TechNation magazine reached out to experts within the industry to find out the latest on I.V. pumps. We gathered tips on how to extend the life of an I.V. pump and what features to look for when considering the purchase of new infusion therapy devices. New technology, appropriate service and other important topics were addressed.
Our roundtable panel of experts consisted of Pacific Medical Technician Manager Brian Barton, Soma Technology Inc.’s Ashish Dhammam, Iatric Systems Senior Vice President of Software Solutions Jeff McGeath, USOC Medical Lead Technician Shawn Nguyen, Elite Biomedical Solutions Vice President of Operations Nate Smith, Tenacore Holdings Inc.’s Bob Spidell and AIV Inc. Sales Director Jeff Taltavull.
Q: How can a biomed extend the life of an I.V. pump?
Barton: You can repair and restore broken pumps or outsource repair and/or service to a third party. Refurbished or used parts can be a cost-effective alternative. You can replace parts such as covers, cases and external cosmetics. You can perform regular service and software upgrades.
Dhammam: Performing regularly scheduled maintenance adds to the life of the pump. Basic troubleshooting instructions and training end users on proper usage, cleaning helps.
McGeath: Best practices to extend the life of an I.V. pump include performing manufacturers’ recommended preventative maintenance, using OEM parts, and especially keeping the batteries charged by plugging the pumps into AC whenever possible.
Nguyen: Periodically inspecting the pump for damaged mechanical parts such as doors and latches and conducting preventative maintenance on it as recommended by the manufacturer’s protocol. Oh, and keep it clean!
Smith: The biomedical groups can extend the service life of a device by properly maintaining it. This involves servicing and testing the device for the intended use of the instrument. A thorough maintenance protocol will ensure the device meets the desired parameters. These groups can perform these services cost effectively by using a recognized and approved third-party provider.
Spidell: Pump life can be extended for as long as the biomed has time and parts availability. For older pumps that are no longer supported by the OEM, alternate sources for parts and/or service can be found. Also, cosmetic appearance shouldn’t be neglected, pumps can be maintained to work and look as good as new, and scuffed, dinged up pumps that look worn out won’t inspire confidence from patients or nursing staff.
Taltavull: There are many ways to extend the life of your infusion pumps. Regular maintenance by trained professionals can keep your pumps running and easily spot small problems before they become major ones.
Q: What are the most important features to look for when purchasing I.V. pumps?
Barton: The way in which a pump is designed, its mobility, and how an I.V. pump integrates with the nurse’s workflow, largely impacts patient safety. Finding a pump that lowers user/medication errors is arguably most important. Integrated, smart technology, and wireless drug libraries with data analytics, will prove most beneficial.
Dhammam: It depends on the entity that is purchasing. For large hospitals, you have to make sure it is compatible with the infrastructure and software levels that are already in place. Wireless bands of transmission are important lately. For smaller places, cost of tubing may be the biggest concern.
McGeath: Ease-of-use, safety and reliability are key components of any pump purchase decision. The ability to integrate with the hospital’s EHR system, as well as the overall cost of ownership, including disposable costs and ongoing license and maintenance fees, should also be heavily considered.
Nguyen: Smart infusion pumps have become increasingly advanced and include close error software. This technology allows infusion pumps to perform functions that assist health care workers with programming and calculating dose and delivery rates. If used properly, these features help prevent I.V. medication errors and reduce patient harm.
Smith: The most important feature to consider is the device’s ability to expand options as the needs of the patients and institutions change. Most of the current providers achieve this through software enhancements. Ideally these changes should be incorporated at the institution, and as efficiently as possible.
Spidell: What’s the long term maintenance plan after the warranty? Will you have time to make repairs in house or will you be outsourcing some repairs? Will you have OEM training and be able to get all parts? How much does the OEM charge? What’s their turnaround time? Can a repair depot do it faster for less?
Taltavull: The most important features to look for are the ones that will benefit your users the most. Infusion pumps today can provide a wide variety of infusion types, but you might only need it for a single function or set of functions. Knowing exactly what you need will help you find the pumps you require and not overspend on unnecessary features or equipment.
Q: Do you have to buy brand new pumps to get quality I.V. pumps?
