CC Plus Guardrails Advanced User Workshop Manual Issue 1 May 2019

Alaris CC Plus Guardrails™ Syringe Pump TM

Advanced User Workshop Manual

Contents Adult Workstations

3

Paediatric Workstations

10

Neonatal Workstations

17

Quiz Sheet

25

Performance Criteria

29

Guardrails Advisories

37

Assessment Form

39

Quick Reference Glossary

47

Framework for Reflection

53

References and Further Reading

55

Course Evaluation Form

57

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• This guide is not intended to be comprehensive instructions for the set-up and operation of the pump • You must ensure that you read all relevant literature before undertaking the training programme • The pump must not be operated until the directions for use have been read and understood

Any assessment during the training against competency criteria is formative only. Full competence (including both knowledge and skills) can only be developed under supervision in the clinical area and formally assessed according to local Trust policy.

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Alaris™ CC Plus Guardrails™ Syringe Pump

Advanced User Workshop Manual - Adult Applications

Adult Applications IMPORTANT: You must ensure that you read all the relevant literature before undertaking the training programme.The pump must not be operated until the Directions For Use and other associated documents have been read and understood.

Workstation 1 Aim 1: For participant to demonstrate proficiency in the safe set up of the infusion pump. Instructions to participant: Please prepare the pump for use, ensuring all safety checks are made. Information/action required: • Observe the pump casing and cables are intact • Check the pump is clean • Check the pump is within its service interval • Attach the pump to the AC power supply, or docking station, ensuring a safe and secure environment • Listen for audible click when attaching to docking station • Switch pump on and observe for self-test Aim 2: For participant to demonstrate knowledge and understanding of the controls and indicators displayed on the front panel. Instructions to participant: Please verbally identify the keys and indicators displayed on the front panel. Information/action required: • Identify all indicators and controls correctly

Workstation 2 Aim 1: For participant to demonstrate proficiency in the use of the infusion pump in a clinical situation. Scenario 1 Mary Jones is a 56 year old insulin dependant diabetic admitted to the ward/unit for stabilisation of blood sugars. Initial prescription chart reads: 50 units of insulin in 50mls of normal saline (1 unit per ml), infusion to commence at 1.50 ml per hour. Instructions to participant: Please start this infusion. Information/action required: • Prepare correct syringe brand and size • Prime extension set, massaging the pressure disc in the direction of flow to prevent ballooning and ensure air removal • Ensure Syringe is installed correctly • Insert the pressure disc into the pressure transducer holder • Power pump on, note pump self-test • Clear set up if required • Confirm profile if required or press NO and select profile from list • Select ML/HR if required • Set rate of 1.50ml/h • Use the Purge function to take up the mechanical backlash/slack 0000CF04048 Issue 1

• Connect extension set to patients’ venous access device • Verify all settings • Start the infusion • Activate rate lock (if configured) Pressure Monitoring: Please check the pressure display reading: • Wait a short time for pressure to stabilise • Select the PRESSURE button • Adjust the downstream occlusion pressure alarm limit either by pressing the AUTO softkey or manually, using the chevron keys

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Alaris™ CC Plus Guardrails™ Syringe Pump

Advanced User Workshop Manual - Adult Applications

Scenario 2 Mary’s blood sugar has risen. Treatment now prescribed is: A bolus infusion of 1 unit of insulin stat and adjust infusion to 2 units per hour Instructions to participant: Please administer the prescribed bolus and change the maintenance rate accordingly. Information/action required: • Unlock rate (if required) • State the pump is not on hold • Administer bolus infusion of 1.00 ml • Note the volume added to volume infused • Put the pump on hold (if titration is not enabled) • Change the infusion rate to 2.00 ml/h • Restart the infusion • Record on fluid/drug chart • Note bolus logged in event log • Activate rate lock (if configured) Scenario 3 Mary’s condition has stabilised. A maintenance infusion has now been prescribed: 8 units of insulin have to be administered before the next blood check in 4 hours time Instructions to participant: Please set a volume to be infused (VTBI) of 8.00 ml. Information/action required: • Select the VTBI softkey • Set a VTBI of 8.00 mls, press OK to confirm • Select appropriate end rate action, press OK to confirm • Press RUN button to infuse • Observe VTBI now displayed on display panel Scenario 4 Add the drug ... to the pump (if enabled). Instructions to participant: Add a drug name to the pump. Information/action required: • Unlock rate (if required) • Press OPTIONS button • Select ADD drug • Follow prompts on screen • Observe drug name (and dose, if configured) on screen Or • Place the pump on hold • Press OPTIONS button • Select infusion set up • Select drugs (A-Z) • Select the drugs alphabetical row from list • Press OK to confirm • Follow prompts on screen • Observe drug name (and dose, if configured) on screen • Start infusion • Activate rate lock (if configured) 0000CF04048 Issue 1

