Mission Hospitals, an 800-bed facility in Asheville, N.C., needed to replace its aging intravenous (I.V.) infusion system. Hospital administrators wanted to include staff from multiple departments in the decision-making process to ensure the right model was selected-one that wasn't only safe and reliable, but also flexible enough to allow for monitoring and modification as needed.
In October 2004, the director of materials management was challenged with developing a team to complete the process, which he asked nurses to co-lead. Two clinical nurse specialists-one from adult services and the other from pediatric services-convened a team of staff and managers from pharmacy, biomed, materials management, and central processing.
Through December 2004, team members completed data analysis, which included a literature review and computer search. They analyzed available I.V. infusion technology and affiliated companies competing in the marketplace. Planning began for a larger group of healthcare professionals to come together and choose the appropriate technology for the facility.
Widening the circle
In January 2005, key players for an expanded team were identified, and the group began meetings. The core team included almost 80 nurses, with anesthesia and emergency medical services personnel. The team's project managers presented data from four I.V. infusion systems. The system's process criteria were chosen based on safety, capabilities, computer interface, ease of use, and functionality. (See "I.V. pump evaluation.")
Communication pathways included lateral, administrative, and clinical routes, as well as key nursing unit directors, clinical directors, and vice president-level staff. Four company representatives presented data on their infusion systems to the core group. Company reps were given a predetermined amount of time to give educational presentations and demonstrations of pump technology.
Information packets were given to each participant to aid in the comparisons. The challenge of this process was to narrow the search to two companies. However, the group decided it was best to leave the field at three to give the team more options.
After the initial data analysis and presentations, evaluations, and eliminations were complete, the project co-managers coordinated a much-anticipated clinical trial. Three companies came to both hospital campuses for 5 days, and spent time with the day, night, and weekend shifts. The I.V. infusion systems were demonstrated in large rooms where staff had ample time to conduct comparison studies and investigate the technology. Evaluations were collected from each staff member, and input from the clinical staff was compiled.
Going live
The final phase of the evaluation process occurred in April 2005. Staff from the expanded team volunteered for different tasks, including site visits, phone interviews, and development of IT requirements for a wireless system. By May 2005, the core group reconvened, and the information was presented by the project co-managers and small group leaders. The group selected an I.V. infusion system based on its medication safety features, wireless capabilities, and continuous quality improvement (CQI) data information systems.
The "go-live" process began with training classes over a 1-month period of time, and super-users were educated the first week. The following 3 weeks of classes were 2 to 4 hours in length and were conducive to both day and night shift attendance. Nursing unit directors accepted the responsibility of overseeing staff attendance. Instructors for each class included vendor representatives, project co-managers, and super-users in a joint and united presentation. Classes included an instructional presentation, user manuals, hands-on time with the new pump, and opportunities for questions and answers.
Once the education component was completed, "go-live" for pump distribution was scheduled for December 2005. The rollout team included biomed and computer services for the wireless connection. Central processing was outsourced to a materials management company to support the logistics tracking equipment. Pharmacy and unit clinical nurse specialists were heavily involved from the beginning and were responsible for developing the drug profiles. Materials management personnel were huge players behind the scenes, staging the tubing and change-out for this new system, including implementation, exchange of the old pumps for the new ones, and clustering supplies for unit delivery.
The rollout team consisted of co-project managers and nursing unit volunteers, a vendor representative, materials management personnel, biomed, and central processing personnel. Super-users were designated in each unit to assist with the change-out process. Each team was assigned a specific area of the hospital. Throughout the implementation day, the team leaders had to communicate at designated times to discuss and resolve opportunities for improvement. Resolutions included reassignment of team members to high volume areas or special needs areas, such as the intensive care units. Good communication was imperative, achieved by a combination of cell phones, beepers, and walkie-talkies. Lastly, as each team left the nursing unit, a list of vendor resource numbers was posted. The resource staff was available around the clock for 1 week after implementation to answer questions and perform bedside consultation as needed.
Since its implementation, the I.V. infusion system has enabled Mission Hospitals to reduce costs, prevent potential adverse drug events, and improve infusion practices. Routine education and staff retraining ensure that process improvements are continually successful.
I.V. pump evaluation
Rate each pump criteria on a scale of 1 to 3, with 1 as your top choice and 3 as your least desired choice.
Criteria
Air trapping protection
Alarm information easy to understand
Alarm volumes
Alarms easy to clear
Bar coding available
Battery time/info
Button response/accuracy
Display easily read
Dose range-changeable to accommodate specific units
Dose range-clear indication when outside of standards
Dose range-min/max easily accessible
Drug calculations
Drug library
Ease of mobility of pump
Easy to titrate
Method to access historical events
Multiple pumps clearly identifiable
Number of steps to make program change
Number of steps to program
Patient profile displays
Piggy back mode
Pole clamp security
Pump easy to turn on and off
Pump easy to program
Screen layout
Screen legibility/font/colors/size
Screen resolution
Size of unit
Tubing easy to load
Weight of unit
Were you able to make this pump fail?
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