Background Lack of compliance with drug libraries among users of smart infusion pumps undermines the efforts to prevent intravenous medication errors. There are little data on drug library use in Australian clinical practice and the barriers to compliance and effective use remain uncertain. Aim To evaluate the use of a smart infusion pump's drug libraries and to identify barriers to effective drug library use. Method Prescription and programming details of the infusions administered via Alaris IV pumps at a health service were audited. Data were used to assess compliance with and use of the drug libraries. In the event of non‐compliance or incorrect use of a drug library, a consented interview was conducted with the nurse to identify barriers. Results Of the 86% (95%CI 83–89) of infusions administered via a drug library, 11% (95%CI 9.1–14) were programmed incorrectly. Interviews with nurses revealed several reasons for non‐compliance, e.g. difficulty in using smart infusion pump technology, composition of the drug library. Incorrect drug library use was mainly attributed to failure to check programming during change of nursing shift, change of clinical area or change to a new fluid bag. Conclusion Despite high compliance with correct drug library use, 11% of infusions were programmed incorrectly due to incorrect selection of a drug library or therapy or both. The interviews revealed concerns with understanding smart pump technology and deficiencies in routine checks of drug library programming.