Benefits and Risks of Using Smart Pumps to Reduce Medication Error Rates: A Systematic Review

Abstract

The literature suggests that smart pumps reduce but do not eliminate programming errors. Although the hard limits of a drug library play a main role in intercepting medication errors, soft limits were still not as effective as hard limits because of high override rates. Compliance in using smart pumps is key towards effectively preventing errors. Opportunities for improvement include upgrading drug libraries, developing standardized drug libraries, decreasing the number of unnecessary warnings, and developing stronger approaches to minimize workarounds. Also, as with other clinical information systems, smart pumps should be implemented with the idea of using continuous quality improvement processes to iteratively improve their use.

A Security Analysis of Cyber-Physical Systems Architecture for Healthcare

“…Recent hardware revisions have augmented devices to include medication libraries that, in addition to drug names, include both soft and hard dosage limits. [21]. Drug libraries are typically custom loaded for the area of a hospital in which the device is being used.…”

“…Studies have mentioned that while these drug libraries do help catch many potential problems, there are still sources of errors that have not been fully addressed [23]. These included clinicians overriding soft and hard limits [21] and facilities setting soft warning levels too strictly or incorrectly. In some cases this led to "alert fatigue" on the part of the nurses [24].…”

“…In some cases this led to "alert fatigue" on the part of the nurses [24]. Drug libraries were also found to be of little use when dispensing experimental drugs or in uncommon methods for rare diseases [21]. An additional augmentation in newer pumps is the inclusion of a barcode scanner.…”

“…An additional augmentation in newer pumps is the inclusion of a barcode scanner. Barcode scanning is being used to cross check prescriptions [21], but additional uses of the technology such as augmenting clinician authentication have not been addressed as of yet.…”

Evaluation of an intravenous preparation information system for improving the reconstitution and dilution process

“…Therefore, our findings need to be confirmed in multiple hospital settings, to enable generalization, and more studies of IPISs are needed. In most countries where IV preparation errors were reported, ready-to-use IV bags, eMARs, and smart pumps with bar codes are not in common use yet [12,13,[22][23][24][25][48][49][50][51][52][53][54]. However, these systems will likely be implemented in the future.…”