provide
specialized care for the tiniest patients.
NICU1: Security Data Access (Zebra – Zatar)
Maintaining security around patient sensitive information is paramount in the
Intelligent Hospital and the NICU. NICU staff can access critical patient information
on a tablet (Nexus Tablet) based on approved authorization levels. The clinician
or physician has a badge that is a combination of NFC and beacons, this badge allows
them to gain access to the patient bedside tablet and access approved information.
The beacon on the badge allows the tablet to detect when someone walks to the
bedside and offer some basic patient information, the physician or clinician is then
prompted to identify themselves which then allows the screen to open up more
information based on approved authorization levels. This information includes
patient temperature, glucose levels, feeding, fluid levels, any falls, sleep or sedation
and what medications had been administered.
NICU2 Infant Security- (Stanley) ** Revised
Within the Pediatric areas of the hospital infant security is of paramount importance
to all hospital operations. Hospital accreditation Standards defines patient
abduction or a pediatric discharge to the wrong parent as a sentinel event.
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This NICU also offers electronic infant security. The clinician has determined that
baby Alice has sufficient body mass and strength to safely wear the small wireless
infant tag on her ankle. [Actor points to tag on baby’s ankle] Once attached, the
tag automatically enrolls in the infant security system [Actor points to shared
monitor screenshot]. Baby Alice is immediately protected in three ways: the tag
cannot be removed without authorization, exits will lock if she is brought near, and
the system continually monitors signals from Alice’s tag so that she can be located
not only in the NICU but anywhere in the hospital covered by Wi-Fi.
Alice’s mother is also wearing a wireless wrist tag [Actor points to tag on mother’s
wrist] to help staff ensure that Alice is always properly matched with her mother
when she visits the NICU. The two tags bonded together when Alice’s tag was
attached. Now, whenever Alice’s mom comes to visit, Alice’s infant tag automatically
checks for a correct match and emits an audible alert tone [Actor points to shared
monitor screenshot] should a mismatch occur. This is an important defense
against mothers inadvertently nursing someone else’s child.
NICU3 Incubator (Drager)
These infants or preterm births are housed in an environmentally controlled
incubator. These systems Oxygenation, through oxygen supplementation by head
hood or nasal cannula, or even continuous positive airway pressure (CPAP) or
mechanical ventilation. Patient observation of modern neonatal intensive care
involves sophisticated measurement of temperature, respiration, cardiac function,
oxygenation, and brain activity, and includes protection from cold temperature,
infection, noise, drafts and excess handling: The incubator provides provisions for
nutrition via an intravenous catheter or NG tube, administration of medications and
maintaining fluid balance by providing fluid and keeping a high air humidity to
prevent too great a loss from skin and respiratory evaporation.
NICU3a: Kanban inventory management with real time intelligence
(Cardinal)
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The Nurse caring for the neonate needs some supplies for the management of the
neonate. She walks over to the general supply area and grabs four general supplies
needed, from the 2-Bin Kanban solution. The 2 bin Kanban solution allows for usage
tracking of low dollar items at bin level instead of item level which eliminates the
need for par optimizations and cycle counting. The 2-bins ensure that there is no
stock-outs based on suggested par levels from historical usage data. It also triggers a
replenishment signal to the materials management system to re-order needed
products as bins are scanned empty. While the order is being replenished the
second bin allows for product availability (no stock-outs) keeping both the clinicians
and materials managers satisfied – and supporting effective First in First Out (FIFO)
management of materials.
(Actor goes to general supply and grabs 4 supplies. She also pulls out an empty bin
and places on top shelf marked “Place empty bins here”)
The solution also allows for charge capture of billable items. The patient list
information is pre-populated from the ADT system to associate accurate charge
capture with the correct patients. (Actor walks to screen near 2 bin system and
interacts with touch screen, selects patient and scans barcode/or hits +/- on the
touch screen for the item). Initially, the system can be pre-configured to only show
billable items on the screen. The system is smart enough, to self-learn from
historical utilization data topre-populate those chargeable items most often used
within each area. As a result, the screen configures itself accordingly, helping
capture billable items as well as leveraging Integrated Advanced Analytics to
provide powerful reports impacting the bottom
NICU4 Medication Administration:
Patients in the NICU are very susceptible to medication issues. In premature
infants, the immaturity of developing body systems affects the absorption,
distribution, metabolism, and excretion of drugs and therefore an exponential risk
for medication errors is present Medications are universally weight-based,
requiring calculations for each dose. NICU patients often have long hospital stays,
which increases their exposure to medications and medication errors.
