Implementing smart pumps for epidural infusions in an academic medical center

Abstract

A hospital's initial experience with the implementation of new smart-pump technology for epidural drug delivery is described, with a discussion of challenges and lessons learned during the implementation process. After a focused review of epidural medication use and prescribing patterns at the University of North Carolina Hospitals and Clinics (UNCH), a multidisciplinary team guided the selection of new smart pumps and the development of associated software tools. The new devices were programmed to display a "master drug library" of recommended drug concentrations, doses, and rates, which were consistent with newly created order sets intended to standardize prescriber ordering and nurse administration intended to help standardize prescriber ordering and nurse administration of adult and pediatric epidural infusions. However, data retrieved from the new units after several months of use indicated that nurses were still programming about 60% of epidural smart-pump infusions without using the onboard drug library (in effect circumventing the units' patient-safety software). In a survey of UNCH nursing staff, respondents indicated they were having difficulty in accessing the library and (when necessary) in manually programming the new devices. The hospital's experience highlighted a number of key points for institutions to consider during the implementation of new smart-pump technology. The implementation of new smart-pump technology for epidural infusions at UNCH revealed the importance of pump features and design in determining the devices' impact on patient safety. In particular, factors pertaining to ease of use (e.g., protocol-selection functions, programming procedures, data recording and retrieval capabilities) are crucial to the overall success of smart-pump implementation.