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Advanced User Workshop Manual - Adult Applications

Scenario 5 Mary’s infusion can be discontinued. Instructions to participant: Please discontinue this infusion, and describe the cleaning and storage procedures to be carried out. Information/action required: • Stop infusion • Isolate line from patient • Note volume infused • Turn pump off • Disconnect extension set from the patient according to unit/hospital policy • Remove syringe and pressure disc from pressure transducer • Remove from AC power (or docking station if used) • Describe the cleaning and storage procedures • Plug into AC power to recharge battery

Workstation 3 Aim: For participant to demonstrate knowledge, understanding and clinically proficient practice for the set-up and use of the Alaris CC Plus Guardrails Dose Error Reduction Software. ™

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Scenario 1 Mary is a 65 year old lady admitted to the Cardiac Care Unit in cardiac failure. She weighs 65Kg. The prescription chart reads: (Drug)... (Concentration)... (Dosage)... Instructions to participant: Using the patient details above, please commence the infusion using Guardrails Dose Error Reduction Software. ™

Information/action required: • Prepare correct syringe brand and size • Prime extension set, massaging the pressure disc in the direction of flow to prevent ballooning and ensure air removal • Ensure Syringe is installed correctly • Insert the pressure disc into the pressure transducer holder • Power pump on, note pump self-test • Clear set up if required • Confirm profile if required or press NO and select profile from list • Select alphabetical group according to drug name, select drug, press OK • Select concentration, modify if required/ permitted • Enter patient weight if required • Confirm set up including dosing parameter • Confirm default dose and adjust if required • Use the Purge function to take up the mechanical backlash/slack • Connect extension set to patients’ venous access device • Verify all parameters • Start the infusion • Activate rate lock (if configured)

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Alaris™ CC Plus Guardrails™ Syringe Pump

Advanced User Workshop Manual - Adult Applications

Pressure Monitoring: • Wait a short time for the pressure to stabilise • Select the PRESSURE button • Adjust the downstream occlusion pressure alarm limit either by pressing the AUTO softkey or manually, using the chevron keys Scenario 2 Mary’s condition has deteriorated. She requires an increase in her drug dose to... Instructions to participant: Please change the dose according to the prescription and the doctor’s instructions. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled, place pump ON HOLD • Enter the new dose rate • Start infusion/confirm new rate by pressing the RUN button • Activate rate lock (if configured) • Review pressure and adjust occlusion alarm level if required Scenario 3 Mary’s condition continues to deteriorate and the dose of her medication requires increasing to... This will exceed the upper soft limit. Instructions to participant: Please change the dose according to the prescription and the doctor’s instructions. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled, place pump ON HOLD • Enter the new dose rate • Start infusion/confirm new rate by pressing the RUN button • Note advisory on screen: DOSE WOULD EXCEED XX. OVERRIDE LIMIT? • Confirm required dose with prescription and/or doctor • Press YES to override limit. • Note upwards pointing arrows at top of screen denoting drug infusing above soft limit Or • Press NO and adjust dose to below upper soft limit • Activate rate lock (if configured) • Review pumping pressure and adjust occlusion alarm level if required • Report action to doctor Scenario 4 Mary’s condition continues to deteriorate and the doctor has asked you to increase the dose of the drug further to ... This dose exceeds the hard limit. Instructions to participant: Please change the dose according to the prescription and the doctor’s instructions. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled place pump ON HOLD • Enter the new dose rate 0000CF04048 Issue 1

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Advanced User Workshop Manual - Adult Applications

