Efficacy of Smart Infusion Pumps from a Nursing Perspective

In today’s healthcare, intravenous (IV) therapy-related errors have become rampant and are responsible for a substantial portion of hospital injuries and deaths. In the last decade, however, since the development and implementation of “smart” IV pumps, a significant number of these IV medication errors have allegedly been reduced. The purpose of this paper is to discuss research surrounding an evaluation of the efficacy of smart IV pumps from a nursing perspective

Contributing to a “culture of safety” by increasing usage of the drug library on smart infusion pumps: A Quality Improvement Project

Background: Computerized infusion devices called smart infusion pumps or smart pumps are clinical tools capable of decreasing IV medication infusion calculation errors through the use of embedded drug libraries. These devices are now important tools contributing to a “culture of safety” defined by the Joint Commission. Reports from April 2015 indicated a 22% occurrence rate in which the devices were not correctly programmed before infusion. AIM Statement: The global aim of this quality improvement project was to improve usage of the IV pump drug library by ensuring medication is correctly labeled before infusion. The specific aim was to increase the IV pump drug library usage from 78% to 90% by July 24, 2015. Method: Kurt Lewin’s Change Theory was used as the theoretical framework to guide the project and usage of the IV pump drug library on a 30 bed surgical unit. A pre- intervention Likert style survey was conducted to identify barriers to library usage, determine level of confidence with the library, and understand nurses’ ability to find a medication in the library. Meetings with the Unit Practice Council (UPC) and educational huddles were conducted to discuss correct usage of the drug library. Based on pharmacy reports, the menu of drugs displayed in the pump was changed to reflect the top ten most frequently used medications. Post-intervention pharmacy reports were compared to baseline. Results: Data from the pre-intervention survey and staff meetings indicated a knowledge deficit in correct usage of the IV pump drug library and perceptions of time constraints and inability to find medication as barriers to its usage. Data post “pump push” indicated the usage of the drug library was 84.2%. Conclusions: Implementation of educational huddles and a “pump push” was anticipated to increase the percentage of IV pump drug library usage. Implications for the role of the Clinical Nurse Leader (CNL) are explored and discussed

Intravenous Smart Pumps During Actual Clinical Use: A Descriptive Comparison of Primary and Secondary Infusion Practices

This descriptive observational study was conducted to increase understanding of medication administration practices during actual clinical use between 2 commonly used, different types of intravenous (IV) smart pumps. Compliance with manufacturer-recommended setup requirements for both primary and secondary infusions and secondary medication administration delay was compared between a head-height differential system and a cassette system. A total of 301 medication administration observations were included in this study: 102 (34%) for the linear peristaltic IV smart pump (medical–surgical: N = 51; critical care: N = 51) and 199 (66%) for the cassette pump (medical–surgical: N = 88; critical care: N = 111). Results found a 0% compliance for primary line setup and 84% compliance for secondary line setup and 1 omitted medication due to a closed clamp with the linear peristaltic system. For the cassette system, there are no head-height requirements. Two roller clamps were found to be in the closed position on initiation of the secondary infusion, but the clinician was alerted by an alarm, so no medication delays occurred. These findings support that the current system requirements for flow rate accuracy using head-height differential systems are difficult to achieve consistently at the point of care. There is a need for additional human factor designed technology to replace manual actions to improve the process of care for nurses and the safety of care for patients

Actionable Patient Safety Solution (APSS) #3D: Pediatric Adverse Drug Events

This report presents a plan of action for introducing a program to reduce the incidence of pediatric adverse drug events (pADEs) and harm ... [that] combine[s] leadership strategies, software (healthcare IT), hardware (drug compounding systems, drug delivery technology, and physiological monitoring systems), and most importantly people (changes in clinical practice, protocols and education) to protect pediatric patients

Quality Improvement of the Extended Antibiotic Infusion Administration Process

Dynamic issues associated with infection create unprecedented demands for quality healthcare improvements and modifications. Researchers found extended antibiotic infusions to be an effective treatment option with significant clinical benefits to patients and astounding cost savings. This scholarly project identified the emergence of several clinical issues threatening to undermine the intended patient responses to extended antibiotic infusion therapy in one large hospital system. Problem: Unrecognized infusion delays and short infusion durations created the need for an educational pilot initiative to improve the administration process of piperacillin/tazobactam on one nursing unit. Intervention: Nurses on the pilot unit received instruction regarding the pharmacodynamics of time-dependent antibiotics and the infusion management of dead space volumes. Random infusions were monitored post instruction for consistency and accuracy. Results: Of the 73 nurses who were emailed a self-instruction module, a total of 30 (41%) nurses submitted an attestation for completing the instruction. Each nurse completing the instruction responded 100% correctly to all five post-test questions (150 questions/150 correct). Of the randomly observed post-instruction infusions, 17 of 29 pumps (59%) were programmed to infuse according to the instruction. Infusions programmed for 100% of the duration ordered increased from zero to 59% post instruction. The difference in minimum inhibitory concentration (MIC) pre and post instruction demonstrated a 72% improvement in the therapeutic duration delivery of piperacillin/tazobactam. Conclusion: The educational intervention, designed to redefine the beginning of the extended antibiotic infusion, was recommended as a sustainable solution to this practice problem

A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations

Parenteral nutrition (PN) serves as an important therapeutic modality that is used in adults, children, and infants for a variety of indications. The appropriate use of this complex therapy aims to maximize clinical benefit while minimizing the potential risks for adverse events. Complications can occur as a result of the therapy and as the result of the PN process. These consensus recommendations are based on practices that are generally accepted to minimize errors with PN therapy, categorized in the areas of PN prescribing, order review and verification, compounding, and administration. These recommendations should be used in conjunction with other A.S.P.E.N. publications, and researchers should consider studying the questions brought forth in this document

