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 ââ¬â GENERAL INFORMATION
A.1 INTRODUCTION ââ¬â 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:
ââ¬Â¢ Increased risk of nosocomial infection
ââ¬Â¢ Impaired immune system
ââ¬Â¢ Delayed wound healing
ââ¬Â¢ Volume depletion
ââ¬Â¢ Increased risk of death and impairment post-stroke in non-diabetic patients
A.2 BACKGROUND ââ¬â 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 ââ°Â¥9%
Surgical cases identified that would benefit from ICU tight blood glucose control:
ââ¬Â¢ CT Surgery
ââ¬Â¢ Coronary Artery Bypass
ââ¬Â¢ Valvular Replacement/Repair
ââ¬Â¢ Lung Resection / Thoracotomy
ââ¬Â¢ Heart transplantation
o Vascular Surgery
ââ¬Â¢ Abdominal Aortic Aneurysm Repair
ââ¬Â¢ Aortobifemoral Bypass
ââ¬Â¢ Lower Extremity Arterial Bypass
o General Surgery
ââ¬Â¢ Liver Resection
ââ¬Â¢ Pancreatic Resection
ââ¬Â¢ Biliary / Intestinal Bypass
ââ¬Â¢ Necrotizing Fascitis
ââ¬Â¢ Major Visceral Resection to include gastric, duodenum, small intestine, colon
ââ¬Â¢ Any inflammatory bowel disease patient undergoing resection
o ENT
ââ¬Â¢ Radical Neck Dissection
ïâ§ Urology
ââ¬Â¢ Radical Prostatectomy
ââ¬Â¢ Nephrectomy
ââ¬Â¢ Cystectomy with or without Ileoconduit
o Other
ââ¬Â¢ Patients with Sepsis
ââ¬Â¢ Acute Pancreatitis
ââ¬Â¢ Morbid Obesity (BMI > 40)
ââ¬Â¢ 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:
ïâ§ Severe sepsis, with or without shock
ïâ§ 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 ââ¬â 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 ââ¬â SUPPORTING INFORMATION
C.1 Place of Performance ââ¬â EndoTool involves the Nurses, IT staff, and pharmacy. The actual performance of the software is in the specialty units.
C.2 Period of Performance ââ¬â 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 ââ¬â If it is contraindicated according to the physician.
C.3.1 Contractor Furnished Materials ââ¬â 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 ââ¬âIt is installed on the bedside monitors
C.3.3 Qualifications of Key Personnel ââ¬âRegistered Nurses that are assigned to the Specialty units and trained on the use of the EndoTool.
C.3.4 Security Requirements ââ¬â 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]
Bid Protests Not Available