• Start infusion/confirm new rate by pressing the RUN button • Note alert and advisory on screen: DOSE NOT PERMITTED. DOSE LIMIT XX • Press QUIT softkey to cancel alert and return to previous dose • Activate rate lock (if configured) • Report hard limit exceeded to doctor Scenario 5 Mary’s condition has improved and her drug dose has been weaned down. Instructions to participant: Please continue to wean Mary’s drug dose to ... This is below the lower soft limit. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled, place pump ON HOLD • Enter the new dose rate • Start infusion/confirm new rate by pressing the RUN button • Note advisory on screen: DOSE UNDER XX. OVERRIDE LIMIT? • Confirm required dose with prescription and/or doctor • Press YES to override limit • Note downwards pointing arrows at top of screen denoting drug infusing below soft limit Or • Press NO and adjust dose to above lower soft limit • Activate rate lock (if configured) • Review pumping pressure and adjust occlusion alarm level if required • Report action to doctor

Workstation 4 Aim: For participant to demonstrate knowledge, understanding and clinically proficient practice for the set-up and use of the Alaris CC Plus Dosing Only facility. ™

Scenario 1 Jack is a 56 year old man admitted to the respiratory ward with acute severe asthma. The prescription chart reads: (Drug)... (Concentration)... (Dosage)... Instructions to participant: Using the patient details above, please commence the infusion using the dosing only facility. Information/action required: • Prepare correct syringe brand and size • Prime extension set, massaging the pressure disc in the direction of flow to prevent ballooning and ensure air removal • Install syringe correctly • Insert the pressure disc into the pressure transducer holder • Power pump on, note pump self-test • Clear set up (if required) • Confirm profile (if required) or press NO and select profile from list • Select DOSING ONLY from list • Select dosing unit and OK to confirm • Select concentration amount and OK to confirm (use UNITS softkey to change concentration unit, if required) 0000CF04048 Issue 1

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Advanced User Workshop Manual - Adult Applications

• Select total volume to be used and OK to confirm • Adjust weight and OK to confirm, if required • Press OK to confirm dosing information • Use the Purge function to take up the mechanical backlash/slack • Connect extension set to patients’ venous access device • Verify all parameters • Start the infusion • Activate rate lock (if configured) Pressure Monitoring: • Wait a short time for the pressure to stabilise • Select the PRESSURE button • Adjust the downstream occlusion pressure alarm limit either by pressing the AUTO softkey or manually, using the chevron keys Scenario 2 Jack’s condition has changed. He requires an adjustment in his drug dose to... Instructions to participant: Please change the dose according to the prescription and the doctor’s instructions. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled, place pump ON HOLD • Enter the new dose rate • Start infusion/confirm new rate by pressing the RUN button • Activate rate lock (if configured) • Review pumping pressure and adjust occlusion alarm level if required

Workstation 5 Instructions to participant: Please locate/demonstrate and explain the following features: Information/action required: • Clear volume infused • Adjust infusion by ml/h or dose rate • Locate adjustable alarm volumes and set accordingly (if configured) • Locate 24 hour log • Explain the profile filter (if configured) • Explain the standby feature (if configured) • Explain the difference between red and amber alarm indicators

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Advanced User Workshop Manual - Adult Applications

Workstation 6 Aim: For the participant to demonstrate knowledge of alarms, warnings and prompts and corrective action to be taken should they occur. Instructions to participant: Please state/demonstrate the cause and corrective action for the following alarms, warnings and prompts: Information/action required: • AC power fail • Add drug not complete • Attention (with “3 Beeps”) • Battery empty • Battery low • Bolus dose not permitted • Bolus dose over • Bolus dose under • Check syringe • Concentration not permitted • Dose not permitted • Dose under • Dose would exceed • Drive disengaged • End of infusion • Error code and message • Line occlusion • Near end of infusion • Occlusion • Pressure disc out • Rate not permitted • VTBI done • Weight outside limit

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Advanced User Workshop Manual - Paediatric Applications

Paediatric Applications IMPORTANT: You must ensure that you read all the relevant literature before undertaking the training programme. The pump must not be operated until the Directions For Use and other associated documents have been read and understood.

Workstation 1 Aim 1: For participant to demonstrate proficiency in the safe set-up of the infusion pump. Instructions to participant: Please prepare the pump for use, ensuring all safety checks are made. Information/action required: • Observe the pump casing and cables are intact • Check the pump is clean • Check the pump is within its service interval • Attach the pump to the AC power supply, or docking station, ensuring a safe and secure environment • Listen for audible click when attaching to docking station • Switch pump on and observe for self-test Aim 2: For participant to demonstrate knowledge and understanding of the controls and indicators displayed on the front panel. Instructions to participant: Please verbally identify the keys and indicators displayed on the front panel. Information/action required: • Identify all indicators and controls correctly

