Infusion Management
Implementation
Karen Corrick, BSN, RN
Great River Medical Center – Burlington, Iowa
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.
GREAT RIVER MEDICAL
CENTER
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
Acute Inpatient & Outpatient
Key Services
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OB/GYN
Orthopedics
Spine Surgery
Cardiology
Interventional Cardiology
Behavioral Health
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Digestive Health
Surgical
Rehabilitation
Hospice
Home Health Care
Emergency Department
Hospital-based Clinic Services
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Wound & Hyperbaric
Cardiology
Cancer Care
Business Health
• Rehab Center
• Wapello Physical Therapy
• Pain Management
Integration Device/Systems
• BBraun Outlook 400 ES
• Cerner Millenium
Team Effort
Biomed Overview
• ICommand
• 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
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
Information System Overview
• Interface mapping
• Servers
• Back up for Biomed and iCommand
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.
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
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.
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
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.
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
Questions???