The VA intends to negotiate on a sole source basis with Hospira to provide Renewal of Software License Agreement VA Tennessee Valley Healthcare Murfreesboro and Nashville. This request is sole source in accordance with FAR 6.302-2 as unusual and compelling urgency. This is a Patient Care Intensive Care Unit Area, high risk and for standardization. Equipment has been installed in Medical Center and has been used for some time. Research has been completed searching for equipment to meet these standards. No phone requests will be honored. Interested parties may submit a proposal which will be considered by the agency. Responses due by 05/17/2010. -Please specify if pricing is GSA or Open Market. -For Open Market items, indicate by line item otherwise all items will be considered as under contract. -Must provide Contract Number and Expiration Date. -Include any shipping costs that may apply, specify Origin or Destination -Must be Brand Name or Equal. -Preference: will be IAW FAR Part 13.003 (b)(1). --------------------------------------------------------------------------------------------------------------------- ITEM NO. DESCRIPTION QITY UNIT OR STOCK NO. --------------------------------------------------------------------------------------------------------------------- SERVICE: 1006-0008-1Y 1 Renewal of Software License Agreement for Endotool Insulin Therapy Glucose Management software for SICU and MICU at the Nashville campus of TVHS. Under October 19, 2006 EndoTool Software License and Use Agreement. CDB Version 1 JB DESCRIPTION/SPECIFICATION/WORK STATEMENT STATEMENT OF WORK PART A – GENERAL INFORMATION A.1 INTRODUCTION – Hyperglycemia is a common occurrence in veterans admitted to an intensive care unit at Tennessee Valley Healthcare System (TVHS). Tight control of glucose has been shown to be associated with reduced morbidity and mortality and improved outcomes for these patients. This clinical problem can occur in both diabetic and non-diabetic patients alike. Complications can include: • Increased risk of nosocomial infection • Impaired immune system • Delayed wound healing • Volume depletion • Increased risk of death and impairment post-stroke in non-diabetic patients A.2 BACKGROUND – Patients without diabetes admitted to MCCU or SICU, including but not limited to those with the diagnoses listed below, with an admitting blood glucose value or random Blood Glucose value of > 130 should be placed on the insulin protocol by physician order in CPRS, unless contraindicated. a. Patients without diabetes who have admission glucose <130 and one of the diagnoses listed below should have glucose monitored every shift and placed on the protocol if hyperglycemia occurs. b. Any patient admitted to the SICU or MCCU already on an intravenous insulin infusion should be placed on the protocol c. Any critically ill patient with a diagnosis of diabetes mellitus should go on the insulin protocol d. All patients with persistent hyperglycemia or any patient with diabetes mellitus should be converted to basal/bolus subcutaneous insulin prior to transfer from the ICU. NPH insulin is the preferred formulary basal insulin and should be used unless the patient was already on glargine insulin prior to admission. e. Use of short acting insulin "sliding scale" without basal insulin leads to very poor glucose control and is thus strongly discouraged in the SICU or MCCU f. All patients with a known diagnosis of diabetes mellitus should have a hemoglobin A1c obtained upon admission to the ICU, to facilitate transition to subcutaneous insulin and adjustment of diabetes medications after ICU discharge. Inpatient endocrine consultation should be strongly considered upon ICU discharge for any patient with an admission hemoglobin A1c ≥9% Surgical cases identified that would benefit from ICU tight blood glucose control: • CT Surgery • Coronary Artery Bypass • Valvular Replacement/Repair • Lung Resection / Thoracotomy • Heart transplantation o Vascular Surgery • Abdominal Aortic Aneurysm Repair • Aortobifemoral Bypass • Lower Extremity Arterial Bypass o General Surgery • Liver Resection • Pancreatic Resection • Biliary / Intestinal Bypass • Necrotizing Fascitis • Major Visceral Resection to include gastric, duodenum, small intestine, colon • Any inflammatory bowel disease patient undergoing resection o ENT • Radical Neck Dissection  Urology • Radical Prostatectomy • Nephrectomy • Cystectomy with or without Ileoconduit o Other • Patients with Sepsis • Acute Pancreatitis • Morbid Obesity (BMI > 40) • Critically ill neurosurgical patients (Note: glucose targets and dextrose infusion rates may need to be modified according to clinical judgement for patients with increased intracranial pressure and/or lowered seizure threshold). MCCU Guideline for tight glycemic control All patients who require critical care treatment in the MCCU will be considered candidates for the insulin protocol as ordered by the ICU physicians. Common diagnoses that will warrant such consideration in the MCCU include:  Severe sepsis, with or without shock  Respiratory failure Pancreatitis Stroke Myocardial Infarction Cardiogenic Shock Acute myocardial infarction Acute coronary syndrome in a patient with known diabetes mellitus or hyperglycemia on MCCU admission (BG persistently >180) All critically ill patients will be considered regardless of a prior known diagnosis of diabetes mellitus. Any serum glucose measurement of greater than 130 warrants consideration for tight glucose control with the decision to institute the intravenous insulin protocol dependant on the orders of the ICU physicians. Note- for patients with critical myocardial ischemia (i.e. unstable angina or critical left main or LAD disease) that are prone to angina at rest should be given a more conservative glucose target of 100-140 mg/dl to avoid hypoglycemia-induced angina. A.3 SCOPE OF WORK – Registered Nurses assigned to the Special Care Units and trained on the use of Endo Tool may titrate continuous insulin infusions according to dose calculator within outlined parameters. STATEMENT OF WORK PART C – SUPPORTING INFORMATION C.1 Place of Performance – EndoTool involves the Nurses, IT staff, and pharmacy. The actual performance of the software is in the specialty units. C.2 Period of Performance – All admission to the specialty units will be considered to be placed on EndoTool for tight glucose control. (please see answer under background) C.3 Special Considerations – If it is contraindicated according to the physician. C.3.1 Contractor Furnished Materials – EndoTool is a unique software system for managing glycemic control in your hospital. This FDA-cleared system will effectively control blood glucose levels, even in the most challenging patients. EndoTool is installed on your hospital's existing IT system. It is easy to use, needing only a current blood glucose level from a point-of-care device to compute the patient's correct insulin dose. EndoTool will prompt the nurse when the patient is glycemically stable, and is ready to be transferred over to subcutaneous insulin via patient-specific orders generated by EndoTool. C.3.2 Government Furnished Materials and Services –It is installed on the bedside monitors C.3.3 Qualifications of Key Personnel –Registered Nurses that are assigned to the Specialty units and trained on the use of the EndoTool. C.3.4 Security Requirements – The software is obtained via computer through individual passwords by each registered nurse in the specialty unit. The physician put the orders in to place and remove from the drip. /es/ Stacey Chumney Purchasing Agent VISN9 ASC Phone: 615-225-6956 Fax: 615-225-5431 Email: [email protected]

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