CHPPC Module 31, Section 1.4: When to Call Biomed vs Anesthesia vs Nursing
MODULE 31: SMART PUMPS & PRACTICAL TROUBLESHOOTING

Section 31.4: When to Call Biomed vs. Anesthesia vs. Nursing; What to Say

A masterclass in rapid triage, effective communication, and navigating the complex web of support for infusion-related problems.

SECTION 31.4

The Troubleshooter’s Triage: Directing the Right Response

From pharmacist-as-verifier to pharmacist-as-dispatcher: routing issues to the correct expert.

31.4.1 Your Expanding Role: From Medication Expert to Systems diagnostician

Up to this point in your hospital pharmacy journey, your role in infusion safety has been largely proactive: verifying orders, building robust pump libraries, ensuring correct preparation and labeling. You have been the architect and the quality inspector, designing safety into the system from the very beginning. But there comes a point in every pharmacist’s shift when the role dramatically shifts from proactive to reactive. A pump starts alarming. An infusion stops unexpectedly. A patient on an epidural suddenly can’t feel their legs. A nurse calls you with a frantic question that is not in any textbook.

In these moments, you are no longer just a pharmacist. You become a clinical systems diagnostician and a communications hub. The nurse calls you first for a simple reason: you are the perceived owner of “all things medication-related.” While the problem at hand may have nothing to do with the drug itself, you are the most accessible and trusted expert available in the moment. Your ability to rapidly triage the situation, identify the likely domain of the problem (Is it the drug? The patient? The pump? The catheter?), and direct the nurse to the correct resource is a critical, advanced skill. A calm, knowledgeable pharmacist who can provide a clear algorithm for troubleshooting can de-escalate a stressful situation and accelerate the path to a safe resolution. A flustered pharmacist who simply says, “That’s not a pharmacy problem,” creates frustration, delays care, and damages interprofessional relationships.

This section is your masterclass in troubleshooting and triage. We will arm you with the mental models to quickly categorize a problem and the communication scripts to effectively engage the three most common partners you will need to call upon: Biomedical Engineering (for pump hardware/software issues), Anesthesia/Pain Service (for clinical issues with epidurals and complex PCAs), and Nursing Leadership/Education (for user-related or workflow issues). Mastering this skill will transform you from a valuable clinical resource into an indispensable system-level problem solver.

Retail Pharmacist Analogy: The Insurance Help Desk Expert

Think about your role as the ultimate insurance troubleshooter in the retail world. A patient comes to your counter with a new prescription for a non-formulary medication. The claim rejects. The patient is anxious, the technician is stuck, and the workflow grinds to a halt.

You don’t just tell the technician, “It rejected.” You have developed a sophisticated triage algorithm in your head. You look at the rejection message.

  • If it says “Refill Too Soon,” you know this is a patient-level problem. Your script is: “It looks like you may have gotten a partial fill of this at another pharmacy. Do you recall that? Let me see if we can call them and consolidate the prescription.”
  • If it says “Prior Authorization Required,” you know this is a prescriber-level problem. Your script is: “This medication requires special approval from your doctor’s office. We will send a request to them electronically right now, and we will call you as soon as we hear back from them.”
  • If it says “Invalid Cardholder ID,” you know this is a plan-level problem. Your script is: “It seems the ID number we have on file might be outdated. Do you have your most recent insurance card with you so we can update it?”
  • If it’s a complex, nonsensical rejection, you know it’s time to call the expert resource—the insurance plan’s pharmacy help desk. You know what to say: “I’m a pharmacist calling about member [ID#]. I’m getting a rejection code of 72 with a host message of ‘Plan Limits Exceeded,’ but this is a new prescription. Can you please look at the patient’s accumulator data and tell me what you’re seeing on your end?”

You have become a master at diagnosing the root cause of the rejection and routing the problem to the right person with the right script. Hospital infusion troubleshooting is the exact same skill, just with a different set of problems (alarms instead of rejections) and a different set of experts (Biomed instead of the help desk).

31.4.2 The First Question: Is the Patient Safe?

Before you begin any diagnostic process, your first thought and your first question must always be about immediate patient safety. A beeping pump is an annoyance; a patient who is not breathing is a catastrophe. When a nurse calls you with a pump problem, you must resist the urge to immediately dive into the technical details. Your first responsibility is to perform a rapid clinical assessment by proxy.

The Golden Question Protocol

When a nurse calls about an alarming or malfunctioning pump, especially one infusing a high-risk medication (opioids, insulin, vasopressors, anticoagulants), your first two questions must always be:

Pharmacist: “Okay, before we troubleshoot the pump, tell me: How does the patient look?“

Pharmacist: “What are their most recent vitals? Specifically, what is their heart rate, respiratory rate, and blood pressure / sedation level?”

These two questions immediately re-center the conversation on the patient. The answer to these questions determines the urgency of the entire situation. If the nurse says, “The patient is sleeping comfortably, respirations are 16, and vitals are stable,” you can proceed with methodical troubleshooting. If the nurse says, “He’s difficult to arouse and his respiratory rate is down to 6,” your response is not to troubleshoot the pump. Your response is: “Stop the infusion, call a rapid response, and I am on my way up.” You have just transitioned from a technician to a clinician. Never forget this critical first step.