Workstation 2 Aim 1: For participant to demonstrate proficiency in the use of the infusion pump in a clinical situation. Scenario 1 Matthew King is a 7 year old insulin dependant diabetic admitted to the ward/unit for stabilisation of blood sugars. Initial prescription chart reads: 50 units of insulin in 50ml normal saline (1 unit/ml), infusion to commence at 0.50 ml/h Instructions to participant: Please start this infusion. Information/action required: • Prepare correct syringe brand and size • Prime extension set, massaging the pressure disc in the direction of flow to prevent ballooning and ensure air removal • Ensure Syringe is installed correctly • Insert the pressure disc into the pressure transducer holder • Power pump on, note pump self-test • Clear set up if required • Confirm profile if required or press NO and select profile from list • Select ML/HR if required • Set rate of 0.50ml/h • Use the Purge function to take up the mechanical backlash/ slack 0000CF04048 Issue 1

• Connect extension set to patients’ venous access device • Verify all settings • Start the infusion • Activate rate lock (if configured) Pressure Monitoring: Please check the pressure display reading: • Wait a short time for pressure to stabilise • Select the PRESSURE button • Adjust the downstream occlusion pressure alarm limit either by pressing the AUTO softkey or manually, using the chevron keys

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Alaris™ CC Plus Guardrails™ Syringe Pump

Advanced User Workshop Manual - Paediatric Applications Scenario 2 Matthew’s blood sugar has risen. Treatment now prescribed is: A bolus infusion of 0.5 units (0.50 ml) stat, then maintenance infusion of 1 unit (1.00 ml) per hour. Instructions to participant: Please administer the prescribed bolus and change the maintenance rate accordingly. Information/action required: • Unlock rate (if required) • State the pump is not on hold • Administer bolus infusion of 0.50 ml • Note the volume added to volume infused • Put the pump on hold (if titration is not enabled) • Change the infusion rate to 1.00 ml/h • Restart the infusion • Activate rate lock (if configured) • Review pumping pressure and adjust occlusion alarm level if required • Record on fluid/drug chart • Note bolus logged in event log Scenario 3 Matthew’s condition has stabilised. A maintenance infusion has now been prescribed: 4 units of insulin have to be administered before the next blood check in 4 hours time Instructions to participant: Please set a volume to be infused (VTBI) of 4.00 ml. Information/action required: • Select the VTBI softkey • Set a VTBI of 4.00 ml, press OK to confirm • Select appropriate end rate action, press OK to confirm • Press RUN button to infuse • Observe VTBI now displayed on display panel Scenario 4 Add the drug name to the pump (if enabled). Instructions to participant: Add a drug/name to the pump. Information/action required: • Unlock rate (if required) • Press OPTIONS button • Select ADD drug • Follow prompts on screen • Observe drug name now on screen Or • Place the pump on hold • Press OPTIONS button • Select infusion set up • Select drugs (A-Z) • Select the drugs alphabetical row from list • Press OK to confirm • Follow prompts on screen

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Advanced User Workshop Manual - Paediatric Applications • Observe drug name now on screen • Start infusion • Activate rate lock (if enabled ) Scenario 5 Matthew’s infusion can be discontinued. Instructions to participant: Please discontinue this infusion, and describe the cleaning and storage procedures to be carried out. Information/action required: • Stop infusion • Isolate line from patient • Note volume infused • Turn pump off • Disconnect extension set from the patient according to unit/hospital policy • Remove syringe and pressure disc from pressure transducer • Remove from AC power (or docking station if used) • Describe the cleaning and storage procedures • Plug into AC power to recharge battery

Workstation 3 Aim: For participant to demonstrate knowledge, understanding and clinically proficient practice for the set-up and use of the Alaris CC Plus Guardrails Dose Error Reduction Software. ™

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Scenario 1 Emma is a 10 year old admitted to the paediatric ward with abdominal pain. She weighs 40kg. The prescription chart reads: (Drug)... (Concentration)... (Dosage)... Instructions to participant: Using the patient details above, please commence the infusion using Guardrails Dose Error Reduction Software. ™

Information/action required: • Prepare correct syringe brand and size • Prime extension set, massaging the pressure disc in the direction of flow to prevent ballooning and ensure air removal • Install syringe correctly • Insert the pressure disc into the pressure transducer holder • Power on, note pump self-test • Clear set up (if required) • Confirm profile (if required) or press NO and select profile from list • Select alphabetical group according to drug name, select drug, press OK • Select concentration, modify if required/permitted • Enter patient weight (if required) • Confirm set up including dosing parameter • Confirm default dose and adjust if required • Use the Purge function to take up the mechanical backlash/slack • Connect extension set to patients’ venous access device

