Direct Observational Study of Interfaced Smart-Pumps in Pediatric Intensive Care

Abstract

Background Processes for delivery of high-risk infusions in pediatric intensive care units (PICUs) are complex. Standard concentration infusions (SCIs), smart-pumps, and electronic prescribing are recommended medication error reduction strategies. Implementation rates in Europe lag behind those in the United States. Since 2012, the PICU of an Irish tertiary pediatric hospital has been using a smart-pump SCI library, interfaced with electronic infusion orders (Philips ICCA). The incidence of infusion errors is unknown. Objectives To determine the frequency, severity, and distribution of smart-pump infusion errors in PICUs. Methods Programmed infusions were directly observed at the bedside. Parameters were compared against medication orders and autodocumented infusion data. Identified deviations were categorized as medication errors or discrepancies. Error rates (%) were calculated as infusions with errors and errors per opportunities for error (OEs). Predefined definitions, multidisciplinary consensus and grading processes were employed. Results A total of 1,023 infusions for 175 patients were directly observed over 27 days between February and September 2017. The drug library accommodated 96.5% of infusions. Compliance with the drug library was 98.9%. A total of 133 infusions had ≥1 error (13.0%); a further 58 (5.7%) had ≥1 discrepancy. From a total of 4,997 OEs, 153 errors (3.1%) and 107 discrepancies (2.1%) were observed. Undocumented bolus doses were most commonly identified (n = 81); this was the only deviation in 36.1% (n = 69) of infusions. Programming errors were rare (0.32% OE). Errors were minor, with just one requiring minimal intervention to prevent harm. Conclusion The error rates identified are low compared with similar studies, highlighting the benefits of smart-pumps and autodocumented infusion data in PICUs. A range of quality improvement opportunities has been identified.

Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety

“…The organisation-wide standardised provision of infusions in ready-toadminister presentations in a large children's hospital led to the almost complete elimination of medication administration errors [25][26][27]. A similar project in Ireland demonstrated the feasibility of implementing smart pumps and standard concentration infusions in paediatric services using a single national drug library, with evidence of effectiveness [11,28,29]. However, the implementation of these interventions has required ongoing sponsorship and coordination at a system level and cannot be led or managed at a local level.…”

“…While the data exploring the benefits of smart pump use are largely equivocal, this may be at least partly related to low uptake of smart pumps across healthcare systems, as well as poor drug library design [3,40,41]. However it is clear that smart pumps have a potential role in all areas where injectable medicines are used, to provide support for adoption and administration of standard infusions safely and consistently [29,36], to offer opportunities for system-wide learning, and to protect patients [9,36]. Smart pumps are most likely to prevent the most catastrophic events, with little impact on the day-to-day discrepancies and deviations seen in large, well-powered observational studies.…”

Mapping Injection Order Messages to Health Level 7 Fast Healthcare Interoperability Resources to Collate Infusion Pump Data

“…We then verified whether the infusion pump settings could be matched with the injection order information. This was not a study of a "smart pump" [7][8][9][10][11] that automatically adjusts the drug speed and dosage; instead, we collected information from the infusion pump and used it for a injection order matching process. Although the linkage of data with smart pumps is innovative, it is not practical to obtain approval from the Japanese regulatory agency, the Pharmaceuticals and Medical Devices Agency.…”

Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings—A Narrative Review of Recent Evidence

“…10,15,27,100 A new area of research interest was smart infusion pump interoperability with EHR, 62,69 also identified as an important area of development elsewhere. [8][9][10]29 Nonetheless, during the analysis process we observed that the current search strategy was not sensitive enough to detect all studies related to the EHR interoperability with smart infusion pump [102][103][104][105][106] and patient-controlled analgesia pumps. 107 Therefore, more targeted research objectives and search strategies are needed in future systematic reviews of new technologies to secure safe IV MMU process.…”