New technology is having an impact on the infusion pump market. The global infusion pumps and accessories market is expected to reach $10.2 billion by 2020, according to a news release from market research firm MarketsandMarkets.
“Growth in this market is mainly attributed to the increasing prevalence of chronic diseases owing to the rising geriatric population; increasing use of infusion products in home care with favorable reimbursement coverage; and technological improvements in infusion products,” according to MarketsandMarkets.
TechNation interviewed industry experts regarding I.V. pumps to find out important features to consider when purchasing devices. The panel of experts also shared tips and insights regarding I.V. pumps. The members of the panel for this roundtable article are Pacific Medical Manager of Technical Solutions Brian Barton, Iatric System Senior Vice President Jeff McGeath, Elite Biomedical Solutions Co-Owner/Vice President Nate Smith, J2S Medical Director Sales and Marketing Sarah Stem and AIV Director of Sales Jeff Taltavull.
Q: What are the most important features to look for when purchasing I.V. pumps?
Barton: Depending on the type of pump being purchased, at minimums it needs to have “smart” technology. I would also look for wireless connectivity, ease of programming, a drug library that is customizable to the given care area, hard alerts, barcode scanning, and maybe the capability of generating alarm evidence based reports with error trending. When purchasing PCA pumps you may also want to look into the ability of connecting and operating in tandem with a respiratory monitoring module that would allow deactivation or to pause the dose and deactivate the patient dose button in the event the patient falls below a defined respiratory rate.
McGeath: Necessary and important I.V. pump features include ability to minimize medication errors, as well as wireless and EHR integration capabilities. As for purchasing the pumps, while many may be sold through distribution in the outpatient and homecare markets, most, if not all, shipments are made directly by the manufacturer. Most third-party pump providers ship used or reconditioned pumps. Because of this, third-party biomedical service companies as well as third-party integration companies are more common. Manufacturers’ certification training should be a minimum requirement for service organizations. Integration companies should also have extensive knowledge of the pump vendor’s capabilities and should have a developed relationship, not proprietary, whereby common integration standards, such as IHE-PCE protocols, have been tested and validated for functionality.
Smith: A device that takes care of the entire hospital’s needs. Be sure to review all recalls that the device has had and that the OEM has properly resolved each issue. Also, what type of service plan do they have? What’s the turn around time? Are there third parties that can help suffice needs if the OEM isn’t addressing their needs in a timely manner?
Stem: Important features to look for would include safety software to reduce patient incident risk as well as total cost of ownership, warranty, and RN/BMET training. Reliable partners will address and consult with buyers on long-term costs associated with software implementation, repair and deployment. Last, continuous field support with global reach is a sign that you are working with a value-focused provider which can be a most valuable feature with software driven equipment.
Taltavull: I think, first and foremost, a facility should look for a safe and reliable pump with ease of use. Secondly, the facility needs a clear understanding of servicing options on the equipment, both OEM and secondary market. Thirdly, requirements for all necessary tubing sets should be considered to best coordinate long-term financial planning.
Q: What are the benefits of the new smart pumps?
Barton: The main purpose of “smart” technology is the reduction or prevention of medication errors. Drug libraries that can be updated, adjusted or maintained wirelessly. Reporting of trends capability. Other benefits include connectivity to other monitoring devices, barcoding capabilities for confirmation of proper medication and the reduction of nursing workload.
McGeath: The key advancement of new smart pumps is integration to EHR systems, which often includes auto-programming, charting, alarm management and device tracking capabilities. For pharmacy, key benefits include having a centralized drug library management and being able to enforce dosing guidelines.
Smith: Eliminates user error along data collection that helps monitor and improve patient safety.
Stem: The premier benefit to new smart pumps would be reductions in the number of patient incidents. Nurses love the ease of use and time savings while biomed can manage alarms to quickly troubleshoot repairs. Legal can access software as well which drives accountability with regards to risk control, potentially preserving hospital funds during serious inquiries. Smart pumps focus attention on patient monitoring, promoting the “five rights,” which helps nurses deliver high-quality care.
Taltavull: Smart pumps make it easier to store patient data as well as ease and safety of dosage calculation. Many of the pumps cross multiple delivery platforms using different modules or stacking features that allow a more all-in-one option where historically, multiple pumps were needed.
Q: How can facilities with budget constraints acquire the latest I.V. pump technology?