31.4.3 The Triage Algorithm: Man, Machine, or Medicine?

Once you have established the patient is stable, you can begin your diagnostic algorithm. The goal is to quickly determine the most likely source of the problem. Nearly every infusion-related issue can be traced back to one of three domains: the User (Man), the Pump (Machine), or the Patient/Drug (Medicine). By asking a few targeted questions, you can rapidly narrow down the possibilities.

Masterclass Flowchart: The Pharmacist’s Pump Triage Algorithm
Nurse Calls with Pump Alarm/Issue
Step 1: Assess Patient Safety
“How does the patient look? What are their vitals?”
Unstable? STOP INFUSION, CALL RRT
Stable?
Step 2: Gather Data – “Read Me the Screen”
“What exactly does the alarm message say on the screen?”
“Occlusion Downstream” / “Air-in-Line” / “Door Open”
Likely Cause: The Line/Setup (User Error)

Issue is with the physical setup.

ACTION: Guide Nursing
“Have you checked the line for kinks? Is the clamp open? Is the patient lying on the tubing? Let’s try flushing the line.”
“Channel Malfunction” / “Error Code [XXX]” / “Pump Failure” / Blank Screen
Likely Cause: The Hardware/Software (Machine Error)

Issue is with the device itself.

ACTION: Call Biomed
“That sounds like a pump failure. Take the pump out of service, label it, and call Biomed. Get a new pump for the patient.”
“PCA Lockout” / “Dose Limit” / Patient has new numbness/weakness (Epidural)
Likely Cause: The Programming/Patient (Clinical Issue)

Issue is with the order or patient’s clinical response.

ACTION: Call Anesthesia/Pain
“This sounds like a clinical issue with the epidural catheter or the PCA programming. You need to page the Anesthesia resident on call for this.”

31.4.4 The Communication Scripts: What to Say and Who to Say It To

Once you have triaged the problem, your next job is to provide the nurse with a clear, concise, and actionable script for communicating with the appropriate service. This empowers the nurse and ensures that the expert on the other end of the phone gets the exact information they need to act. Your goal is to facilitate a “SBAR” (Situation, Background, Assessment, Recommendation) handoff, even if you are not the one making the call directly.

Masterclass Table: The Pharmacist’s Communication Playbook
Who to Call When to Call Them (The Trigger) The Script You Provide to the Nurse
Nursing (Charge Nurse or Educator) The issue is clearly related to user action, workflow, or a knowledge gap. Examples: repeated “occlusion” or “air-in-line” alarms that are not due to a bad IV site; confusion about how to perform a secondary infusion; difficulty programming a dose that is clearly within the library limits.

Your Assessment: “This doesn’t sound like a pump or a drug problem; it sounds like a tricky setup issue.”

The Script: “I would suggest calling your charge nurse or the unit’s clinical educator to come to the room and provide a second set of eyes on the line setup and pump programming. They often have tricks for dealing with positional lines or complex infusions. Let me know if that doesn’t solve it.”

Why It Works: You are empowering nursing to solve their own practice-related issues, respecting their expertise in line management, and appropriately escalating within their own chain of command.
Biomedical Engineering The issue is clearly related to the physical device. Examples: The pump will not power on; the screen is blank or frozen; it is displaying a specific error code (e.g., “Channel Failure 123”); it has been dropped or has visible damage; it fails a self-test upon startup.

Your Assessment: “That error code means there’s an internal problem with the pump itself. We can’t fix that on the unit.”

The Script: “Here’s what we need to do. First, get a new pump and program it for this patient so there’s no delay in therapy. Second, take the broken pump, label it clearly with a description of what happened, and send it to Biomed. Here is their phone number [Have it handy!] to call and report the malfunction.”

Why It Works: You provide a clear, two-step action plan that prioritizes patient care (get a new pump) while also ensuring the broken device is handled properly so it can be fixed and not put back into circulation.
Anesthesia / Acute Pain Service The issue is clearly related to the patient’s clinical response to an epidural or a complex PCA. Examples: A patient with an epidural reports new, dense motor blockade (can’t move legs), a “one-sided” block, or a headache that is worse when sitting up. A PCA patient is having uncontrolled pain despite hitting the hourly limit. The pump is alarming “PCA Lockout” and the patient is still in agony.

Your Assessment: “The pump is working as programmed, but the patient is having a clinical problem that needs a specialist’s assessment. This is beyond a simple programming issue.”

The Script: “You need to page the on-call Anesthesia resident or the Acute Pain Service immediately. When you call, be ready with this information: ‘This is [Nurse Name] from [Unit]. I’m calling about the patient in room [Room #] with a [thoracic/lumbar] epidural. The patient is reporting new-onset, dense motor weakness in both legs. Vitals are stable. We need an urgent assessment.’ Be sure to have their full vitals and sedation score ready.”

Why It Works: You are providing a perfect SBAR handoff script. You’ve identified the service, the patient, the critical situation (“new motor weakness”), and the request (“urgent assessment”). This ensures the on-call provider understands the gravity and responds appropriately.