Pump It Up! Elevating Smart Pump Interoperability through Education and Training

Purpose: This is an overall review of the method, length, and content of nursing training to increase overall compliance and success with smart pump interoperability in a staggered rollout at a large multi-facility health system. The objective was to implement a system-wide continuous quality improvement (CQI) project with a focus on creating a standardized training approach. An auto-programming compliance target of >90% was established to gauge project success. Industry average auto-programming compliance rates are 70%-80%, suggesting opportunities to optimize training, goal setting, and implementation success.

Description: This is a comparative analysis of auto-programming compliance reports between site 1’s go-live (October 10th, 2022) and site 2’s go-live (February 2nd, 2023) with smart pump interoperability. A collaborative multidisciplinary approach was utilized drawing on the expertise of nurse informaticists, pharmacy leaders, nursing leadership within the health system, and our vendor partners. This collaborative effort focused on a comprehensive review of training materials, duration and content of hands-on training sessions, supplemental support materials provided to site 1, and a review of the safety and efficacy of the new system-wide drug library. After a review of site 1’s auto-programming compliance rates, observations of nursing workflows, and a lessons learned debrief, it was determined that enhancements were needed to effectively improve auto-programming compliance and success, not only at site 1, but also across subsequent sites. The nurse informatics project team revised the initial training incorporating several enhancements: one nurse per pump for hands-on training (previously 2:1), mandatory completion of a comprehensive two-hour training module (previously optional), an extended training session with additional workflow scenarios (previously condensed with basic workflows), a competency quiz to evaluate comprehension, and more accessible training reference materials. Early manager involvement and weekly check-in calls were implemented to ensure and cultivate engagement.

Evaluation/outcome: Managers’ active involvement in promoting and mandating hands-on training led to a substantial rise in classroom attendance, from 73% attendance at site 1 to 97% attendance at site 2. After adopting the enhanced training methodology (additional workflow scenarios, competency evaluation, and more accessible training materials) at site 2, auto-programming compliance soared to 97% overall average during the first week of go-live, surpassing our established goal of >90%. Site 1 also substantially increased auto-programming compliance from 64% to an impressive 86% following re-education with the enhanced training materials. Additionally, at site 1, 6 months after go-live, drug library override rates decreased from 26% to 7% and infusion-related adverse drug events were zero (Q1 2023).

Conclusion: By integrating comparative analysis and a CQI approach into our training methodology, we have effectively enhanced the understanding of the new nursing-integrated infusion pump workflows. As a result, we observed a significant boost in auto-programming compliance rates during the go-live phases at subsequent sites. Nurse informaticists are critical to help provide training oversight, establish targets, and measure outcomes. However, achieving long-term success and maintaining continuous quality improvement necessitates active engagement from stakeholders at the site level including leadership, nursing, pharmacy, IT, and biomed. Interoperability requires constant vigilance, ongoing support, and a plan for sustaining success.