NIC Workflow Overview Alaris Project Infusion Management Auto

NIC Workflow Overview Alaris Project: Infusion Management & Auto. Pump Programming

Agenda Review • Project update – What is being worked on – Committees • Steering - Nursing, Pharmacy, CED, Clinical Engineering, Cerner KC and Columbia • Nursing workgroup – Timeline • Request for input – Workflow • Current list • Additions? – Issues list • Current issues • Additions • Discussion

Project Update • Pharmacy Catalog Updates • Steering Committee Development – In Process – To make policy and procedure decisions • Infusion Management Project Team – First Meeting June 17 th – Composed of Nursing Team Members – Agenda in development – Workflows in development

i. Aware Update

i. Aware Dashboard • Currently in ICUs – Do not need to sign in -- always on – Flowsheet displayed on screen above patient bed – 1 available view

i. Aware Dashboard

i. Aware Personalized • • Provides information in different formats Unit View: Comprehensive View of Infusions Patient View: Comprehensive Documentation Patient View: Customized

i. Aware Personalized Unit View: Comprehensive View of Infusions

i. Aware Personalized Patient View: Comprehensive Documentation

i. Aware Personalized Customized Patient View

Project Team Clinicians CED Pharmacy Applications Clinical Engineering Device Integration Server Team Nursing Project Management Pharmacy Technical Care. Aware Care. Net Cerner. Works Device. Works Point of Care Project Management Sales

Project Timeline Proposed 4/10 Clinical Walk-through 5/3 Gateway Test Servers Installed 5/6 – 14 Alaris Pump Upgrades 5/10 Kickoff TBD Design Review 6/17 - 9/1 Workflow Localization (Nursing Project Team) 7/8 System Validation 5/10 – 7/31 Pharmacy Dataset Build 8/1 – 8/31 Dataset Testing 9/1 – 10/24 Clinician Training 10/29 Go. Live!

Workflows Association/Disassociation Primary Infusion Secondary Infusion Titrations Bolus Infusion Management Only – PCA – Epidural • Order Entered Incorrectly • Downtime • • •

Workflow Format

Request for Input Alaris Project: Infusion Management & Auto. Pump Programming

Issues and Questions List ID Title Solution Status Priority Discussion 1 Zero Pumps Transfusion Management/Care. Fusion Active High 2 24 Hour Intake Transfusion Management/Care. Fusion Active High How often should a nurse zero the Alaris Pump and at what point? How will the 24 hour intake work on various units? Will this be standardized? High What weight will be used? Weights used today vary by unit, by med, by physician to calculate dose and rate. 3 Weight Transfusion Management/Care. Fusion Active Category Resolution Due Date Policy/Procedure sort resolved, grey 4 Wireless Networks Transfusion Management/Care. Fusion Resolved High Is there a wireless network in all areas? IT 5 Nursing Involvement Transfusion Management/Care. Fusion Resolved High Will nursing be involved in how things are built in Pharmacy Project Yes, wireless networking is available in all areas Yes, nursing involvement will be requested for specific questions, and the Clinical Strategist will also attend all meetings 6 Kickoff Power. Point Transfusion Management/Care. Fusion Resolved High Will nursing get a copy of the Kickoff Power. Point? Project Helen Jankowski sent Power. Points on 5/10/2013 IT UM does use i. Aware, but it is only above the heads of beds in ICU's. This is called the i. Aware dashboard but we don't have the i. Aware that is available in this project. 7 UM i. Aware Usage Transfusion Management Resolved Low Does the University of Missouri use i. Aware now? Transfusion Management/Care. Fusion Resolved High Can you alter what is in the order for the pump? For example, can you change the weight? Functionality Infusion Management 9 Screen Transfusion Management/Care. Fusion Resolved Low How do you get to the infusion mangament screen? Order Alteration on 8 Alaris Pump 10 MAR questions Transfusion Management/Care. Fusion Resolved Medium Assigned To SR Functionality Can you do everything from the MAR? Functionality Technically, you can change the weight, but changing the weight will change the dose. This was a question stemming from Issue 3, as it was hoped that the weight used could be changed without changing the dose on the Alaris Pump. Issue 3 is still unresolved. i. Aware link will be a button on the toolbar a. You can do all scanning from the MAR b. You must go to i. Aware to confirm the information from the pump on the MAR c. Information then flows to the I&O tab in i. View Created By/Contact

Localized Workflow Situations List ID Solution Status Discussion Category 1 IV Syringe Medications Title Infusion Management/Care. Fusion Active Some not in the Care. Fusion Library, so need to use basic infusion Functionality 2 Flushes Infusion Management/Care. Fusion Active 3 Drip Chart Infusion Management/Care. Fusion Active Manual flushes Nurses use a drip chart to program rate into Alaris pump Process Policy and Procedure 4 Heparin Infusion Management/Care. Fusion Active Heparin added to all fluids by Pharmacy Policy and Procedure 5 TPN Infusion Management/Care. Fusion Active TPN + carrier fluid – not on EMAR, Pharmacy mixes per paper order 6 Iron Infusion Management/Care. Fusion Active For Iron infusion, use basic infusion and run over an hour Policy and Procedure 7 KCL Infusions Infusion Management/Care. Fusion Active Use basic infusion for KCL infusions 8 Mg. SO 4/Pitocin Infusion Management/Care. Fusion Active Pit and Mg are titrated. Pit not recognized by scanner Policy and Procedure 9 Total Fluid Adjustments Infusion Management/Care. Fusion Active Total fluid intake ordered – adjust IV fluid based on Pit and Mg rates Policy and Procedure 10 Pitocin Infusion Management/Care. Fusion Active Pit ordered volume/hour Policy and Procedure 11 Pepcid and Vistaril Infusion Management/Care. Fusion Active Pepcid and Vistaril – don’t scan correctly – say “wrong med” – so nurses use basic infusion Functionality 12 Medication Verification Infusion Management/Care. Fusion Active Meds are not verified by Pharmacy; removed from Pyxis Policy and Procedure 13 Infusion Management/Care. Fusion Active Policy and Procedure Infusion Management/Care. Fusion Active Use basic infusion for intermittent antibiotics and IV fluids l Infusion Management/Care. Fusion Active Buretol Resolution

Discussion Thank you!