Continuous quality improvement using intelligent infusion pump data analysis

Abstract

Compliance rates for use of infusion pump safety software varied among CCAs over time. Education, auditing, and refinement of drug libraries led to improved compliance in most CCAs.

Organizational, Cultural, and Psychological Determinants of Smart Infusion Pump Work Arounds: A Study of 3 U.S. Health Systems

“…5,6,10 Case study and qualitative research evidences have begun to confirm what clinicians have long known: end users bypass safety features or inappropriately override alerts on smart pumps. 11,12 For example, in a qualitative study from 2007, McAlearney and colleagues 5 found that nurses responded to numerous practical challenges when using smart infusion pumps by deliberately improvising steps within the intravenous (IV) medication delivery process and bypassing various safety features. Such improvisations are often referred to as work arounds, which have been defined in the literature as "… informal, temporary practices for handling exceptions to the normal workflow."…”

“…14,15 Despite the widespread adoption of smart pump technology, its benefits have not been fully realized, and ensuring institutionwide compliance has proven challenging. 11,12 Health care professionals acknowledge that many of these challenges are not technical but instead organizational, cultural, and psychological in nature. 16 To date, much of the literature regarding smart pump use comes from engineering and clinical perspectives.…”

“…16 To date, much of the literature regarding smart pump use comes from engineering and clinical perspectives. 5,6,9,11 This research has provided invaluable insight into the technical aspects of smart pumps and nurses' perceptions of the technical issues that hinder compliance with safety regulations. However, despite anecdotal evidence and recognition that smart pump work arounds have many nontechnical causes, 16 very limited research has specifically endeavored to understand the organizational, cultural, and psychological factors that lead nurses to bypass and override the safety features on smart pumps.…”

Using Smart Pumps to Understand and Evaluate Clinician Practice Patterns to Ensure Patient Safety

“…This decreased error rate also has been associated with cost savings, workflow improvement, and legal risk reduction. [2][3][4] Through the use of IV infusion pumps equipped with safety software (''smart'' or ''intelligent'' infusion pumps), many high-risk medications can be administered safely. There is evidence that by integrating IV infusion pumps with institutional information systems (eg, electronic medical records, barcode point-of-care, and computerized physician order entry), evidence-based standards could be applied to patient care, thereby increasing patient safety.…”

“…[2][3][4]7 The Association for the Advancement of Medical Instrumentation (AAMI) has released a list of actions that hospitals can take to immediately improve medication infusion safety. These actions include ensuring that wireless capability is an essential requirement in purchasing decisions, maximizing the use of smart-pump features and capabilities, and analyzing and using the continuous quality improvement data generated by these infusion systems.…”