Barton: The facility needs to understand that although it may cost capital up front it will provide a return on investment (ROI) in the future. Negating just one medication error would most likely pay for the entire cost for the upgrade. Also, having the smart technology will help nursing work flow
McGeath: From a pump standpoint, an “upgrade-able” platform should be considered. For example, adding a wireless card or a wirelessly enabled battery pack to an existing infusion pump can enable more advanced communication and external software applications when a facility has developed the wireless infrastructure to support these advances. This eliminates the expense of purchasing new devices, as well as reduces the time required to configure and train clinical staff on their use. Essentially, a wireless card/battery is plugged in, and devices are configured to communicate on the hospital’s network.
Smith: There are plenty of third parties in the marketplace that can sell refurbished I.V. devices for half the cost that the OEM sells them for. You can get the same software levels and quality that the OEM sells. Also, third parties help by offering a trade-in for your older devices.
Stem: Facilities can acquire the latest I.V. pump technology easily by purchasing from a quality aftermarket supplier. Some companies provide I.V. pumps re-certified with a no-hassle, OEM-matched warranty allowing customers to extend their buying power. Another option during a capital freeze is to lease or rent equipment.
Taltavull: Financially challenged facilities do face an uphill battle with newer equipment. This issue can potentially be overcome as the secondary market continues to be a strong option for the purchase and servicing of pre-owned equipment. In all cases, each facility needs to do its research to determine their needs including the latest software revisions, delivery capabilities, and all options for equipment maintenance.
Q: How can a biomed extend the life of an I.V. pump?
Barton: Regular maintenance. Upgrades when needed. Sometimes staff training for not only the nursing staff, but also the transporters, and central services or whoever is in charge of the cleaning and distribution. Sometimes it also may be necessary to perform preventative maintenance more often than the OEM recommended intervals, depending on the service area and the history of repairs.
McGeath: It is highly recommended that hospitals and biomed departments seriously consider purchasing some of the value added warranty and training options pump vendors provide. Ensuring you have good technical and parts support from your vendor will allow the biomed engineer to leverage existing best practices inside the department to maximize the life of the pump equipment.
Smith: Replacement parts can help extend the life of all infusion pumps. Third parties offer biomed-tested recertified parts also companies like Elite sell new replacement parts, which last much longer that re-certified parts. These parts also come with a one-year warranty and can extend the life of a pump for up to 5 years.
Stem: Biomed can extend the life of an I.V. pump by partnering with a provider that supports both current and end-of-life technology. Maintaining annual preventative maintenance also ensures equipment is operating in accordance with a manufacturer’s set specifications. Addressing correct operation and offering training with RN staff is another way to reduce repair and extend the life of infusion equipment.
Taltavull: The biggest thing we see, as a third-party repair company, is a tendency in letting OEM recommended preventive maintenance slide. Keeping up on your PMs and regular safety checks, calibration checks and general structural integrity of the units is the best way to keep your pumps alive. I think it is important to make sure staff is aware of the small things that can lead to big repairs and increased cost.
Q: Is cybersecurity a concern regarding I.V. pumps? How can health care facilities protect patients and patient information from hackers?
Barton: As all medical devices become more connected they will obviously become more vulnerable to hackers. The Department of Homeland Security is or has already investigated more the two dozen suspected cybersecurity flaws in medical devices. This is something that will be an ongoing and moving target to maintain and/or overcome not only on the design side but in the way the device connects wirelessly to each facility. This subject is an entire article in itself.
McGeath: Cybersecurity is important for all medical devices. In October 2014, the FDA issued guidance for all medical device manufacturers, stating: “Manufacturers should address cybersecurity during the design and development of the medical device, as this can result in more robust and efficient mitigation of patient risk.” Smart pumps should never allow an attacker to remotely start, stop or change infusion details of any medication delivery. Ensuring that pumps always require a human confirmation step and physical interaction to initiate or stop medication delivery are examples of pump requirements you can establish with your vendor to greatly reduce risk.
Smith: I’m not familiar with the cybersecurity side of I.V. therapy. That would be up to the IT department working with the OEM to ensure this doesn’t happen.
Stem: Software driven equipment does pose a cybersecurity concern and facilities can address this by implementing strong security protocols. Incorporating firewalls on closed networks where outside access is not possible is common when trying to prevent hackers and protect patient safety. Safety software will engage and prompt the device to alarm if the delivery rate is outside the range for a particular drug – this is a powerful reason for hospitals to consider smart pump technology.
