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Introducing Intravenous Interoperability: Expanding the Pharmacist’s Role in Medication Administration

Amanda E. Prusch, Pharm.D., BCPS, Tina M. Suess, R.N., B.S.N., Richard D. Paoletti, R.Ph., M.B.A., Stephen T. Olin, M.D., Starann D. Watts, B.S.N., R.N., C.R.N.I.

 

Lancaster General Health, Lancaster, Pennsylvania

Intravenous (IV) interoperability, known as auto-programming, integrates intelligent infusion devices (IID), bar-code medication administration (BCMA), and electronic medication administration record (eMAR) systems into a bar-code driven workflow that automatically populates pharmacist-validated, provider-ordered infusion parameters on the IID.  The purpose of this project was to improve medication safety through the integration of these emerging technologies and decrease error potential during the medication administration process. 

By directly linking the medication order to pump programming, pharmacists directly impact how medications are administered at the bedside.  In addition, by establishing pharmacy involvement, two additional safety checks, pharmacist infusion rate oversight and nurse independent validation (second check) of the auto-programmed rate were introduced.   Four key phases were essential to both the development and implementation of IV interoperability: (1) preparation, (2) IV interoperability pilot, (3) preliminary validation, and (4) expansion.  After thirty-three months of extensive testing and validation by a multidisciplinary team, a pilot was officially launched on a cardiac-telemetry unit and within four months expanded to two additional nursing units (64 total patient beds).  While in the pilot phase, a time and motion study was conducted to compare the manual pump programming process to the interoperability system.  The study demonstrated a 24.8% reduction in nursing time for the interoperability pump programming process when compared to the manual process (p < 0.0001) and streamlined the workflow from 17 programming steps to 7.  Based on the results from the time and motion study and preliminary pilot data, the team continued to expand the program and within 8 weeks completed implementation on all telemetry (184 licensed beds) and medical/surgical nursing units (208 licensed beds).

After instituting IV interoperability, which guarantees IID dose/rate checking, the telemetry units’ compliance to the drug library increased by greater than 30% (p < 0.0001) and the medical/surgical nursing units’ compliance rate increased by 83.4% (p < 0.0001).  As compliance to the IV interoperability software increased, the number of violations to the soft and hard dose limits that prompted the nurse to “edit” (or reprogram) the pump trended down with telemetry and medical/surgical drug libraries demonstrating a reduction of 94% (p <0.0001) and 97% (p < 0.0001), respectively.  In July 2009, IV interoperability was used with 12,020 IV medication administrations and demonstrated a successful auto-programming rate of 90%.  Through the integration of the BCMA-IID systems and the incorporation of pharmacist oversight for all rate changes, the telemetry and medical/surgical patient care areas demonstrated a 60% reduction in reported monthly IV heparin errors. 

Pioneering IV interoperability with pharmacist oversight has brought recognition that safe IV medication administration does not rest solely with the nurse at the bedside thereby strengthening the collaborative partnership between pharmacy and nursing and providing our patients with a safer medication experience.  

View a pdf of the poster from the Midyear Meeting (740 KB).