Barton: It’s less a matter of quality and more a matter of how much capital the establishment has. If a hospital simply cannot afford the latest technology, there are still lots of quality, refurbished units to be found.
Dhammam: No! Many hospital systems have chosen to lease/rent/buy their I.V. pumps from rental companies and third-party vendors. This is an active practice that is only becoming more popular now. The pumps are not always new. In most cases, they are refurbished pumps that are moved from one place to another. As long as they are certified/calibrated to OEM specifications, the quality can be guaranteed to be the same as new pumps.
McGeath: In general, yes, buying new pumps is often the best option, as they will have the most recent hardware and software updates, and integration capabilities. While there are third party re-sellers of pumps, these devices may/may not be refurbished using OEM parts and don’t always contain the latest software versions. They are, essentially, used devices.
Nguyen: No. Not all medical facilities have the budget to buy brand new. A reputable third-party vendor can be a great alternative.
Smith: No, many options are available in the marketplace today. Most of these platforms can be or have been expanded to be comparable to new offerings. An institution can realize considerable savings when considering these truly viable options.
Spidell: No, but I think it’s the best place to start if you have that kind of budgetary luxury. If not, you should try to find a trustworthy vendor to sell you quality refurbished pumps that are patient ready and backed by the best warranty.
Taltavull: Absolutely not.
Q: How often should regular service be performed on an I.V. pump?
Barton: Obviously there is not one rule that pertains to all pumps. Ultimately, it depends on the type of pump, how it is being utilized in the facility, its history, and, of course, the OEM recommendations.
Dhammam: Standard practice is every six months. Facilities where end users are not trained properly generally see service performed often on their I.V. pumps.
McGeath: Annual PMs are recommended and considered a best practice, but the most important aspect is to follow manufacturer service recommendations.
Nguyen: Annually.
Smith: An overall performance assessment should be performed periodically considering several operational parameters. How the device will be used as well as the OEM guidelines should be considered. A review of performance; repairs or corrective actions throughout the service life should be part of this assessment.
Spidell: Beyond regular PMs, I don’t think there is an answer for that. The life and experience of each pump is fairly unique and it’s not possible to predict damaging mishaps or malfunctions. I think it’s most important to have a trained and vigilant nursing staff that can identify problems as they arise.
Taltavull: This depends on the model. At the very least, pumps should be inspected during your facility’s preventative maintenance (PM) periods. Some pumps may need more frequent inspection. When in doubt, it is always beneficial to consult the user/maintenance manual from the OEM.
Q: How will new technology and other advances impact the I.V. pump market?
Barton: Smart technology will be the norm. No question about it. At some point, because of the ability to reduce medication errors, the advantages of advanced alarming, history log data, and the ability of pharmacists to oversee the uploaded wireless drug libraries, are technologies that will become industry standards.
Dhammam: BG band upgrades to wireless transmission has been a focus for I.V. pumps as with many other categories of medical equipment. BD/Carefusion has focused on the complete solution including the monitoring of vitals through their smart pump solution. We are seeing more on-screen clinical advisories, therapy specific programming and increased number of drug libraries. Proprietary software and service options are making pumps less easily serviceable by third-party vendors.
McGeath: The majority of changes are likely to impact external versus internal applications. Of course, networking and encryption/authentication protocol changes may impact the wireless hardware and firmware on the device, but consideration should be given to hardware and/or software requirements and architecture necessary to install and maintain these external software applications. This could include minimum requirements for server hardware, operating software and database software, such as MS-SQL. While this doesn’t directly impact pump maintenance, it certainly impacts overall infusion (data) functionality from a system standpoint. A number of these same external applications may help the actual maintenance of the pump including, retention of data logs, alarm history and even the ability to locate the device. Emerging data protocols from the smart pump community include the ability to communicate device management data such as software revision, battery status, last service date, etc. These operational data elements could vastly improve the biomedical engineering workflow.
Nguyen: I think the sophisticated technology we have now for infusion pumps can help reduce medication errors, but I know it can’t prevent all programming and administration errors. Health care workers must use professional judgment and stick to established standards of care and operating procedures for safe medication administration when using this or any technology.
