Smart pump alerts: All that glitters is not gold

Manrique-Rodríguez, Silvia; Sánchez-Galindo, Amelia; Fernández-Llamazares, Cecilia M.; López‐Herce, Jesús; Echarri-Martínez, Lara; Escudero‐Vilaplana, Vicente; Sanjuro-Sáez, María; Carrillo-Álvarez, Ángel

doi:10.1016/j.ijmedinf.2011.10.010

Cited by 30 publications

(27 citation statements)

References 18 publications

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“…Analysis of clinical alerts produced by DERS is available with most infusion pumps by accessing infusion pump log data. Alert data can be stratified by type (soft vs hard and minimum vs maximum), drug, care profile, and clinician response (cancel, reprogram, or override) and analyzed using manual tools, pump vendor portals, or third‐party applications . It is also important to keep in mind that alert data can only be captured if clinicians do not bypass the DERS.…”

Section: Types Of Alerts and Alarmsmentioning

confidence: 99%

“…Further, a large total alert burden may reduce a clinician's ability to distinguish between a true signal and background noise (d 0 ). This dichotomy may be supported by observing varying DLL compliance across drug classes within the same care setting 16 and nurse reduction of alarm volume as a workaround that would reduce all noise. 5 Although these frameworks suggest that quantitative measures of alert fatigue may be possible, there is no consensus on metrics.…”

Section: Framework Used To Evaluate the Value Of And Clinician Respomentioning

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%

“…Alert data can be stratified by type (soft vs hard and minimum vs maximum), drug, care profile, and clinician response (cancel, reprogram, or override) and analyzed using manual tools, pump vendor portals, or third-party applications. 16,27,30 It is also important to keep in mind that alert data can only be captured if clinicians do not bypass the DERS. Thus, high DLL compliance is often the first goal of any smart pump quality improvement project.…”

Section: Metricmentioning

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: Types Of Alerts and Alarmsmentioning

confidence: 99%

Section: Framework Used To Evaluate the Value Of And Clinician Respomentioning

confidence: 99%

Section: Metricmentioning

confidence: 99%

Section: Metricmentioning

confidence: 99%

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

2018

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“…51,81 However, as with the introduction of CPOE described above, new systems such as smart pumps can introduce new potential errors and must be appropriate for paediatrics. 230,231 Bar-coding is a point-of-care system where identification bands are compared to medications before administration. 81 It is designed to validate patient identity, verify actual medications administered, assure the correct time of administration and provide safety alerts to prevent medication errors from reaching the patient.…”

Section: Other Technology -Smart Pumps and Bar Codingmentioning

confidence: 99%

Advanced practice in paediatric pharmacy: What is it, how do you get there, and what does it mean for children?

Stacey¹

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The quality and safety of medicines use is as important in paediatrics as in adult medicine, and closely linked to the skills, knowledge, attitudes and behaviours of health professionals responsible for patient care. The aim of this research was to investigate advanced paediatric pharmacy practice; how to develop and assess advanced skills; and how these skills improve outcomes for children.Prevention of adverse medication events (AMEs) is the most researched pharmacy impact on patient outcomes. However, there is limited evidence in paediatrics. The first phase of this research investigated AMEs in children, with the hypothesis that: Voluntary reports of AMEs can be used to identify trends over time in response to safety improvement initiatives, and identify associated skills required of health practitioners.The first component of this phase reviewed six months of potential and actual AMEs identified from three databases: clinical incident reports, pharmacist intervention reports and administrative coding using the International Classification of Diseases 10 th Revision (ICD-10). Analysis identified 447 individual AMEs. Little duplication between data sources was found. ICD-10 coding identified the most cases of harm, and intervention and incident reports identified the most cases of error. ICD-10 events rarely involved error and were time-consuming to retrieve, hence this method was not used in subsequent research. The second phase of research tested the hypothesis that:iii Paediatric hospital pharmacists value formal recognition of advanced pharmacy practice, can describe the characteristics of advanced practitioners and identify preferred methods of assessment of advanced practice.Four focus groups, involving 31 Australian paediatric pharmacists, concluded that advanced practice should be formally recognised, and include a foundation in clinical practice, together with education, research and service improvement outside the institution. Multiple methods of assessment were recommended; most preferred were direct observation of practice, peer review and portfolio review. Knowledge of paediatric diseases and drug handling, and skills in communication with children and families, were important.The third phase of the project reviewed two existing datasets to test two hypotheses, the first of which was: Pharmacist interventions can document progression to advanced practice.Six hundred interventions recorded by four pharmacists from one paediatric hospital were retrospectively reviewed over three separate periods from 2005 to 2012. Skills demonstrated in these interventions were rated using a pilot scale from 1 to 5, representing skills typical of intern pharmacists through to advanced practice. Skills increased over time, with more Level 3-5 interventions recorded in the later time periods, and mean skill level increasing from 1.9 to 2.6 (p<0.01).The second hypothesis in this phase was: Training and development priorities in paediatric pharmacy can be identified by direct observation of pharmacists working ...

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Reducing intravenous infusion errors: an observational study of 16 866 patients over five years

Poole

Ahlin

Dooley

2018

Pharmacy Practice and Res

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Background Medication administration errors account for the largest proportion of medication errors in hospitals, impacting significantly on patient safety. Intravenous infusions carry a high risk for error due to their complex nature and use in high acuity settings. Two safety strategies for infusion safety introduced across a tertiary hospital network include the utilisation of the clinical pharmacy review and annotation of infusion orders, and the introduction of smart infusion pump technology with dose error reduction software. Aim The objective of this study was to evaluate the effects of two medication safety strategies: clinical pharmacist review including medication order annotation, and introduction of smart infusion pumps on rate and severity medication administration errors. Method A pre‐ and post‐intervention, observational study was undertaken at four time points over a five‐year period which included the review of 16 866 patients in a large tertiary referral hospital. Results Pharmacist annotation independently resulted in a reduction in errors from 16.6 to 8.1%. Subsequent implementation of smart pumps with a comprehensive drug library and high user compliance resulted in a further reduction from 8.1 to 3.9%. These reductions were sustained, with an overall error rate of 5% after two years. Conclusion The importance of timely clinical pharmacist review of intravenous infusion medication orders, and the implementation of smart infusion pump technology, along with well‐resourced drug library development with emphasis on quality management, education and training, should be prioritised, in order to reduce medication administration errors and to maximise patient safety.

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Smart pump alerts: All that glitters is not gold

Cited by 30 publications

References 18 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

Advanced practice in paediatric pharmacy: What is it, how do you get there, and what does it mean for children?

Reducing intravenous infusion errors: an observational study of 16 866 patients over five years

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