Interoperability of Operating Room Drips Kendra Fittante, BSN - - PowerPoint PPT Presentation

Interoperability of Operating Room Drips

Kendra Fittante, BSN Jennifer Newcombe, DNP Leonard Bailey Cardiothoracic Intensive Care Unit

Objectives

» Discuss how a multidisciplinary taskforce identified and proposed a solution to fix the interoperability of three EPIC applications: Op time (Operating Room), Willow (Pharmacy) and Clin Doc (Nursing Documentation) in regards to vasoactive medication infusion safety.

Introduction

» Medical errors may account for as many as 251,000 deaths annually in the US (Anderson & Abrahamson, 2017) » Medical errors are the third leading cause of death (Anderson & Abrahamson, 2017) » Error rates are higher in the U.S. than in other developed countries such as Canada, Australia, New Zealand, and Germany (Anderson & Abrahamson, 2017) » Bar code scanning is a safe and efficient way to reduce medication errors (Waxlax, 2015)

Background

» Loma Linda Electronic Access Portal (LLEAP) is the electronic health record (EHR) system utilized by LLUCH » LLEAP is based on software designed by EPIC » EPIC is a modular system » LLUHS has implemented 20 applications systems ~ Any change in one application model can affect changes within other modules

Identified Problems

» Patient arrives to the CVICU with a medication infusing that was started in OR by an anesthesiologist, but concentration and rate ordered by the surgeon are different than what is infusing. » Vasoactive drips made in the OR do not contain a bar code. » Hemodynamic instability of patients during drip changes in the immediate post-operative period. » Nurses were discarding a lot of unused medications, syringes and tubing ~ Inotropic medication cost $20.00 per syringe

Formation of a taskforce

» Ryan Lauer, MD

Pediatric Anesthesiologist

» Jason Gatling, MD

Pediatric Anesthesiologist

» Jim Eguchi, MD

CVICU Medical Director

» Asma Razavi, MD

CVICU Medical Director

» Norm Hamada, Pharm D

Director of Clinical Pharmacy

» Jenny Chu, Pharm D

CVICU Pharmacist

» Joanna Robbins, Pharm D

CVICU Pharmacist

» Thomas Hatch, Pharm D

IT support/Pharmacist

» Carlos Fierro

IT support

» Kendra Fittante, BSN

CVICU Nurse Educator

» Jennifer Newcombe, DNP

Cardiothoracic Nurse practitioner

Project Objective

» Form a multidisciplinary taskforce that will identify changes in the EPIC build that will allow interoperability of an inotropic agent to be ordered in the OR (OP time), verified by pharmacy (Willow), barcode scanned by the nurse, and documented in the nursing flow sheet (Clin Doc)

Project Design

Project Goals

» All inotropic medications made in the operating room will have a bar code » CVICU nurses will be able to document and bar code scan all inotropic medications made in the OR once the patient arrives in the CVICU » Pharmacy will not re-dispense an inotropic medication syringe in order to verify medication made in OR » No inotropic syringe changes made during the immediate post-operative period

Meetings

» 1st meeting January 5, 2016 ~ Process map done from the time an anesthesiologist wrote a vasoactive drip order, to the time patient arrived in CVICU » Met every 2 weeks until April then monthly » Minutes taken and sent to taskforce members not present

Project Methodology

Project Methodology

» Tested functionality of the build in the EPIC training environment » EPIC Build finalized March 1, 2016 » Department champions were instructed to train end users in their departments about revised workflow » Nursing staff/Medical CVICU staff trained 3/1/16-3/8/16

Audits

Issues with Implementation

» Real time feedback with anesthesia when problem occurred with bar code scanning » New users (i.e. new anesthesia residents, pharmacist) » Educate night pharmacy staff regarding workflow

Results

10 20 30 40 50 60 70 80 90 100 1 month 6 months 1 year

Vasoactive Medications with Bar Code

% of Medications with Bar Code

Results

10 20 30 40 50 60 70 80 90 100 1 month 6 months 1 year

Bar code scanning rates

Bar code scanning rates

Results

10 20 30 40 50 60 70 80 90 100 1 month 6 months 1 year

Medication Redispense Rates

Medication Redispense Rates

Conclusion

» Initially walking the process and our interdisciplinary approach was pivotal to the project’s success. » Staff turnover does continue to present challenges, however, real-time communication with all disciplines is very helpful. » Process currently under review after a recent LLEAP upgrade.

References

» Anderson, J. & Abrahamson, K. (2017). Your health care may kill you: Medical erros. Stud Health Technol Inform; 234, 13-17. » Waxlax, T. (2015). Preparing challenging medications for bar code

• scanning. Am J. Health-Syst Phar; 72, 1089-1090.