Optimizing Smart Pump Technology by Increasing Critical Safety Alerts and Reducing Clinically Insignificant Alerts

Abstract

Background:Alerts generated by intravenous (IV) infusion pump safety software prevent lifethreatening situations that might otherwise go unnoticed. However, when alerts are often clinically insignificant, health care workers may become desensitized and discount their importance, resulting in potentially dangerous situations. Little research has been devoted to visual alert desensitization. Method: This paper describes how the Carolinas HealthCare System decreased the number of nonclinically relevant infusion pump alerts by analyzing alert data that were formatted into scatter plots. This in turn enabled the identification of the medications associated with the most meaningful alerts and those associated with the least meaningful alerts. Conclusion: By revising drug library limits for specific medications, it was possible to decrease the number of less clinically meaningful alerts, reduce alert fatigue, and thereby increase the effectiveness of the smart infusion pumps. This added another layer of safety to patient care.

Strategies for Managing Smart Pump Alarm and Alert Fatigue: A Narrative Review

“…Although a high sensitivity (i.e., a threshold that detects all medication errors) is desirable, a high specificity (i.e., a threshold that correctly bypasses clinically irrelevant programs) is also desirable. Thus, the key to optimizing the value of smart pump alerts may lie in tuning pump parameters to balance these conflicting priorities . (Adapted from reference .…”

“…The DLL is updated, and updates are pushed to all smart pumps. A follow‐up analysis of alerts is recommended after the library update . Although alert rates vary widely by patient population, data sharing among hospitals and benchmarking may help hospitals develop and refine their DLL …”

“…Potential Limitations Total number of alerts or alarms [17][18][19][20] Although this may be a measure of global burden, alert fatigue is likely specific to technology, care setting, drug, clinician, and patient Number of clinically irrelevant alerts or PPV 14,16,[21][22][23][24] Judging clinical relevance of an alert retrospectively is time intensive and prone to unavailable information Alerts overridden 5,23 Override is often an appropriate response if the alert is clinically insignificant or there is a legitimate clinical reason to give a dose that exceeds the threshold Low DLL compliance 5 Bypass DERS may be justified for rare drugs, rare doses, and emergencies when time constrained Nurse perceptions through survey 19,25,26 No validated tool exists Time to override 27 We do not know what an appropriate time is to override an alert Workarounds 5,25 Workarounds are more a symptom of fatigue, and several exist PPV = positive predictive value; DLL = drug limit library; DERS = dose error reduction software.…”

“…A follow-up analysis of alerts is recommended after the library update. 14,17,24,27 Although alert rates vary widely by patient population, data sharing among hospitals and benchmarking may help hospitals develop and refine their DLL. 27 Researchers 24 described an iterative effort by a quality improvement team to achieve a roughly 10% reduction of nuisance alerts in each of four DLL updates and a 72% reduction in alerts generated by the 25 highest alerting drugs.…”

Influence of technique used to attach the infusion set to peristaltic finger smart-pumps on dispensing time: an experimental study

“…Infusion pumps are used to strictly manage the dispensing rate of medicine, and thereby improve medical care safety [ 1 – 3 ]. However, a number of factors can influence the accuracy of continuous intravenous dispensing, including the characteristics of the pharmaceutical product and its additives, medical staff’s affinity with medical equipment and the infusion set in particular, staff’s actual handling of the medical equipment, and the conditions in which staff must use this equipment [ 4 – 6 ].…”