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Alaris™ CC Plus Guardrails™ Syringe Pump

Advanced User Workshop Manual - Paediatric Applications • Verify all parameters • Start the infusion • Activate rate lock (if configured) Pressure Monitoring: • Wait a short time for the pressure to stabilise • Select the PRESSURE button • Adjust the downstream occlusion pressure alarm limit either by pressing the AUTO softkey or manually, using the chevron keys Scenario 2 Emma’s condition has deteriorated and the doctor has increased her medication further to ... This will exceed the upper soft limit. Instructions to participant: Please change the dose according to the prescription and the doctor’s instructions. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled, place pump ON HOLD • Enter the new dose rate • Start infusion/confirm new rate by pressing the RUN button • Note advisory on screen: DOSE WOULD EXCEED XX. OVERRIDE LIMIT? • Confirm required dose with prescription and/or doctor • Press YES to override limit • Note upwards pointing arrows at top of screen denoting drug infusing above soft limit Or • Press NO and adjust dose to below upper soft limit • Activate rate lock (if configured) • Review pressure and adjust occlusion alarm level if required • Report action to doctor Scenario 3 Emma’s condition continues to deteriorate and the doctor has asked you to increase the dose of the medication further to ... ... This dose exceeds the hard limit. Instructions to participant: Please change the dose according to the prescription and the doctor’s instructions. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled, place pump ON HOLD • Enter the new dose rate • Start infusion/confirm new rate by pressing the RUN button • Note alert and advisory on screen: DOSE NOT PERMITTED. DOSE LIMIT XX • Press QUIT softkey to cancel alert and return to previous dose • Activate rate lock (if configured) • Report hard limit exceeded to doctor

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Advanced User Workshop Manual - Paediatric Applications Scenario 4 Emma’s condition has improved and her medication has been weaned down. Instructions to participant: Please continue to wean Emma’s medication to ... This is below the lower soft limit. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled, place pump ON HOLD • Enter the new dose rate • Start infusion/confirm new rate by pressing the RUN button • Note advisory on screen: DOSE UNDER XX. OVERRIDE LIMIT? • Confirm required dose with prescription and/or doctor • Press YES to override limit • Note downwards pointing arrows at top of screen denoting drug infusing below soft limit Or • Press NO and adjust dose to above lower soft limit • Activate rate lock (if configured) • Review pressure and adjust occlusion alarm level if required • Report action to doctor

Workstation 4 Aim: For participant to demonstrate knowledge, understanding and clinically proficient practice for the set-up and use of the Alaris CC Plus Dosing Only facility. ™

Scenario 1 Jack is a 14 year old boy admitted to the respiratory ward with acute severe asthma. The prescription chart reads: (Drug)... (Concentration)... (Dosage)... Instructions to participant: Using the patient details above, please commence the infusion using the dosing only facility. Information/action required: • Prepare correct syringe brand and size • Prime extension set, massaging the pressure disc in the direction of flow to prevent ballooning and ensure air removal • Install syringe correctly • Insert the pressure disc into the pressure transducer holder • Power on, note pump self-test • Clear set up (if required) • Confirm profile (if required) or press NO and select profile from list • Select DOSING ONLY from list • Select dosing unit and OK to confirm • Select concentration amount and OK to confirm (use UNITS softkey to change concentration unit, if required) • Select total volume to be used and OK to confirm • Adjust weight and OK to confirm, if required • Press OK to confirm dosing information • Use the Purge function to take up the mechanical backlash/slack • Connect extension set to patients’ venous access device 0000CF04048 Issue 1

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Advanced User Workshop Manual - Paediatric Applications • Verify all parameters • Start the infusion • Activate rate lock (if configured) Pressure Monitoring: • Wait a short time for the pressure to stabilise • Select the PRESSURE button • Adjust the downstream occlusion pressure alarm limit either by pressing the AUTO softkey or manually, using the chevron keys Scenario 2 Jack’s condition has changed. He requires an adjustment in his drug dose to ... Instructions to participant: Please change the dose according to the prescription and the doctor’s instructions. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled, place pump ON HOLD • Enter the new dose rate • Start infusion/confirm new rate by pressing the RUN button • Activate rate lock (if configured) • Review pressure and adjust occlusion alarm level if required