Smith: As technology advances, new operational features and tools to assist the clinicians will become available. These features should assist the clinicians in improving the efficiency, efficacy and safety of patient care. A current platform that can expand to meet those advances is the most desirable.
Spidell: I.V. pumps have been shrinking in size and weight making them easier to handle and move around. They can also be more difficult to find when needed. Wireless asset tracking can help biomeds locate pumps that are hiding when PMs are due.
Taltavull: You will see pumps that become more flexible/adaptable and less one dimensional, as well as more connected. All of the new technology means that biomeds and repair companies will need to become better versed in the new technologies to ensure these new pieces of equipment are used/serviced properly.
Q: What type of credentials should third-party organizations posses or maintain? What should be considered when evaluating third-party organizations?
Barton: It is imperative, before considering outsourcing repairs to a third-party organization, that ISO certifications have been verified, are up-to-date, and that OEM certifications have also been verified. Other than credentials, quick turn-around times on repairs and replacements should be incredibly important. Nobody wants to be without equipment. Also, when working with third-party organizations it is paramount to anticipate a quick turn time to ensure there is no lapse in patient care.
Dhammam: How long have they been in business? What is their capability/training/certifications to service infusion pumps? ISO certification is a big plus. Consider the volume of pumps they sell/rent. Does this organization have a nationwide network for field service and support in addition to depot repair capabilities? Large GPO approved third-party vendors are good organizations to work with.
McGeath: We may see pump vendors begin to create third-party certification programs that allow the pump vendor to “certify” the third party’s software (be that a core EHR vendor or third-party integrator) for performance against its feature set. For now, a great source of information about the technical abilities of EHR and third-party integrators is the IHE-sponsored Connectathon events where the integration profiles have undergone extensive, week-long testing between different vendor software applications. See connectathon-results.ihe.net for additional information.
Nguyen: Third parties should be certified by the OEM or by other credentialing entities. It is important that the third party is well versed in your particular pump manufacturer and model and that they have a proven track record of outstanding service on this equipment. Having systems in place like ISO 9001 is a must, this is a quality management system that helps to mitigate any issues that may occur with how repairs are performed.
Smith: A quality third-party organization should possess the experience and follow the current practices of the I.V. industry. The credentialing should include, but not be limited to, the OEM product training offerings as well as the many professional certifications in the pertinent fields. We also believe experience in this field is important.
Spidell: They should be FDA registered, have ISO certification, and OEM training on the equipment they service. Look for an organization that you can build a trusting relationship with, that is responsive to your questions and concerns and offers a solid warranty on their work.
Taltavull: Pertinent certifications/accreditations for the items the company sells, repairs and manufactures. When looking for a third-party vendor it’s always good to do your homework. See what your peers at other facilities and in your local associations are saying, chances are if they like the vendor you will as well.
Q: What else do you think is important for TechNation readers to know about I.V. pumps?
Barton: Do your PMs regularly, update software as needed, and be sure to outsource repairs when they prove to be too much. There is no reason to shotgun repairs. At the end of the day, attempting to fix problems on your own, without the proper training, only serves to hurt those we are committed to helping.
Dhammam: There are many new makes and models that are being released actively. The overall solution is important to large hospital systems, backwards approach with the end goal in mind would probably help simplify the right choice of the I.V. pump for these systems. There are inexpensive alternatives to buying new pumps through third-party vendors and this should be considered in order to save on capital spending.
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 would be beneficial for biomeds to become familiar with the wireless hardware contained within a device to understand not only how to troubleshoot but also configure these components. Wireless and encryption/authentication protocols are constantly being updated and a basic knowledge of wireless networks would be very advantageous. Computer literacy will also be a “must have” as new applications are developed and released that will help biomedical personnel configure, troubleshoot and even locate devices for service.
Nguyen: Quality, efficiency, and longevity are the most important things to look for in an infusion pump. Make sure you’re properly educated and trained to service and maintain all infusion pumps used in your facility and always look out for updates and changes.
Smith: When selecting a product, first consider the application and operational environment. Next, consider what the total cost of the device will be throughout the entire service life. Other factors to consider are selecting parts and service providers that can provide a tested and quality product and one that can answer the service needs for the life of the device.
Spidell: Look for extra cost savings by using quality replacement cases from third-party vendors.
