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• First All Digital Hospital in U.S.

• Fully integrated EMR across 2 Hospitals & 60 Clinics

• National Valve Center • Five Star Hotel for;

Patients, Physicians, Nurses & and all team members!

Serving the State / Leading the Nation

Organizational Overview

• 15K Logins Daily, • 35K Charts Opened Daily • 1600 Patients Seen Daily • 1600+ Caths Monthly • 7000+ Echos Monthly

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Nurse Connect

ECG & PACS (Xper, Xcelera, iSite) Patient Monitoring & Infusion/Med Mgmt

okheart.com

Education / Entertainment

EMR

Technology Eco-System

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 2

Reality of Medication Errors

Adverse Drug Events may occur in one-third of hospital patients.1

More than 1.9 million ADEs per year.2

More than 180,000 patients die from ADEs annually.2 41% of fatal errors related to administering the wrong dose.3

Med errors cost $3.5 billion to treat annually & affect 1.5 million patients.3

Preventing just one ADE per day could save a hospital over $3 million annually.4

Over 56% of medication errors are associates with IV medications5

Over the last five years, the FDA has received reports of 710 patient deaths linked to problems with infusion pumps5

61% of the most costly and serious medication errors are IV-related6

Medication Administration Errors Using Infusion Pumps is the #3 technology hazard in healthcare7

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Workflow Comparison (Before & After)

Manual Process (Over 20 manual steps/keystrokes)

1. Press Channel Select on module Select channel

2. Press Guardrails Drugs Scroll to find medication

3. Press Page Down or use alpha speed keys to find drug

4. Select/Press Drug 5. Select/Press __mg/__mL 6. Press Yes to drug selection confirmation 7. Press Drug Amount 8. Enter value for Drug Amount 9. Press Diluent Volume 10. Enter value for Diluent Volume 11. Press Patient Weight 12. Press NEXT 13. Press DURATION 14. Enter Duration 15. Press Start

Automated Pump Programming Process

1. Scan patient wristband 2. Scan IV Medication 3. Scan barcode on appropriate Alaris System

module 4. Press NEXT on Alaris System 5. Press START on Alaris System

86% Reduction!

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1. Scan the patient’s wristband 2. Scan the medication

4. Review & Confirm

Pump Programming Workflow

3. Scan the pump

5. Sign (on computer or scanner depending on hardware)

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Nursing Unit View / Alerts

Alerts Routed to Wireless mobile via

"Connexall"

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Patient Demographics

Medication Order Details

Current Running Infusion Time Remaining & Current

Rate Location Rm #

Pharmacy Time

Remaining Priority of Next

Dispense Distribution Status of Dispenses

Pharmacy Dashboard

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Infusion Documentation (Inside EMR)

Black text Indicates verified

By Nurse Purple indicates Nurse needs to verify

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ICU Summary (Brings it all together)

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Bumps along the way…

• Weights – We found we documented weights multiple ways. We had to align our weights to one event code and create a process for nursing to document this prior to giving meds

• Pump Firmware Upgrades (Pump Round-up / time & Logistics) • Pharmacy dedication – We learned that a dedicated pharmacist

to the implementation was necessary. • Required a tremendous amount of time from the nursing analyst

and clinical educators. • Biomed and MIS/Network Engineering were also critical players

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 10

Interoperability / Cooperation

Pre-Population of Infusion Parameters

Infusion Status for Documentation

CareAware Smart Pump Programming

CareAware Infusion Management

Alaris / CareFusion Connectivity

Cerner CareAware

Cerner iBus

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Troubleshooting Wasn’t Easy

1. Custom Organizer-Level Page in EMR / PowerChart 2. Shows each error by patient along with:

a) Order ID b) Log ID c) Actual Error d) Nurse Name

3. Reports are generated to pinpoint major issues

Ability to expand/collapse each patient to see actual error log

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What our nurses are saying…

“It takes out that manual programming piece of it and allows the nurse just to double check what’s actually going on…and of course you can’t go forward if you’re doing something wrong.” - Kristin, R.N.

“We all know that we’re human, capable of error at any given moment on any given day. [Smart Pump Programming] takes a component of the human error out.” - Denise, R.N.

“We’ve had several examples where if the nurse had followed proper procedure and used [Smart Pump Programming] it would have prevented some pretty significant errors. - Lisa, R.N.

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Clinical Quality

2011 Q4 (pre-project) vs. 2012 Q3 (post-project) Patient armband scanning went from 36% to 62% Total Guardrails Infusions went from 61% to 73% Total Guardrails Alerts went from 4,429 to 3,762 Severe Harms Averted went from 30 to 23 Reprogrammed Infusions went from 515 to 289 High Risk Overrides went from 88 to 46

Basic vs. Guardrails Infusions Basic went down from 14,115 to 8,859 Guardrails went up from 22,089 to 24,421

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Benefits Realized

1. Preventing adverse drug events! 2. Increasing patient safety! 3. Giving nursing more time to spend with the patient

a) Nurses generally spend only 30% of time doing direct patient care and technology issues are a key distractor.

4. Increased nursing satisfaction a) Several nurses have commented how they feel safer when using auto-pump

programming

5. Ability to analyze data across Alaris, iBus and EMR 6. Decreased pharmacy costs due to wasted medications

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Lessons Learned

• Train! Train! Train! Especially Classroom training! But also videos, job aides, emails, etc

• Test! Test! Test! Ensure you have the environments & equipment you need (Cert, Mock, Train, devices dedicated to this process)

• Understand your current processes! Do a pre-project nursing assessment to confirm what you “think” they are doing

• Promote as a tool for patient safety…not as a time saver • Take time to visit a site who is live or have a call • Define all hospital departments and how/where you will use pump

programming • Properly assess your WiFi network (We no longer support wireless “b”) • Create a Training Check List or Script for nurses to use in training classes • Consider a post-go live nursing survey to review their thoughts/implement

improvements • Partnership is key not only with the vendor but also internally (Nursing,

Pharmacy, Biomed, IT)

Don’t be a Department of NO, be one of KNOW-HOW!

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References

1. Classen, D.C., R. Resar, F. Griffin, F. Federico, T. Frankel, N. Kimmel, J. C. Whittington, A. Frankel, A. Seger, and B. C. James. 2011. “Global trigger tool” shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs 30(4):581-589.

2. Department of Health and Human Services’ Office of Inspector General, November 2010 3. Gurses, A.P., Carayon, P., Performance Obstacles of intensive care nurses (Abstract), Nurs

Res. 2007 May-Jun;56(3):185-94. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/17495574

4. Westbrook et al. BMC Health Services Research. 2011. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals 11:319. http://www.biomedcentral.com/1472-6963/11/319 (accessed April 4, 2012)

5. Vanderveen T. 2005 (May/June); 1-11 6. Timothy L'Hommedieu, Pharm.D., M.S. and Karl Kappeler, M.S., Lean Methodology in IV

Medication Process, American Journal of Health-System Pharmacy, 2010; 67(24):2115-2118

7. The ECRI’s TOP 10 HEALTH TECHNOLOGY HAZARDS FOR 2012