Workstation 5 Instructions to participant: Please locate/demonstrate and explain the following features: Information/action required: • Clear volume infused • Adjust infusion by ml/h or dose rate • Locate adjustable alarm volumes and set accordingly (if configured) • Locate 24 hour log • Explain the profile filter (if configured) • Explain the standby feature (if configured) • Explain the difference between red and amber alarm indicators

Workstation 6 Aim: For the participant to demonstrate knowledge of alarms, warnings and prompts and corrective action to be taken should they occur. Instructions to participant: Please state/demonstrate the cause and corrective action for the following alarms, warnings and prompts: Information/action required: • AC power fail • Add drug not complete • Attention (with “3 Beeps”) • Battery empty • Battery low 0000CF04048 Issue 1

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Alaris™ CC Plus Guardrails™ Syringe Pump

Advanced User Workshop Manual - Paediatric Applications • Bolus dose not permitted • Bolus dose over • Bolus dose under • Check syringe • Concentration not permitted • Dose not permitted • Dose under • Dose would exceed • Drive disengaged • End of infusion • Error code and message • Line occlusion • Near end of infusion • Occlusion • Pressure disc out • Rate not permitted • VTBI done • Weight outside limit

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Advanced User Workshop Manual - Neonatal Applications

Neonatal Applications IMPORTANT: You must ensure that you read all the relevant literature before undertaking the training programme. The pump must not be operated until the Directions For Use and other associated documents have been read and understood.

Workstation 1 Aim 1: For participant to demonstrate proficiency in the safe set-up of the infusion pump. Instructions to participant: Please prepare the pump for use, ensuring all safety checks are made. Information/action required: • Observe the pump casing and cables are intact • Check the pump is clean • Check the pump is within its service interval • Attach the pump to the AC power supply, or docking station, ensuring a safe and secure environment • Listen for audible click when attaching to docking station • Switch pump on and observe for self-test Aim 2: For participant to demonstrate knowledge and understanding of the controls and indicators displayed on the front panel. Instructions to participant: Please verbally identify the keys and indicators displayed on the front panel. Information/action required: • Identify all indicators and controls correctly

Workstation 2 Aim 1: For participant to demonstrate proficiency in the use of the infusion pump in a clinical situation. Scenario 1 Emily Rogers is a 750 gram, premature baby. She requires a morphine infusion whilst being ventilated. Initial prescription chart reads: Make up morphine in 50mls of 5% dextrose, commence at 0.50 ml/h Instructions to participant: Please start this infusion. Information/action required: • Prepare correct syringe brand and size • Prime extension set, massaging the pressure disc in the direction of flow to prevent ballooning and ensure air removal • Ensure Syringe is installed correctly • Insert the pressure disc into the pressure transducer holder • Power pump on, note pump self-test • Clear set up if required • Confirm profile if required or press NO and select profile from list • Select ML/HR if required • Set rate of 0.50ml/h • Use the Purge function to take up the mechanical backlash/ slack 0000CF04048 Issue 1

• Connect extension set to patients’ venous access device • Verify all settings • Start the infusion • Activate rate lock (if configured) Pressure Monitoring: Please check the pressure display reading: • Wait a short time for pressure to stabilise • Select the PRESSURE button • Adjust the downstream occlusion pressure alarm limit either by pressing the AUTO softkey or manually, using the chevron keys

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Alaris™ CC Plus Guardrails™ Syringe Pump