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NICU 5a: TPN bedside electronic Order Entry (BBraun)
Updated mar 20, Repositioned Mar 25
In pediatric cases [Pharmacist 1 : physician holding an iPad or tablet provided by
bbraun shows how to pull up prior parenteral nutrition orders through screen shots
of TPN Manager.]
In this case the doctor is seeing a pediatric patient Sarah admitted 2 days ago with
short bowel syndrome and sepsis stemming from her catheter site. She is being
treated with IV antibiotics and total parenteral nutrition, also known as “TPN”.
While reviewing the labs, the doctor sees that with the exception of low serum
calcium, all of her electrolytes are within normal limits, but her height and weight
put her below the growth curve for her age. Her small stature concerns him about
whether she is receiving adequate nutrition, and her low serum calcium could result
in poor bone development. Using a tablet computer, the doctor reviews previous
TPN orders for this patient.
[slide 1]
The doctor updates Sarah’s weight to 24 kilograms and acknowledges that he has
reviewed it and yesterday’s order [slide 2] for TPN on this tablet computer using a
special "app" designed specifically for ordering and managing TPNs. [slide 3] Once
he knows what he wants to modify, he makes changes to yesterday’s order right at
the bedside.
[slide 4 - WITH RED CIRCLE APPEARING AROUND 1.5 (TROPHAMINE) AND 6.25
(DEXTROSE)]
[Brief pause, 2 seconds]
Because he chose an amount of calcium that is too high, a calcium‐phosphate
curve...
[Slide 5: RED CIRCLE ON 2.00 (CALCIUM GLUCONATE 10%), HIGHLIGHT CHART
ON SCREEN SHOT 5]
..displays showing that the calcium will precipitate if this amount is allowed to be
given. He uses a special tool within the system that guides him to a recommended
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amount of calcium & phosphate that will not cause precipitation and adjusts his
order accordingly.
[Pharmacist 1 : still holding the iPad illustrates the calcium-phosphate curve that
the software generated.)
[Slide 6: WITH RED CIRCLE APPEARING AROUND 1.00 (CALCIUM GLUCONATE
10%]
[Brief pause, 2 seconds]
Within a short time, he has entered a new TPN order customized to meet Sarah’s
current nutritional needs. The clinical decision support incorporated into the
software flags [Slide 7] him with warnings about being below the per liter limit of
lipid and exceeding the warning levels of phosphate and aluminum. He
acknowledges the warnings and submits the order.
[Slide 7?: receipt of the order shown through screen shots of TPN Manager]
This order will now be transmitted electronically back to the central pharmacy we
saw earlier in our tour. [slide 8] The order will be reviewed by that central
pharmacist for…
[Slide 9]
…appropriateness and accuracy, and then be [slide 10] authorized for compounding
to begin without any need for order transcription or reentry by the pharmacist.
[slide 11]
Also important here is the fact that the precipitation error was averted during the
ordering phase of the medication use process, the best phase to catch an error! Had
this not been caught at the ordering stage, it would have been transmitted to the
pharmacy. If it were lucky enough to be caught by the pharmacist, it would have
resulted in a delay of care while the physician is paged or called for an order
clarification, a timely and inefficient process.
NICU6 Medication Dispensing System: (Carefusion)
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The nurse taking care of baby Alice has determined it is time for her medication.
This medication happens to be stored conveniently in this automated dispensing
cabinet system which provides an efficient, patient-focused workflow allowing a
nurse to easily see their patients and their medication due times. The workflow
gives each nurse the ability to easily remove the right medications for their patients
quickly and accurately.
[Screen shot: (1) Shows close-up of nurse touching My Patients, (2) selecting the
patient from their My Patients list, (3) and accessing patient order information,
including DOPamine.]
The system also includes a label printer that enforces the printing of a barcoded
label for any medication, as configured by pharmacy.
[Actor: Point to printer]
Thanks to the capacity of the highly configurable pockets, larger IV bags, syringes
and other bulky medications can be securely stored here.
[Screen shot: (4) Shows image of drawer open and CUBIE pocket with syringes.]
In this case, the nurse is removing a syringe of medication which needs to be
labeled specifically for baby Alice.
[Screen shot: (5) Shows image of label, (6) and labeled syringe.]
[Actor: Go to label printer, pick up label, pretend to put it on syringe, show syringe
already labeled.]
The medication – centrally stored and readily available for nursing use – is now
appropriately labeled for baby Alice’s specific order, ensuring medication safety and
accuracy.
[Transition to Actor who is standing next to an Alaris pump, begins to simulate
Alaris programming]
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NICU8: Final Available Pump (CareFusion / Stanley)
The nurse is ready to start an infusion, but the clean equipment room is empty.