Taltavull: Cybersecurity has to be a concern in today’s society as these pumps become smarter and contain more patient data. While there are huge benefits to this it also opens the door to risk. Manufacturers are constantly updating software, so make sure to stay current with all service and upgrade recommendations.
Q: Why is bi-directional integration between smart pumps and EHRs important?
Barton: The ability of an infusion pump to be auto-programed from EMR will reduce pump programming errors. The ability of communicating with the pharmacy of activity by notifying them the dose is almost complete will enable the next I.V. to be started in a more timely matter. It would also allow any updates to the drug library to be “pushed out” in a timely manner. The accuracy of documentation is another important ability of bi-directional communication.
McGeath: By implementing an auto-programming workflow between the pump and the EHR, hospitals can greatly reduce the risk associated with human error of pump setup. Facilities with different equipment in different locations, or facilities with traveling nurses, can have greater risk of human error. For example, one pump may increase a value by hitting a “plus” sign on the keypad but another pump may do that via a “right arrow” sign on the keypad. Further, one pump may increment the value by 10 with each key press, while another pump may only increment the value by one with each key press. A lack of consistency can create risk, but auto-programming integration with the EHR reduces this risk. Once a pump is running, getting start time, stop time, and medication delivery data into the EHR can also have positive revenue impact. An outbound (from the pump) documentation interface into your EHR may allow for better billing data and reimbursements.
Smith: The ease of transporting patient information so both the nurses and doctors have real-time patient information. This will clinically help them take care of each of their patients much more effectively.
Stem: Integration between smart pumps and EHR technology allows for comprehensive patient care; utilizing the barcode system also aids in efficiency. Physician orders go direct to pharmacy which programs the device allowing nursing to again verify with automatic documentation complete; time saved which equals better bedside care. A closed loop system aids in asset tracking and alarm management. It is great tool for biomed during annual preventative maintenance.
Taltavull: As smart pumps become more integrated and wireless, they will be depended on to capture all of the data between multiple functioning units to maintain accurate health records for the patient. The more compatible they are, the more data that will be captured, leaving less risk of oversight from clinical staff.
Q: What else do you think is important for TechNation readers to know about I.V. pumps?
Barton: Make sure you’re properly educated to manage all infusion pumps used at your facility. I think that anytime a new device is being implemented in your facility it’s just as important for the CE staff to be trained on the device at least as well, if not more, than the staff using it.
McGeath: Current and future trends will continue to emphasize system integration via the hospital’s wireless network. Along with initial and ongoing device certification training, it is beneficial for biomeds to become familiar with the wireless hardware contained within a device to understand not only how to troubleshoot but how to configure these components. Wireless and encryption/authentication protocols are constantly being updated and a basic knowledge of wireless networks is advantageous. Computer literacy will also be a “must have” as new applications are developed and released to help biomedical personnel configure, troubleshoot and even locate devices for service.
Smith: There’s really only four big OEMs in the marketplace (Hospira, Carefusion, B.Braun and Baxter). Customers really need to ensure they are getting the device that truly meets their needs from cost, implementation, maintenance/recalls to end of life. You definitely need to ensure that you have a back-up plan for maintenance and service if the OEM runs on back order or has unreasonable service rates or turn around time. This is the largest installed base in the marketplace and it get’s real expensive if you have to start renting devices because the OEM take care of your needs.
Stem: It’s important for facilities considering new or additional infusion equipment to partner with providers that deliver efficient, reliable and cost-effective solutions. Considering aftermarket and non-OEM parts is a great way to extend the life of a device while preserving capital. I.V. pumps that are software driven pose connectivity issues, buyers should be sure to match revisions when buying capital or parts to avoid interruption.
Taltavull: The I.V. pump world is ever evolving. OEMs are making it harder for end users to have flexible options to controlling their costs. I can’t emphasize enough how pertinent it is for a facility to do it’s full due diligence when making a buying decision. A facility must understand the long-term costs, the long-term servicing options and, more importantly, if there are options. They also need to be responsible when using third-party services on these ever changing pumps. They need to find reliable, educated and ISO-certified repair partners to help control their costs. That can be in depot repair, service parts or calibration. Knowledge is the best buying power a hospital can have.
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