Provider issues related to patient controlled analgesia and nurse controlled analgesia errors in a pediatric hospital

Background: Medical errors are a danger to patient safety and a significant cause of morbidity and mortality. Additionally, they increase expenditures in an already significantly indebted U.S. health care system. Much confusion exists about definitions of medical errors, which include medication errors and adverse drug events (ADEs). Several federal and international organizations have attempted to standardize definitions in order to streamline data collection, but until these standards are universally adopted, error reports and trends are still subject to questions of validity. Reporting errors, in general, has become a more socially acceptable practice in health care with the advent of several anonymous reporting databases. There have also been several initiatives aimed at reducing the incidence of errors, which range from national programs to intrafacility guidelines. Several pieces of health information technology (HIT) have made an impact on error incidence and data collection, although there is much room for improvement. Patient controlled analgesia (PCA) pumps for pain management have been in existence for decades, and "smart pump" software has improved their safety and ease of programming. PCA use in children presents challenges to clinicians, and the characteristics of providers who write PCA orders and those who program PCA pumps may play a role in the incidence of events related to PCA. This study seeks to elucidate trends in errors as they related to these different PCA providers in a pediatric hospital in the northeastern U.S. and provide recommendations for how PCA practice can be improved in this facility. Methods: Safety Event Reporting System (SERS) reports of PCA events (n = 117) during the period of 2004 - 2012 were analyzed retrospectively to determine several key variables for data analysis. The main focus of this analysis was those variable trends related to providers, including: proportion of events caused by human error, proportion of events related to subcategories of human error, proportion of types of prescribers involved in PCA events, proportion of errors in medical and surgical patients, proportion of errors occurring on day and night shifts for the nursing staff, and proportion of events that were dosing mistakes. Statistical analysis was performed for these results when possible to determine significance. Results: Human errors were implicated in 84.1% of events, whereas PCA pump mechanical errors and software errors were implicated in 7.1% and 7.9% of events, respectively. Statistically significant differences were found in all variables tested, including the proportion of nursing errors (60.9%) versus prescriber errors (28.7%) (p < 0.0002). For types of prescribers, the proportion of PCA events occurring when a M.D. wrote the PCA order (56.41%) was statistically different than when a N.P. wrote the PCA order (39.32%) (p = 0.0129). More surgical patients (61.5%) were affected by PCA events than medical patients (36.8%) (p < 0.0002). There were more events occurring on the nursing staff day shift (59.8%) than the night shift (36.8%) (p = 0.0004). Finally, dosing mistakes (66.7%) were implicated in significantly more PCA events than any other error type (33.3%) (p < 0.0002). Conclusion: Several recommendations for improving the safety of PCA in pediatric pain management are justified by the results of this data analysis. First, further education and simulation for entering PCA orders into the CPOE system is needed for all prescribers. Secondly, further education and simulation in PCA pump programming and system set-up is needed for all nursing staff members. In regard to prescriber credentials, it is recommended that Pain Treatment Service (PTS) staff members train M.D. residents in writing PCA orders and entering them into the CPOE system. Finally, it is recommended that the SERS management team publish standardized error report content and entry format in order to streamline data analysis for quality improvement (QI) purposes

The Impact of Using Smart Infusion Pumps among Nursing Practice

The most prevalent cause of medical injuries is medication errors especially when patients take multiple medications at the same period of time with different doses. One of the technologies that have been developed to improve patient outcomes is the smart infusion pump, which has the ability to identify several programming problems when applied correctly. However, based on existing use, there are contradictory reports on smart pumps' potential to avoid patients' harm in the absence of other features, as well as deliver professional care to patients. This study aimed to understand the experience of nurses when performing smart infusion pumps in their practice, the influence of this technology on their confidence, and how much this technology is trusted to rely on to prevent medical errors. Previous studies focused entirely on longitudinal and quantitative studies, which take a long time and cost a lot. A qualitative study collected from an online survey that contained three types of questions: open-ended questions, closed-ended questions, and rating questions to evaluate participants' answers about smart infusion pumps among their practices in Saudi Arabia hospitals, a survey targeting nursing staff and we got 30 replies. The outcomes have revealed a significant impact of smart infusion pumps on nursing practice

Information Overload: Auditing the Clinical Utility of Smart Pump Reporting Tools

Purpose: Smart pump technology provides detailed information about each infused drug and fluid that can be used to examine trends and assist in data set optimization. When smart pumps interface with the electronic health record through interoperability, additional data are available. Methods: The primary outcomes of this study were to identify the top 10 drugs implicated in smart pump near miss events and to reduce the number of near miss events related to smart pump programming. Interoperability data from April 2017 to October 2017 were assessed for near miss trends. Potential interventions for the top 10 drugs were compared using a risk matrix. Secondary outcomes measured the number of data sets circulating prior to each data set update and the duration of time taken for 80% of pumps to accept the most recent data set. Results: A total of 291,503 infusions were included in the preliminary analysis. There was a low frequency of near miss events, with 4,440 alerts (1.5%) comprising the top 10 drugs. An evaluation of the number of circulating data sets prior to each bimonthly update demonstrated that 98.87% to 100% of pumps in active circulation were using the most recent data set. The time for 80% of smart pumps in active circulation to accept the newest data set was between day 0 and day 1 following the data set update. Conclusion: Interoperability data is not ideal for continual monitoring of smart pump metrics but can be useful for identification of workflow optimization opportunities