Quality-improvement analytics for intravenous infusion pumps

Skledar, Susan J.; Niccolai, Cynthia S.; Schilling, Dennis; Costello, Susan; Mininni, Nicolette C.; Ervin, Kelly A.; Urban, Alana

doi:10.2146/ajhp120104

Cited by 39 publications

(51 citation statements)

References 11 publications

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“…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 …”

Section: Strategies To Reduce Clinically Irrelevant Alerts and Alarmsmentioning

confidence: 99%

“…Researchers 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. A different group described the use of scatterplot visualizations to widen soft limits and add hard limits, resulting in a 35–100% reduction of alerts for modified entries.…”

Section: Strategies To Reduce Clinically Irrelevant Alerts and Alarmsmentioning

confidence: 99%

“…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.…”

Section: Metricmentioning

confidence: 99%

“…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.…”

Section: Addressing Drug Limit Library Compliancementioning

confidence: 99%

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

2018

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Although smart infusion pumps are intended to prevent medication errors by alerting users about doses that exceed set thresholds, a large number of clinically insignificant alarms and alerts create the potential for alert and alarm fatigue. We searched the PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for peer-reviewed literature (January 1, 2004-August 31, 2017) on managing smart pump alerts, alarms, and related fatigue. Twenty-nine articles that met the inclusion criteria were reviewed and organized into themes. Smart pumps give users two types of signals: alarms that indicate mechanical issues such as occlusion, air in the line, or low battery; and clinical alerts that indicate that a programmed dose exceeds a predefined safety limit. Mechanical alarms occur with greater frequency than clinical alerts, but alarms and alerts vary widely by pump model, patient population, time of day, month, and type of drug. Several causes of clinically insignificant alerts and alarms may be actionable, and strategies proposed in the literature include development of a multidisciplinary team to oversee the quality improvement effort with involvement of end users, standardization of medication administration practices, widening of drug limit library thresholds when clinically appropriate, maintaining up-to-date drug limit libraries, and interoperability. Whereas many strategies have been proposed, and case studies have been reported, none have been rigorously evaluated. In addition, more research is needed related to managing occlusion and air-in-line alarms, especially for complicated infusions. Future work should focus on the evaluation of specific and replicable alert and alarm reduction strategies with a greater emphasis on quantitative metrics.

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Section: Strategies To Reduce Clinically Irrelevant Alerts and Alarmsmentioning

confidence: 99%

Section: Strategies To Reduce Clinically Irrelevant Alerts and Alarmsmentioning

confidence: 99%

Section: Metricmentioning

confidence: 99%

Section: Addressing Drug Limit Library Compliancementioning

confidence: 99%

See 2 more Smart Citations

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

2018

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“…The drug library revision process identifies additions or modifications that can enhance safety and potentially intercept future events. 9 Also, modifications of the drug library can make the alerts more clinically significant and decrease the number of nuisance alerts.…”

Section: Optimizing Smart Pump Technologymentioning

confidence: 99%

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

Mansfield

Jarrett

2015

Hosp Pharm

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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.

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Smart Technologies in Healthcare: Overview of Human Factors and Infusion Pumps

Obuseh

Yih

et al. 2022

Human-Automation Interaction

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Quality-improvement analytics for intravenous infusion pumps

Cited by 39 publications

References 11 publications

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

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

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

Smart Technologies in Healthcare: Overview of Human Factors and Infusion Pumps

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