Hi everyone, my name is Susan Mingle. I'm a clinical specialist educator for Med One Group.
I'm happy to be here today, my purpose today is to show you the Alaris point of care unit and the PCA
module that you've recently acquired for use. I'd like to start out the presentation with an
overview of what we call the point of care unit or PCU. A lot of nurses like to call this the brain,
because without this nothing works. So let me just go through some of the features of
the PCU before we get started with the PCA part. The PCU is designed much like an ATM interface,
you see arrow keys that surround the screen, you have a very large color screen, you have your
silence button and your options, and then you have your system on. Just below is your numeric keypad,
notice that the decimal is highlighted with a red circle. On the sides of the PCU are
what we call IUI connectors. This is where the modules of the Alaris system will attach and
reattach at 45-degree angles up to a maximum of four. If you'll notice on the back of the PCU,
is where your power cord is this will power up to four devices with only the one plug. You do have
a black button here, if you press that and hold it, it will lock out the keypad so that patients
and or family members will not be able to access the panel on either the PCU or any of the modules.
There's also a ABGN card, which is your wireless card, should that be connected to the network once
these devices are brought into the organization. Lastly, the battery is located beneath the PCU
and for biomed it's a very easy release and pop out and a replacement if necessary. This is the
IUI connector that I previously discussed, this is where the PCU is able to communicate with any
of the Alaris modules. In this case I will be attaching the PCA module. Hold the PCA by the
handle, raise it to a 45 degree angle, insert it. into the IUI connector and then click it
into place you should hear the click knowing that you've got connectivity established. So
the PCA module, if you noticed was placed on the right-hand side the PCU, we'll talk about
that in just a second. Some things I would like you to notice on each of the modules;
you have a channel select, a pause, a channel off, and a restart button. A few things are done
on the PCA module itself, but the majority of the programming is going to be done on the PCU. This
is where the key is inserted so that you can have access to opening the acrylic door, but I
also want you to notice why it's on the right-hand side is that if you'll see here, I added a large
volume pump to demonstrate this visually. You have to press the blue button to remove the module,
with the PCA notice there's no blue button. You actually have to have a key to gain access to
be able to open up the door, there by pushing this latch and then you can remove the module.
You do have multiple options for the tubing for the PCA syringes. For our purposes today,
I'm going to be using what we refer to as a pigtailed set. so I'm able to Y in my carrier
fluids when I start my PCA. The PCA will accept any 20 to 60 ml syringe. BD, Monoject, Terumno,
any of those syringes and the good news about that is is that if there's a plant shutdown or
a backorder on any of the glass files that you may currently use, pharmacy is able to compound
these and make them themselves. Tubing wise I'm using a pigtailed set but there's multiple
choices that you could use in your facility. That would be up to you and your pharmacy and nursing
to decide. Prior to starting this we want to go ahead and prime our tubing and in this pigtail
set you just want to make sure you've primed your tubing and then Y your carrier fluids through and
then attach it at the IV insertion site. Then we always recommend going ahead and clamping it off
prior to starting it. You have to have a key, or you can use a code to access the door. Most
hospitals use a key, so we're going to place our key in and we're going to turn it to unlock, we're
going to open the door and this is a three-step load. You're going to have claws at the top, place
your flanges underneath this gray area, if you'll notice this little black button that's actually a
sensor and it determines the internal diameter of each of the manufacturers syringes because
they're all different and it's important to note that once we start choosing our syringe size.
Then we're going to pull out this barrel clamp and move it away. So now I'm going to load it;
one, two, and three. Then we're going to close the door, and we're going to go ahead and lock
it back and now we're ready to turn it on and start our infusion. So before we turn it on,
just so you know, your hospitals Pharmacy has loaded PCA drugs to each profile that they've
chosen. A profile is simply a care area or type of patient you're taking care of for example;
Med Surg, Critical Care, or Pediatrics, Oncology. Just depending on what your
Hospital has chosen and each of those profiles have minimum and maximum rates and weights and
also the drugs that they've chosen have what we call our Guardrails limits. So
that if you make a programming error or miss a decimal, the guardrails will give you a prompt,
a screen that says are you sure you want to do this because you're outside hospitals
best practice. That's also what's known as a smart pump and this is a smart PCA pump.
