At Instinct, we’re always thinking about ways to improve patient care and medical safety.
Instinct is a unique tool that offers your hospital new and powerful ways to be globally efficient while enhancing patient care. Digitizing critical patient workflows requires a thoughtful approach towards avoiding unintended consequences of technology.
To this end, we put together the following guidelines which cover several important considerations and best practices for Instinct hospitals.
💡 ProTip: Check out this great Pick the Brain article on Turning Workarounds Into Workflow in Veterinary Practice.
Instinct Workflow Safety Tips
Hospital workflows are integral to keeping patients safe and teams efficient with any technology implementation.
Here are the key lessons learned from 100+ go-lives:
Tip 1: The most successful Instinct hospitals look at this as an opportunity to create fresh workflows rather than trying to mimic existing analog workflows digitally, where it may not make sense.
Tip 2: Resist the urge to use Instinct to replace team interaction. Look at this as a way to make your team better communicators, not as a replacement for strong communication.
Tip 3: The most successful hospitals reevaluate existing charging schemes to take advantage of Instinct’s charging automation. Common examples include medication administration fees, hospitalization charging, weight-based charging, and timed charges such as oxygen, CRI and IV fluids. This doesn’t have to be done all at once but this is a great time to supercharge your team and take advantage of Instinct to the fullest.
Tip 4: It is helpful to schedule Instinct Workflow meetings regularly with your staff to review Instinct updates, iron out frustrations, and to make sure the staff is utilizing Instinct in the most efficient/optimal manner.
Instinct Medical Safety Basics
Instinct has several built-in patient safety features and functionality. The following are 5 basic safety items to understanding how Instinct works:
Instinct will never adjust quantities or frequencies on its own.
Instinct utilizes kg weights only. When weights change, Instinct will not automatically update quantities (mL/tab/cap). Instead, the dose (mg/kg) will update live. This is to protect the patient, in case the wrong weight is entered or the clinician is using an alternative weight dosing (renal or lean body weight). If desired, you can use an order that prompts a doctor to review/update medication dosages daily.
Instinct never imports weights from other systems. This prevents old weights from being used erroneously.
Instinct displays medication data consistently. This includes showing quantity (mL/tab/cap), dose (mg/kg), and total dose (mg). These are displayed in a consistent order, but clinicians can order medications how they choose (starting in any of the 3 fields) and Instinct will generate the others.
Instinct allows you to limit ordering for individuals (students, interns, new residents, new technicians), by using the “draft order” feature, which is set up by your administration team. Once orders are entered, other staff (such as the primary doctor on the case) will have to review the order before it can be set “live”.
Medication Safety Best Practices
The following are some best practices for medication safety in your software systems:
Product Naming Best Practices
Instinct uses the current naming convention from your existing practice software inventory list for each product. However, we understand that many Instinct hospitals use this time to review all medications and create a clean naming convention if this does not already exist. If doing this, things to consider include: using tall man lettering, incorporating concentrations in the name, using generic and brand names, not using all caps, and keeping your naming convention consistent.
Tips for displaying medications in your product list:
- For tablets, capsules, caplets: label clearly with total pill strength
- For injectable drugs and oral solutions: label clearly as total strength per reconstituted mL (it is not recommended to label a drug in this manner: 5mg/2mL, 5mg/20mL, or 1g/vial)
- Include relevant terms when naming: formulation such as tablet vs. injections should be included. Also if the product is extended release or compounded, this info should be included.
- Include both the generic and trade name of the medication.
- Amoxicillin/Clavulanate Potassium (Clavamox) 62.5mg Tablet
- Doxycycline (Vibramycin) 10mg/mL Oral Suspension
- Enrofloxacin (Baytril) 22.7mg/mL Injectable
Medications with Multiple Formulations
Following best practices, we strongly recommend only carrying one active medication concentration at a time in your hospital.
If you must carry two formulations (Hydromorphone 2mg/mL vs. 10mg/mL), best practices require clear labeling and having two different products in your database (separate product for each formulation). Clinicians ordering these medications can then select the correct formulation.
Reconstitution Best Practices
Committing to a hospital-wide standard reconstitution protocol for each medication (i.e. ampicillin) is a simple patient safety best practice.
If you must have variable reconstitutions, the above principles about having separate Instinct products clearly named applies.
When editing or adding new medications to the Instinct product admin, we strongly recommend having a veterinarian or medical director be the final sign off because of the risk for errors impacting patient safety.
Important: if you get a new medication formulation, even if used temporarily (think in times of backorder), never update a previous item. Instead, always create a new product for these items.
CRIs and IV Fluid Ordering Safety
Tips for Using CRIs/IV Fluid Additives in Instinct:
At setup, you will customize units for each CRI/IV fluid additive.
- Each IV fluid, additive, or CRI will have it’s own line on an Instinct Treatment sheet. This is for safety, clarity of record keeping, and easy tracking (think being able to see the KCl dose in mEq/L on the trend line).
- Whenever you want to change the CRI or IV fluid order for a patient, best practice is to use the order “Change” orders (Change IV Fluid) which can be set as a one-time order to clearly indicate the change requested. The team then completes that order and adjusts the Tx Sheet and pump.
- Use the order notes to over-communicate. One suggestion is to write as mg/kg/day and ml/hr so there is no confusion. You can also include specific instructions or key info in the notes, such as the max dose (think K-max).
Patient Safety Warnings (PSW)
Instinct comes with a built-in Patient Safety Warning System.
This includes dose ranges for the most commonly used/overdosed drugs. The data for this is driven by the Instinct’s team research with input and review by specialists. We are constantly updating and maintaining this data but you have full control of it in your Instinct settings.
To change a warning range for a medication, simply head the Admin section of Instinct and go to the Product section where you can search for a medication name and change it’s Safety Warning settings.
We plan to grow our Patient Safety Warning System over time.
Go-Live Day Safety Tips
The initial transition to Instinct can be the biggest risk for safety issues. We recommend the following to help:
- One Treatment Sheet: No patient should ever have both paper and digital sheets simultaneously. Once a patient’s orders are put into Instinct, commit to the full transition by putting a label (or an “x” through the rest of the paper sheet) and a sign on their cage to avoid duplication errors.
- Assign to Me: Encourage your team to use the “Assign to Me” button out of habit whenever working on a patient. This button mimics the act of picking up a paper treatment sheet and walking around with it. Think of it as taking charge of that patient’s current orders and telling others to come to you first before helping.
- Communicate: Default to over-communicating during the transition. This includes over-documenting in order and treatment notes and over-communicating with your staff about the workflow and plan ahead of and during go-live.