Because our Intelligent Hospital has deployed a wireless system allowing the RFID
tags on the pump to communicate to a tracking system, the nurse can use “Find near
me” features on mobile devices to find the nearest available pump to their specific
location. (Stanley Healthcare)
[Actor nurse picks up the iPhone and executes a search (iPhone 6Plus so the screen can be
seen by the audience).]
[Screen Shot: iPhone - search]
There are no locally available pumps so the nurse submits a request through the
Asset Management system. This sends a request to Central Supply and
simultaneously to the technician, generating equipment orders for delivery of the
asset to the patient room.
[Actor central supply goes across the room and brings the pump to the bedside]
[Screen Shot: iPhone – request for pump]
(Alaris) With integration between RTLS and the infusion system, biomed has
optimized the distribution of infusion devices. This is enabled by having visibility
into the status of every infusion device – whether it is currently infusing and how
frequently it has been used. This information then enables the hospital to allocate
the optimal number of infusion modules, like pumps, syringes and PCA modules to
the care areas with the highest historical usage.
[Screen Shot: iPhone – request for pump]
NICU9: Asset Management Visibility and Analytics: Increase Operational
Efficiency, Patient Safety and Lower Costs (Carefusion / Stanley) * Updated
Mar 20
As you just heard, the integration of RTLS and infusion systems improves operational efficiency,
staff communication and patient safety with immediate decision making—like locating the
nearest available pump. This integration also allows business status to be accurately tracked—
you not only know where your equipment is, but whether it is in use, clean, soiled, needs
maintenance or part of a recall. Now you can take it a step further by transforming the real-time
data collected in the systems into visual analytics dashboards to make better decisions, identify
process improvement opportunities, and apply predictive analytics to optimize performance.
Whether you employ on-demand or par-level delivery, streamlining equipment utilization is key
to operational efficiency… and in the NICU, it’s crucial to stage for high-acuity patients with the
right numbers of functional, life-saving equipment. This dynamic analytics dashboard [Actor
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points out wall monitor and then taps iPad to drill in to dashboard – changes on large
monitor] gives managers rapid visibility into every step of your equipment process in real-time,
assuring the NICU has the necessary equipment they need. This data allows you to identify,
analyze, diagnose, and address process challenges. Efficient utilization of your high-demand
devices is paramount to keeping your equipment costs down, while still saving lives and
providing outstanding quality of care.
NICU5 Infusion Systems: (Carefusion) * Updated Mar 20
Syringe pumps are most commonly used in NICU. These environments often require
the precise delivery of very concentrated drugs or antibiotics.
The nurse receiving intravenous medication will now get it ready for administration
using a smart pump like this. What makes this pump smart is that it has an
electronic brain that contains a library of drugs with individual maximum &
minimum dosing limits and safety parameters. These limits help prevent
programming errors which can lead to over and under dosing of the medication.
[Nurse Actor scans the barcode on the patient wristband, drug label, and syringe
module]
[Screen Shots: workflow: scanning of wristband, scanning of drug label, scanning of
syringe module]
The Intelligent Hospital has deployed a wireless system enabling the pumps to
communicate with the hospitals electronic medical record. As soon as the nurse
scans the barcodes on: the patient ID band, medication, and on the syringe pump an
association is established which pre-populates the order for this drug on the pump
with the exact dose and rate that the physician ordered. The nurse simply verifies
the order, eliminating the need for manual programming, decreasing an opportunity
for error. This is especially important in the NICU where the sickest and most
vulnerable patients are.
[Nurse Actor loads the syringe, verifies the parameters, presses NEXT, finishes
verification and presses START.]
[Screen Shots: verification of parameters on pump, pressing NEXT / START]
The association between the smart pump and EMR system is bi-directional, which
allows all of the infusion status information to flow back to the EMR. Every
titration, pause, start and stop is recorded in near real-time. This provides a single
reliable record to increase accuracy and timeliness of infusion documentation. The
nurse simply verifies the data being sent by the pump, and if appropriate, completes
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the documentation by accepting it.
[Nurse Actor stands at the workstation on wheels as if typing in documentation.
Monitor shows a close up of the pump screen with I&O flow sheet receiving
documentation messages.]
[Screen Shots: EMR documentation, data feed going into EMR.]
This concludes the demonstration within the ICU / NICU, which highlighted how the
integration of different technologies and applications to enhance patient care and
safety, optimize staff workflow, meet Joint Commission and statewide mandates and
assist the inventory and supply management. Please visit the other rooms in the
Intelligent Hospital™ to find out how the other patients fair.
Thank you.
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