© aurora health care, inc. alaris pump compliance julie l. kindsfater (puotinen) october 2013
TRANSCRIPT
© Aurora Health Care, Inc.© Aurora Health Care, Inc.
Alaris Pump Compliance
Julie L. Kindsfater (Puotinen)October 2013
© Aurora Health Care, Inc.
Aurora Health Care
• Private, non-profit• 15 hospitals• 159 clinic sites• 30,000 caregivers• 1.2 million patients
© Aurora Health Care, Inc.
AHC compliance – IPI chartJanuary – August 2013
50
55
60
65
70
75
80
85
90
95
100
Aurora Hospitals andMedical Centers
St. Francis Hospital
University ofWisconsin Hospital
Wishard Hospital
University of IowaHospitals and Clinics
Indiana UniversityHealth
© Aurora Health Care, Inc.
AHC compliance by profileAugust 2013
93 95 91 95 93 9986
97 100 100
7 5 9 5 7 114
3 0 0
0102030405060708090
100
Guardrails Non-Guardrails
© Aurora Health Care, Inc.
Achieving high compliance – set high expectations
Set an objective goal and incorporate into your institution's safety goals
– E.g. compliance at least 90% in all profiles
– Supported by hospital, nursing, and safety leadership
– Communicated to and understood by staff– Achievable with your data set
© Aurora Health Care, Inc.
Achieving high compliance - accountability
Define accountable parties and process to respond to compliance data
•System Alaris analytics team– Nurse representative from each site, drug policy, risk management– Review system data, share lessons learned, review library change
requests, discuss system-level issues
•Site-based Alaris analytics teams– Nurse (from system committee), pharmacy, quality, risk– Review site data, create and implement site action plan for
performance improvement, identify issues to forward to system team– Compliance data sent to team members and site Chief Nurse Officer
© Aurora Health Care, Inc.
Achieving high compliance – data set
• Standard concentrations• Drug names match eMAR entry• Entries accommodate clinical practice and
order sets• Provide additional tools as needed• Solicit feedback
– E.g. Alaris email for library questions/issues
© Aurora Health Care, Inc.
© Aurora Health Care, Inc.
Dashboard – v.1February 2011
© Aurora Health Care, Inc.
Dasboard – v.2February 2012
© Aurora Health Care, Inc.
© Aurora Health Care, Inc.
Dashboard v.4Q2 2013
© Aurora Health Care, Inc.
Addressing low compliance
• Investigate– Identify root causes/contributing factors– Solicit feedback– Compliance rounds
• Engage accountable parties
• Re-educate– What and why
© Aurora Health Care, Inc.
© Aurora Health Care, Inc.
AHC compliance by profileAugust 2013
93 95 91 95 93 9986
97 100 100
7 5 9 5 7 114
3 0 0
0102030405060708090
100
Guardrails Non-Guardrails
© Aurora Health Care, Inc.
AHC – pediatricprofile
• Discussed with nursing practice council and pediatric nursing groups
• Clarified profile name and moved to 1st screen
• Revised fluid build• Re-educated nurses on
rationale for using library entries and age definitions
• Monitored and reinforced
© Aurora Health Care, Inc.
Improving compliance – optimization
Drug # Alerts % alerts overridden
Proposal
Blood products 339 87% Change soft min from 25 mL/hr to 10 mL/hr
Propofol ANESTH 232 99% Change anesthesia alert limit to 150 mcg/kg/min
Irinotecan 207 94% Change duration soft min to 80 min (i.e. distinguish from default of 90 min)
Vasopressin ANESTH 281 99% Change anesthesia alert limit to 0.4 units/min
Sodium chloride 3% 91 100% Change soft max from 35 to 50 mL/hr
Etoposide 92 100% Change duration soft max from 90 min to 12 hours
PCA lockout 49 100% Change PCA lockout soft max from 20 min to 30 min
AHC - minor changes should eliminate 17% of all Guardrail alerts (white noise)
© Aurora Health Care, Inc.
Concerns and lessons learned
at other organizations?