I think it is safe to say that greater than 95% of infusion pumps are not associated with the patient for whom the drugs and fluids are being infused. With the exception of a small but growing number of hospitals that have pump and information technology (IT) integration—and a few more where the nurses key in or scan in the patient’s ID—pumps are typically not correlated with a specific patient. This is true even though a growing number of pumps are connected wirelessly to hospital networks. “So what?” you may ask. Simply put, taking infusion to the next level and solving many of today’s problems will not happen until the patient-pump association becomes the standard of practice.
Some exciting new capabilities are already in place to take advantage of a patient-pump connection. For example, providing the pharmacy with near real-time status of infusions at each bedside allows it to anticipate demand for subsequent bags, identify changes in infusion status, eliminate stat preparation orders, and reduce waste from compounded IVs that cannot be used. Without the patient and pump correlation, the information streaming from the pumps on the wireless network is of little use for the pharmacy operation.
With that patient-pump link, the clinical pharmacist also can be alerted to specific events such as a critical drug override of a soft limit or a workaround involving a hard limit that is reprogrammed as a basic (no drug) infusion.
Another benefit is accurate documentation of infusion start and stop times in the emergency department and outpatient clinics. Hospitals lose significant reimbursement funds due to missing or inaccurate infusion records. Reimbursement rules from the Centers for Medicare & Medicaid Services (CMS) are very specific and require the exact time infusions were administered. Billing technicians frequently attempt to reconstruct the infusion history from incomplete records. Associating each patient and pump—and collecting wirelessly the infusion data—can provide the accurate information for billing. Additionally, it can ensure that any billing has the audit trail should the reimbursement be challenged.
Additional capabilities such as remote or distributed alarms directly to caregivers responsible for specific patients also require the patient-pump association. As hospitals look for ways to reduce nuisance alarms and address the high noise level from medical devices, infusion pumps are becoming a target. Infusion pumps as a group make up the largest number of mobile medical devices in the hospital and contribute much of the noise. Sending patient-specific infusion pump data to third-party alarms vendors will not only help reduce the noise; it will also make the caregivers more productive. Today, the nurse walks the halls to find the source of the alarms and once at the bedside determines the source of the alarm. Often, the nurse must make another trip to obtain the next infusion or other supplies. If the location and cause for the alarm were provided directly, there would be far fewer trips to the bedside.
This correlation would also help with investigations. Currently, unless pumps are immediately sequestered following an incident, the cause of any given problem may never be known. Interpretation of “smart pump” data is of significantly less value.
Since most hospitals have implemented barcode medication administration (BCMA) and nurses are using hand-held or bedside computers with scanners, one possibility for enabling the patient-pump association is an app on the BCMA system. Other creative solutions will no doubt surface as hospitals realize the power of correlating a specific infusion pump to a specific patient.
Tim Vanderveen, a member of the AAMI Board of Directors, is an infusion specialist consultant with Becton, Dickinson and Company.