So now we're ready to start an infusion I'm going to go ahead and reach out to the system
on key and turn it on and you'll notice some lights that are going to light up here on the
PCA just meaning that the connectivity between the PCU and the PCA is intact. The first clinical
question that's going to ask you is this a new patient, remember the arrow keys that correspond
the screen you're just looking for the answer that you're looking for in this case is this
a new patient I'm gonna say yes that's what I want. It will default to the last profile that
it was used in which is Med Surg, and that is what I want for this scenario. Now it's
going to be in just a calm quiet mode until I'm ready to go ahead and activate the PCA,
so backing up to the initial turn on if it's not a new patient you would say no. If you're not
working in Med Surg then you would have said no and gone back to your hospital's customized list
of profile areas and choose the one that you want. What that does is like I'm in Med Surg right now,
that means the list of drugs for PCA and Med Surg are available for me to use they could be
different. Let's say if I were in pediatric using a PCA, they would have smaller max and minimum
rates and weights. So it's always good to make sure that the profile that it defaults last to is
the one that you want to go ahead and move forward with, if not just say no and again you'll see your
hospitals customized list of those profiles. So now I'm ready to go, we have our tubing primed
and loaded. I'm going to keep it clamped until I'm ready to hook it to the patient, so I'm going to
go ahead and hit channel select. It's telling me I need to turn my key to program, confirm that
that's the correct time of day, obviously if it's not you would change the time. Then you're going
to those going to ask you it's going to recognize a syringe notice there wasn't anything there so I
hid all syringes now it recognizes that there's a BD 50-60 and that's what I'm going to choose
and I'm going to press confirm. Then here's my list of drugs that your pharmacy has loaded in,
based on your formulary and in this demonstration I'm going to choose morphine. Notice there's two
choices; acute and chronic. I'm going to choose acute and I'm just going to choose the one - one.
Is this correct, yes. This is a clinical advisory just a post-it note to nurses to follow a practice
or a protocol. You confirm it, I'm going to confirm pass this next screen because the PCA
with the pause protocol, the end tidal module is not going to be part of this if it's something
you're interested in you should see your Med One rep for more information. So now I'm just
gonna verify one two one, I'm going to confirm that and now here's my infusion modes which
are your multiple ways to infuse your PCA meds. I'm going to choose PCA dose plus continuous and
this is pre-populated based on physician orders. If this were not, you would be able to program
each one of these steps to follow a doctor's order. Now it's telling me to close and lock
the door, and now I can press Start. I will take the key out and next we're going to talk about the
does request cord or the patient request cord. So now we have started our infusion and I'm holding
the dose request cord or patient request cord. I have it in a profile called one and there are
three profiles available. Profile one is by far the most popular and preferred on our PCA module.
When a dose is available the light is on. so I do have a dose available so I'll press the button.
You'll hear a beep, you'll also read that it's delivering that bolus dose and then also the light
is flashing when I'm getting my additional dose. Once the dose has been given, this light will stop
blinking and go into what we call our lockout mode which is for ten minutes. So when you're
instructing to your patient about when these are available and when they're in the lockout,
it really helps them to understand that they're getting it and that they're in a ten-minute
lockout as long as this light is off. So once this is done, now you'll see it has flipped back over
to my continuous dose of one and that that was completed and now my light is off. Profile two,
the light is on all the time. Whether one's available whether they're receiving it or
whether they're in their lockout. Profile three just the opposite it's off all the time, so I
guess you guys could see it's it's probably better to use profile 1 just from a patient compliance
standpoint so they won't be pressing the button all the time. So I'm going to go ahead and press
it another time and you see nothing happens and then I'm gonna press it one more time and you see
nothing happens so I think it'll really cut down on the numbers of attempts that a patient will
make when they really understand that when a light is on then they're extra medications available.
