Reason: In an ever-changing field of health care, nurses are expected to be at the top of their game, keeping pace with changes to standards of care, medication treatment changes, social issues, and pandemics just to name a few. With the increase in nurse responsibilities, the organization made the decision to implement smart pump interoperability to employ nursing workflows that utilize technology to decrease manual pump programing and enhance patient safety through decreasing medication errors. The organization’s smart pump interoperability compliance goal was set at 90% system wide.

Problem: The compliance goal post-implementation, which included 7 markets and 50+ hospitals ranged from 85-89% for 2022 and Q1 2023. The lowest compliant markets ranged from 79-85%.

Methodology: The project steering committee consisting of nursing informatics, nursing professional development, pharmacy, electronic health record (EHR) specialists, and nursing operational leadership completed a multiapproach evaluation targeting markets with the lowest compliance.

Common themes: Low pump guardrail usage, high basic infusion programing, process gap with high-volume smart pump interoperability nursing workflows, knowledge gap with understanding interoperability EHR error codes and troubleshooting steps

Utilizing the PDCA (plan-do-check-act), the committee collaborated with one market to implement and test compliance improvement strategies.

Plan: Target highest interoperability EHR error code.
• Do: Trialed an interoperability tip sheet with custom EHR error code language to improve the front-line nurse ability to troubleshoot and resolve the error
• Check: Monitor compliance and seek feedback from front-line nursing to improve custom error code language prior to building error code messaging in the EHR.
• Act: Collaborate with EHR specialists and pharmacy to build custom error code messaging that nursing will receive at the point of care to support troubleshooting and resolution.

Results
• Overall market interoperability compliance improved 6% from Q1 2023 (pre-intervention) to Q2 2023 (post-intervention)
• Targeted error code was reduced by 1% (pre-intervention - 4.53% and post-intervention 3.61%)
• Significant improvement in days between errors code occurring

Implications: Custom error code messaging improved interoperability compliance and enhanced nursing knowledge on best practice workflows with interoperability noted by the improvement in days between errors codes firing. the steering committee is actively working with the EHR specialists to customize the error code messaging that will provide the front-line nurse critical troubleshooting steps to continue to decrease manual pump programing and enhance patient safety through decreasing medication errors.

Joshua Pickle BSN, RN

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