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Development of A Decision
Support Tool for Drug Infusion
Performance Evaluation
Poster Title:
Risk-based Scoring Method for Overridden IV Infusions
Wan-Ting (Kerina) Su1,2*,
Poching DeLaurentis1,
Mark Lehto2
1 Regenstrief
04/21/2016
Center for Healthcare Engineering, 2 School of Industrial Engineering, Purdue University
Drug Infusion Performance Evaluation Cycle
Smart Infusion Pump
Drug Limit Library
Define/Revise Drug
Limits
Program Infusion Parameters
Update Drug Limits
on Pumps
Record Infusion/Alert Data
Data
START
Evaluate Drug
Infusion
Performance
Drug Limits
What cause
Issues?
Workflow
YES
Other
Nurse
Improve
Workflow Design
Safety Issues?
Improve
Nurse Training
NO
Other
(e.g. Improve
Communication)
STOP
Administer Drug
Infusions
Analysis Tools
• Global Measures:
 Key Performance Indicators (CareFusion)
 Infusion Pump Safety Score (Carlson et al., Intermountain Healthcare, 2015)
• Global and Individual Measures:
 IV Medication Harm Index (Sullivan, 2004; Williams, 2006)
CareFusion. (2016). Knowledge Portal for Infusion Technologies v2.10.
Carlson, R., Johnson, B., & Ensign, R. H. (2015). Development of an “infusion pump safety score.” American Journal of
Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists, 72(10), 777–779.
Sullivan, J. (2004). IV Medication Harm Index: Results of a National Consensus Conference. In Infusion safety: addressing
harm with high-risk drug administration (pp. 29–31). San Diego, CA.
Williams, C. K., Maddox, R. R., Heape, E., Richards, H. E., Griffiths, D. L., & Crass, R. E. (2006). Application of the IV
Medication Harm Index to Assess the Nature of Harm Averted by “Smart” Infusion Safety Systems: Journal of Patient Safety,
2(3), 132–139.
Research Goal:
Develop Decision Support Tool to Help Medication
Safety Teams Evaluate Drug Infusion Performance
Phase I:
Individual Assessment
Phase II:
Global Assessment
(each soft limit
overridden infusion)
(hospital system level assessment
of infusion practice)
RQ 1: How can risk score for each
overridden alert be generated?
RQ 2: What global risk measures for
system evaluation can be defined?
A Matrix-based Method
(Huang and Moh, 2016)
Refer to IV Harm Index
Aim 1:
Create Risk-based
Infusion Score to exam
overridden IV infusions
Slim-Maud Method
(Embrey et al., 1984)
Aim 2:
Estimate probability of
ADEs for Risk-based
Infusion Score Validation
Aim 3:
Generate a global risk
measure (from Phase I)
Interview &
Observation Research
Aim 4:
Conduct Task Analysis to
break down the tasks of
System Evaluation
Refer to KPIs, IP Safety Score,
and Expert Knowledge
Aim 5:
Define all other global
risk measures
Phase III:
Decision Support Tool
Development
RQ 3: How can overall risk be estimated?
RQ 4: What medication-care unit combinations
will be targeted as higher risk?
Causal mapping approach to
constructing Bayesian Network
(Nadkarni and Shenoy, 2004)
Aim 6:
Derive causal maps
(from phase II )
Estimate overall risk
using probability
encoding techniques
Aim 7:
Target the combinations
of care units and highrisk medications
(from Aim 6)