So now we're going to look at patient history, how many delivers how many demands just an
overall detail of what's been going on to the patient since the PCA started. So this you're
going to do with the channel select and then go over here to our options button which is below
the silence button. Now you're going to see the PCA patient pause limits, infusion modes,
patient history, and that's what you want to see. If you want to look at those three setups here,
the dose record that we spoke about that's a good place to look at there. Here we're going to go to
patient history now this will default to eight hours of history, if you want earlier history;
one, two, four hours whatever you just press this zoom button to zoom in to that section of time
that you want to specifically look at. Now this is a 24 rolling total, keep that in mind so your
total drug, the number of demands, and the ones ones that were delivered and see I pushed on the
button twice after we got this thing started. So that's where you'll see all the information that
you need, if you need more of a detail, press the detail button. Then you can see exactly the total
drug the dose the continuous versus that loading or any bolus doses that you've given and an
average a drug per hour if that detail is needed. So again to get out of this, you press exit and
it's you don't really have to restart it it's still continuing to infuse while you're looking at
all that history but you just want to start to get out of that screen and back to the main screen.
So now my patient is complaining of having breakthrough pain that's not being resolved by the
dose that he's on. So I have a physician order to give a bolus dose and I'll show you how you
do that. Of course you're gonna have to have your key, channel select, I want to give a bolus dose,
I set my key to program and I'm also going to show you how the Guardrail safety software works
should I make a decimal error or key press error. I'm gonna think that I'm hitting 2.5, but I'm
accidentally going to hit 25 so this is example of where pharmacy can set a hard stop meaning I
can't do anything except for reprogram the pump. Nothing past three, now I'm going to go back and
put in two and make sure I hit that decimal point five and press confirm. Now this is what we call
a soft limit, because it's asking me do you want to proceed; yes or no. I have a physician order,
my patient condition is warranting it, so I'm gonna say yes and I'm going to overwrite that
and press Start. It's not a bad thing if I have a physician order and my patient's condition is
warranting it, just so you know this is the smart PCA we talked about and you can have hard stops
and soft limits so that the soft limits can be overridden and notice the G right here this just
means I'm in a Guardrail alert and if you press that you can see what the Guardrail alert is and
what the Guardrail limit was of - and I overrode that by half a milligram. So now you can see
that we're delivering this bolus dose and it's scrolling across saying that it's a bolus dose
and the green light is infusing meaning that the dose is going. Once the dose is complete,
then it's going to flip back to the base rate that we had of that 1 milligram and you'll be able to
also see that reflected in your patient history under the bolus dose. You look under the patient
detail and you'll be able to see how much was given and what time it was given. So during the
delivering of our bolus, we received what's called a near end of infusion alert. Notice it's still
green but it's beeping amber color to let you know that you need to go get your next syringe. So you
can press the silence button and go retrieve your syringe, this is going to continue to be just like
a near end a KVO on a large volume infusion until you come back with your subsequent syringe. If
you don't come back in time, the syringe will go to a syringe empty alarm, meaning that it's
empty and it will stop infusing. I'm gonna also simulate that syringe empty for you so you can see
what that looks like as well. So this is what happens after the near end of infusion alert,
if you haven't come in to change your syringe it'll go to this syringe empty alarm and it
will stop infusing because there's no green light. So I'm gonna silence this and I'm gonna
go ahead and show you how you would change a syringe out let's say you're coming back
in with the same volume the same drug the same parameters. You're going to reload your syringe;
the three steps and close and lock the door. Hit channel select and turn your key to program and
look for your syringe. You confirm your syringe size and notice this restore button, if everything
is the same and you're swapping out a syringe that was the exact same as the one prior you press
restore and all those parameters will populate for you so you don't have to put everything back
in again it'll pre populate the same thing and you're ready to start back over by pressing start.
So now your patient has been given discharge orders and you're ready to turn the PCA device
off. First thing you need to do is make sure you check your history so you can
document that prior to discontinuing, remember channels select, options, patient history,
then you'll have a total of all the history of that patient so that you can chart it prior to
discontinuing the device. So you can exit out of there once it's done, and then simply on the PCA
module itself, one of those buttons we talked about is channel off. Go ahead and press and
hold till you hear a little chirp, let go and now you've powered down your PCA. Thank you very much.