July / August 2006
Partnering for a Successful Technology Conversion
|Photo courtesy of B. Braun Medical, Inc.
Converting an entire hospital to a new infusion pump system is a task that can seem insurmountable at first. But with efficient planning, the right vendor partnership, and a dedicated team of both internal and external experts, the process can result in a successful conversion with lasting impact for cost-reduction and improved patient care.
Last year, during my tenure at 270-bed Mt. Sinai Hospital in Chicago, we undertook just such a task; our nursing staff championed an institution-wide conversion to a new infusion pump system. We chose this new technology for two distinct reasons: 1) the extensive customer service program offered by the medical device company we selected and 2) the system’s numerous safety features. These two aspects assured both short-term ease of conversion and long-term safety and quality benefits for our nurses and patients alike.
In the end, streamlining Mt. Sinai’s infusion pump equipment proved a wise cost-cutting, care-managing measure for the institution as a whole, and we discovered that a successful process is based on a successful partnership.
Need for Change
Accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) depends on ensuring patient safety and maintaining the latest in equipment and training. We are always on the alert for new products and services to help us comply with JCAHO’s National Patient Safety Goals. Our priority list for medication safety includes establishing set-based free-flow protection, improving the safety of high-alert medications, and ensuring and documenting user-authorized delivery of medications.
In the research we conducted prior to making the changeover, we learned that some of the most common medication errors involve manual programming of incorrect infusion parameters into a device (AHRQ). In addition to safety assurance, we needed a system that would address our patient needs and staffing realities. As the nursing shortage is expected to worsen and temporary workers become more common, the selection team considered the benefits of a system that is easy to learn and use, and thereby reduces training time. Our vigor to change was based on improving three main areas: safety, advanced technology, and modularity of the device design.
We were pleased to find a system that satisfied those criteria. With a fully customizable drug library and automatic dose-rate calculation, the system is adaptable to our individual facility needs. Its dose-limiting technology enables us to reduce the incidence of error by having set dose limits and preprogrammed concentrations from which to choose. When institution-set dose limits are exceeded, the nurse is alerted and required to review the infusion order. These safety benefits are like having an ancillary workforce on duty, alerting our floor staff to possible problems and serving as an electronic peer-support process.
Further, we know that when our hospital is ready to advance to pump-based barcode technology, the infusion device will be ready as well. When this change occurs, barcode technology will help ensure that three of the Five Rights of medication administration are met: right drug, right dose, and right patient.
Finally, a supplementary safety feature is provided by the system’s unique, independent modular design, which supports the Institute for Safe Medication Practice’s recommendation to reduce channel confusion (ISMP, 1999). The pump is also easier to read and transport than multi-channel pumps.
The Importance of Planning
The most important step for implementation internally was to coordinate a hospital conversion team task force and ensure the participation of every department impacted by the conversion. I convened an initial meeting with representatives from pharmacy, materials management, bio-med, nursing, chief residents, and anesthesia. Separate meetings were held with the surgical floor and particularly the ICU and CCU staffs to determine their needs for any type of specialty tubing or anesthesia sets. The key to success was to think from the staff’s point of view at all times. The idea of change was more difficult for some departments than others. The emergency department, for example, was somewhat resistant to the idea of conversion because of time restraints, but after meeting with colleagues and management to explain the safety features and benefits of our new system, the staff was eager to cooperate with the conversion process.
The planning stage was managed by our task-force team, which handled much of the planning prior to going live with the new infusion devices. During this pre-conversion phase, team members worked with the education department to prepare for staff training and with the occupational health team to discuss workplace environmental issues. The task force rewrote policies and created a detailed calendar and timeline of events up to and including go-live day. Numerous meetings were also held with our vendor’s expert team, which had over 15 years of collective conversion experience. Together, the entire team of combined hospital and vendor leaders was proactive in their planning and addressed many of the possible scenarios in advance. The 2 weeks we set aside for this planning stage were imperative to the success of the conversion as well as continued success for the staff.
The Importance of Clinical Partnerships
It is daunting for a hospital to embark on a conversion that will alter the way nearly all staff members operate. It is critical, therefore, to form a partnership with the vendor company and to feel that they are as committed to the success of the conversion as you are. After having been involved intimately with the trial phases of two pumps from the same vendor, I was familiar with the equipment and the company, and I knew that their support and education staff would become a part of the conversion team within the hospital.
As I had hoped, these external experts proved to be an integral part of the conversion and remained dedicated throughout the process. Before Mt. Sinai purchased the infusion devices, the vendor performed a comprehensive clinical analysis of our infusion therapy products and practices and helped us determine that we actually needed fewer infusion devices than we originally thought.