Advanced User Workshop Manual - Neonatal Applications

Scenario 2 Emily is breathing against the ventilator, which may result in a pneumothorax. She requires additional morphine. Treatment now prescribed is: A bolus infusion of 0.50 ml morphine stat and then adjust infusion to 1.00ml/h Instructions to participant: Please administer the prescribed bolus and change the maintenance rate accordingly. Information/action required: • Unlock rate (if required) • State the pump is not on hold • Administer bolus infusion of 0.50 ml • Note the volume added to volume infused • Put the pump on hold (if titration is not enabled) • Change the infusion rate to 1.00 ml/h • Restart the infusion • Record on fluid/drug chart • Activate rate lock (if configured) • Review pumping pressure and adjust occlusion alarm level if required • Note bolus logged in event log Scenario 3 Emily’s condition deteriorates. She requires Human Albumin Solution (H.A.S.) for poor perfusion. Prescription reads 8ml of H.A.S. over 20 minutes. Using an additional pump, start infusion. Instructions to participant: Please set a VTBI of 8.00 ml over 20 minutes. Information/action required: • Prepare correct syringe brand and size • Prime extension set, massaging the pressure disc in the direction of flow to prevent ballooning and ensure air removal • Install syringe correctly • Insert the pressure disc into the pressure transducer holder • Power on, note pump self-test • Select OPTIONS button and highlight VTBI over time • Press OK softkey • Set a VTBI of 8.00 mls, press OK to continue • Set a time of 20 minutes, press OK to continue • Select appropriate end rate action, press OK • Use the Purge function to take up the mechanical backlash/slack • Connect extension set to patients’ venous access device • Verify all settings • Press RUN button to infuse • Activate rate lock (if configured) • Observe VTBI now displayed on display panel Pressure Monitoring: • Wait a short time for the pressure to stabilise • Select the PRESSURE button • Adjust the downstream occlusion pressure alarm limit either by pressing the AUTO softkey or manually, using the chevron keys

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Advanced User Workshop Manual - Neonatal Applications

Scenario 4 Add the drug name to the pump (if enabled). Instructions to participant: Add a drug name to the pump. Information/action required: • Unlock rate (if required) • Press OPTIONS button • Select ADD drug • Follow prompts on screen • Observe drug name now on screen Or • Place the pump on hold • Press OPTIONS button • Select infusion set up • Select drugs (A-Z) • Select the drugs alphabetical row from list • Press OK to confirm • Follow prompts on screen • Observe drug name now on screen • Start infusion • Activate rate lock (if configured) Scenario 5 Emily’s H.A.S. infusion is now complete. Instructions to participant: Please discontinue this infusion, and describe the cleaning and storage procedures to be carried out. Information/action required: • Stop infusion • Isolate line from patient • Note volume infused • Turn pump off • Disconnect extension set from the patient according to unit/hospital policy • Remove syringe and pressure disc from pressure tranducer • Remove from AC power (or docking station if used) • Describe the cleaning and storage procedures • Plug into AC power to recharge battery

Workstation 3 Aim: For participant to demonstrate knowledge, understanding and clinically proficient practice for the set-up and use of the Alaris CC Plus Guardrails Dose Error Reduction Software. ™

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Scenario 1 A 3.2 kg neonate has been admitted and needs an inotrope infusion commencing. The prescription chart reads: (Drug)... Concentration)... (Dosage)...

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Advanced User Workshop Manual - Neonatal Applications

Instructions to participant: Using the patient details above, please commence the inotrope infusion using Guardrails™ Dose Error Reduction Software. Information/action required: • Prepare correct syringe brand and size • Prime extension set, massaging the pressure disc in the direction of flow to prevent ballooning and ensure air removal • Install syringe correctly • Insert the pressure disc into the pressure transducer holder • Power on, note pump self-test • Clear set up (if required) • Confirm profile (if required) or press NO and select profile from list • Select alphabetical group according to drug name, select drug, press OK • Select concentration, modify if required/permitted • Enter patient weight (if required) • Confirm set up including dosing parameter • Confirm default dose and adjust if required • Use the Purge function to take up the mechanical backlash/slack • Connect extension set to patients’ venous access device • Verify all parameters • Start the infusion • Activate rate lock (if configured) Pressure Monitoring: • Wait a short time for the pressure to stabilise • Select the PRESSURE button • Adjust the downstream occlusion pressure alarm limit either by pressing the AUTO softkey or manually, using the chevron keys Scenario 2 Baby’s inotrope requirements have changed. Please adjust the inotrope rate to ... This will exceed the upper soft limit. Instructions to participant: Please adjust the rate accordingly. Information/action required: • Unlock rate (if required) • If TITRATE enabled, do not place pump ON HOLD • If TITRATE not enabled, place pump ON HOLD • Enter the new rate • Start infusion/confirm new rate by pressing the RUN button • Note advisory on screen: DOSE WOULD EXCEED XX. OVERRIDE LIMIT? • Confirm required dose with prescription and/or doctor • Press YES to override limit • Note upwards pointing arrows at top of screen denoting drug/fluid infusing above soft limit Or • Press NO and adjust dose to below upper soft limit • Activate rate lock (if configured) • Review pressure and adjust occlusion alarm level if required • Report action to doctor

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