Medication Errors Reduced with Smart-Pump Infusion

Abstract

Source: Larsen GY, Parker HB, Cash J, et al. Standard drug concentrations and smart-pump technology reduce continuous medications-infusion errors in pediatric patients. Pediatrics. 2005;116:e21–e25.Authors from Primary Children’s Medical Center, Salt Lake City, Utah, combined implementation of standard drug concentrations and “smart-pump” technology to reduce continuous medication infusion error rates. The authors developed standard concentrations for the 32 medications that comprise approximately 95% of all medications commonly delivered by intravenous continuous infusions. Depending on the medication, from 1 to 4 concentrations were needed to meet most pediatric patient needs. Next, a multidisciplinary task force (staff from nursing, pharmacy, clinical engineering, and the neonatal and pediatric intensive care units [NICU and PICU]) met with a hospital patient safety manager to develop criteria to select a “smart” syringe pump. Once the pump was selected, the drug library dosing ranges were modified to avoid 10-fold overdoses. Finally, the pharmacy generated label changes to facilitate the correct transfer of information from the label to the smart-pump during programming by the provider. Hospital implementation was accomplished in 1 week.The authors analyzed the number of errors reported to the hospital incident reporting system in the year before changing to smart-pumps (2002) compared to the year after (2003). After the switch to smart pumps, 87% of the continuous medication in the NICU and 99% in other areas of the hospital used the standard concentrations. Errors reported with continuous medication infusions decreased by 73% hospital-wide. The rate decreased from 3.1 to 0.8 per 1000 doses (P<.001). Pharmacy preparation errors decreased from 0.66 to 0.16 per 1000 doses, and the number of 10-fold errors decreased from 0.41 to 0.08 per 1000 doses. During the 2 years of the study, the hospital-wide event-reporting rate did not change overall.Dr. Bratton has disclosed no financial relationships relevant to this commentary.Recent reports by the Institute of Medicine (IOM),1–3 the Institute for Health Care Improvement,4 and the Agency for Healthcare Research and Quality (AHRQ)5 have highlighted medical errors and frequent gaps in patient safety. High-acuity, error-prone departments, such as ICUs, require focused quality efforts because patients receive many interventions that may be error-prone.This report is an excellent example of a well-coordinated plan to improve safety. Strategic planning occurred with input from patient care staff. Implementation involved cooperative effort with support from the many groups using the ICUs. The hospital had a stable system to assess the efficacy of the interventions.The IOM and Leapfrog group have advocated increased use of technology to decrease errors with “forced” checks within the system. Smart-pumps are a new and exciting technology for increasing the safety of infusion delivery. The devices incorporate sophisticated computer technologies for storing drug information (ie, drug library), making calculations, and checking entered information against dosing parameters.6 These features offer a ready safety net for nurses to check medication orders.System factors are any elements or factors that influence health care delivery in a health care setting. System factors can be categorized as patient, task, provider, team, ICU environment, and institutional environment. Human factors were evaluated and optimized through simple steps to streamline and coordinate pharmacy labels with steps needed to program the pump.Finally, the authors found that most infusions in a children’s hospital can be delivered using standard concentrations. Some have argued that excessive volumes of fluid will be delivered to small patients; however, the authors reported that, over time, rates of acceptance for the standard concentrations increased in the NICU.