Our original proposal called for a large number of additional infusion devices, since all of our nurses reported that they were constantly short on pumps. However, our vendor’s conversion support team demonstrated that it was not a lack of pumps creating the shortage; rather, the shortage was caused by under-utilization of infusion channels among our mix of dual- and single-channel pumps throughout the hospital. Their analysis demonstrated that 38% of our dual-channel pumps had only one line operating. By replacing all infusion pumps with single modularity devices, our utilization rates quickly rose to 100%, and we avoided purchasing a large number of unnecessary pumps.
In addition to guiding us in the purchase of our new infusion pumps, our vendor’s clinical analysis alerted us to another safety practice issue. Although the hospital had converted to safety IV catheters months prior, the analysis uncovered areas that were still using non-safety IV catheters. Identifying and removing the non-safety catheters from our practice resulted in the standardization of nursing practice and products, reduction of potential needlestick injuries, and compliance with needle-free legislation.
The team also tracked all of the clinicians who were in-serviced (trained) during the pre-conversion education period. They worked with materials management to incorporate a process for cleaning out old stock and rotating in new pumps, sets, tubing, and needles and needle-free ports on implementation day. Perhaps most important was our vendor’s unique “Super-User” mentor program, which trained particularly keen and interested nurses to become the hospital go-to experts after completing the conversion. Having these specially trained nurses on site created a sense of calm and order in the weeks following conversion day.
Together, we created enough internal communications to keep all departments abreast of the conversion status and to invite staff to ask questions or raise concerns with us, both prior to and following conversion day.
Implementation: Go-Live Day
Conversion day was like a well-choreographed dance. We began at 0700 with a meeting for department managers and the task force to review the day’s time-and-events calendar. Everyone was given a printed work schedule so they could expect when their floor would convert. At predetermined intervals, a conversion crew, including materials managers, infusion pump manufacturer representatives, and site leadership, swapped the pumps and accessories. As all of the approximately 500 nurses at Mt. Sinai had been readied for the effort, patient care was seamless.
We assigned either a Super User or clinical trainer supplied by the vendor on each floor for last-minute questions or to handle alerts. By the end of the day, we had transformed the infusion-delivery mechanism throughout the hospital’s 23 departments into a cohesive, immediately operational system.
Discovering Challenges, Finding Solutions
Despite all of our planning, there were some challenges that required new plans as the process rolled out. For example, the education room was too far from the main patient care floors, making it inconvenient for some to attend classes. To address this challenge, some unit-based in-services were scheduled. To address low attendance for classroom education, I turned to my colleagues in managerial roles, who in turn alerted their staff to the mandatory nature of the classroom training. In this way, while attendance was only 17% on the first day, by the end of day three, a full 75% of staff were educated for conversion.
Follow-up and Lessons Learned
Our vendor’s clinical trainers stayed on hand for 1 week after implementation to ensure the system was functioning and that all staff were comfortable and competent. This presence put all departments at ease and reinforced the Super Users’ training. After that week, our highly skilled Super Users eased into their roles and kept the pump system running smoothly, without the need to have external support called back.
I met with our vendor’s support team following the changeover to discuss process improvement, and they welcomed my input. One of the lessons we gleaned was to include materials management in the in-service training program. Had we trained that department during the preparation phase, we could have relied on them to repair pumps rather than call in our vendor’s technical services. We also suggested that all department managers be better readied to have the same staff-eye-view as our task force. Often those away from the trenches forget how the functionality of equipment or a sudden change in protocol can drastically affect staff morale and productivity. We also realized, rather late, that it is nearly impossible to roll out any equipment changes during the holidays, which delayed our actual implementation until January. While it all worked out well, we lost many weeks in December when staff was on vacation.
Overall, the process was simple and smooth, and the results are exemplary. Workers make fewer errors, efficiency and costs have improved, and the hospital has maintained a patient safety advantage over other area hospitals. Successful change in any hospital, large or small, depends wholly on the cooperation of the staff and managers and a close partnership with the service provider dedicated to your facility.
Nancy Crossett is patient care manager at St. James Hospital Health Centers, an affiliation of Sisters of St. Francis Health Services, in Chicago Heights, Illinois. Previously, she was unit director at Mt. Sinai Hospital in Chicago and supervised the infusion pump implementation described in this article. She may be contacted at Nancy.Crossett@ssfhs.org.
Agency for Healthcare Research and Quality (AHRQ). (2006). Medical errors & patient safety. Available at www.ahrq.gov/qual/errorsix.htm#docs
Institute for Safe Medication Practices (ISMP). (1999, AprilJune , July 14). ISMP Quarterly Action Agenda. Available at www.ismp.org/Newsletters/acutecare/articles/A3Q99Action.asp