Interoperability Preparedness: What Hospitals Can Do to Be Ready for Smart Pump-EMR Interoperability

Standardization of medication labels is also necessary. The pharmacy label should match the order to provide the nurse with the information required to match the order to the drug library entry in the smart pump. This provides an additional visual check for correct drug amount, diluent volume, final concentration, and dosing unit.

All medications must be bar-coded to maintain consistent workflow for the clinician at the bedside. This includes floor stock fluids (0.9% normal saline, D5½NS, etc.), fluids stocked in automated dispensing cabinets, and solutions prepared by outside compounding suppliers. Nursing workflow is greatly improved when all things match—the drug label, the EMR formulary, and the pump drug library.

Mismatches such as the following will not allow for pre-population or sending infusion status for documentation:

• Vancomycin 1 gm/250 mL will not align to vancomycin 1000 mg/250 mL
• Cefazolin 2 gm/70 mL will not align to cefazolin 2 gm/50 mL
• Dose modifier—a weight-based starting dose heparin infusion (units/kg/hr) will not pre-populate a non-weight-based heparin (units/hr) set up in the infusion drug library

Nursing

Interoperability, by itself, does not improve practice and compliance. An in-depth assessment of current compliance levels with BCMA and smart pump drug library is necessary to identify problems that need to be addressed. Assessment of nursing practice will also help guarantee that every bar code scan works for the nurse, that the drug library has all the necessary drugs, and that the order will successfully pre-populate the pump. The nursing team simply needs to be honest: “We need to know what you’re truly doing and why, so we can choose the best practice and standardize.”

Align databases 

All databases—formulary, EMR, CPOE, PIS, BCMA, ADC, MAR, and IV infusion systems—must be aligned 100% to decrease variability, improve IV medication safety, and support pre-population for every infusion. This is a time-consuming and difficult process. The EMR system needs to be standardized first so the drug libraries can be aligned with it.

Drug library

Experience supports maintaining one drug library data set for all hospitals as a best practice. All data sets and physician orders need to be consistent—interoperability will not work if a physician orders something that is not exactly what is in the data set. Aligning all data sets with formulary management also reduces drug SKUs, stocking, and dispensing variation. Within the one common drug library, profiles should be consolidated to a core set consisting of adult, pediatric, NICU, and outpatient infusion center.

Consensus is key for interoperability to succeed. If every hospital has a different record for a dobutamine drip, interoperability will not work. Similarly, a drug-library dosing limit in the pump that is much tighter than the CPOE limit can also create issues. Dosing limits, concentrations, dosing units, and nomenclature all need to be aligned. Ampicillin has to be ampicillin, not “ampicillin” in one care area and “Polycillin-N” in another.