Smart pumps and random safety audits in a Neonatal Intensive Care Unit: a new challenge for patient safety

Bergón-Sendín, Elena; Perez-Grande, Carmen; Lora-Pablos, David; Moral‐Pumarega, María Teresa; Melgar-Bonis, Ana; Peña-Peloche, Carmen; Diezma-Rodino, Mercedes; Jose, Lidia García-San; Cabañes-Alonso, Esther; Pallás‐Alonso, Carmen Rosa

doi:10.1186/s12887-015-0521-6

Cited by 19 publications

(18 citation statements)

References 22 publications

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“…This high rate of compliance has been shown to be critical to the effective use of smart pumps. [8,18,19] Although our rate of compliance is higher than previously reported rates [12,13], basic infusions, which lack the safety features of the DERS, were still used for 11-16% of infusions. Informal assessment revealed that our library had limited options for intravenous fluid selection that did not match the large variety of fluids being used.…”

Section: Discussioncontrasting

confidence: 51%

Smart Pumps Improve Medication Safety but Increase Alert Burden in Neonatal Care

Melton

Timmons

Walsh

et al. 2019

Preprint

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Background: Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source of alert burden and alert fatigue in an intensive care environment. Methods: Using smart pump records, over 370,000 infusion starts for continuously infused medications used in neonates and infants hospitalized in a level IV NICU from 2014-2016 were evaluated. Attempts to exceed preset soft and hard maximum limits, percent variance from those limits, and pump alert frequency, patterns and salience were evaluated. Results: Smart pumps prevented 160 attempts to exceed the hard maximum limit for doses that were as high as 7-29 times the maximum dose and resulted in the reprogramming or cancellation of 2093 infusions after soft maximum alerts. While the overall alert burden from smart pumps was not high, alerts clustered around specific patients and medications, and a small portion (17%) of infusions generated the majority of alerts. Soft maximum alerts were often overridden (79%), consistent with low alert salience. Conclusions: Smart pumps have the ability to improve neonatal medication safety when compliance with dose error reducing software is high. Numerous attempts to administer high doses were intercepted by dosing alerts. Clustered alerts may generate a high alert burden and limit safety benefit by desensitizing providers to alerts. Future efforts should address ways to improve alert salience.

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Section: Discussioncontrasting

confidence: 51%

Smart Pumps Improve Medication Safety but Increase Alert Burden in Neonatal Care

Melton

Timmons

Walsh

et al. 2019

Preprint

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“…Other authors have also demonstrated the usefulness of RRTSAs in preventing errors resulting from system failures and consider their implementation in NICUs to be fundamental. 7,10,14,15 Limitations It is also important to consider the limitations of our study. First, this was a multicenter study performed in neonatal units with similar delivery-room newborn care provision (level III-A, according to the Spanish Society of Neonatology).…”

Section: Discussionmentioning

confidence: 99%

“…These authors detected defects in areas as important as the use of ventilation materials and respiratory monitoring (383 audits; adequate overall use: 33.7%), 13 resuscitation materials (296 audits; adequate overall use: 62.5%), 14 or infusion pumps (160 audits; adequate global use: 73.1%). 15 This low percentage of audits without defect should lead us to reflect upon whether our current hospital delivery room protocols are able to ensure the correct and complete preparation of positions used during the care of newborns at the time of their delivery. Current protocols state that specific staff members at each center should periodically review the materials and medications available to ensure the adequacy of the radiant warmer set-up, the avail-ability of enough spare parts for each instrument, and periodic verification of the expiration date of expendable materials and medications.…”

Section: Discussionmentioning

confidence: 99%

“…7,12 Several studies on RRTSAs have been performed in neonatal intensive care units (NICUs) for various procedures and materials (for example, ventilation and respiratory monitoring, materials available for resuscitation, infusion pumps, and prevention of nosocomial infections). 11,[13][14][15][16] However, to the best of our knowledge, no specific work on RRTSAs has been performed for neonatal delivery room CPR stabilization areas. Thus, the objective of this study was to use audits to verify the level of preparation of these areas, analyze any circumstances that could influence their correct availability, and check the value of this quality-control tool to prevent safety-related incidents in this field.…”

mentioning

confidence: 99%

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Real-Time Safety Audits of Neonatal Delivery Room Resuscitation Areas: Are We Sufficiently Prepared?

Ortiz-Movilla

Funes-Moñux²,

Domingo-Comeche

et al. 2020

Am J Perinatol

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Objective This study aimed to use real-time safety audits to establish whether preparation of the equipment required for the stabilization and resuscitation of newborns in the delivery room areas is adequate. Study Design This was a descriptive, multicenter study performed at five-level III-A neonatal units in Madrid, Spain. For 1 year, one researcher from each center performed random real-time safety audits (RRTSAs), on different days and during different shifts, of at least three neonatal stabilization areas, either in the delivery room or in the operating room used for caesarean sections. Three factors in each area were reviewed: the set-up of the radiant warmer, the materials, and medication available. The global audit was considered without defect when no errors were detected in any of the audited factors. Possible differences in the results were analyzed as a function of the study month, day of the week, or shift during which the audit had been performed. Results A total of 852 audits were performed. No defects were detected in any of the three factors analyzed in the 534 (62.7%, 95% confidence interval [CI]: 59.3–65.9) cases. Slight defects were detected in 98 (11.5%, 95% CI: 9.4–13.8) cases and serious defects capable of producing adverse events in the newborn during resuscitation were found in 220 (25.8%, 95% CI: 22.9–28.9) cases. No statistically significant differences in the results were found according to the day of the week or time during which the audits were performed. However, the percentage of RRTSAs without defect increased as the study period progressed (first quarter 38.1% vs. the last quarter 84.2%; p < 0.001). Conclusion The percentage of adequately prepared resuscitation areas was low. RRTSAs made it possible to detect errors in the correct availability of the neonatal stabilization areas and improved their preparation by preventing errors from being perpetuated over time. Key Points

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“…[10,11] Issues that have been raised in the literature include workarounds like the use of basic infusions that do not employ the drug library dosing limits, improper patient or medication identification during pump programming, and high override rates for soft alerts, all of which negate the safety features of smart pumps. [8,12] The use of an additional alerting system in the ICU environment also raises the concern of alert fatigue and the salience of smart pump alerts, due to suboptimal levels of actionable alerts. [13] As a result of alert fatigue from cognitive overload or densitization with time, responsiveness to smart pump alerts may be influenced by other factors, such as work shift, month, repetitiveness of alerts or work complexity.…”

mentioning

confidence: 99%

Smart Pumps Improve Medication Safety but Increase Alert Burden in Neonatal Care

Melton

Timmons

Walsh

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source of alert burden and alert fatigue in an intensive care environment. Methods: Using smart pump records, over 370,000 infusion starts for continuously infused medications used in neonates and infants hospitalized in a level IV NICU from 2014-2016 were evaluated. Attempts to exceed preset soft and hard maximum limits, percent variance from those limits, and pump alert frequency, patterns and salience were evaluated. Results: Smart pumps prevented 160 attempts to exceed the hard maximum limit for doses that were as high as 7-29 times the maximum dose and resulted in the reprogramming or cancellation of 2093 infusions after soft maximum alerts. While the overall alert burden from smart pumps for continuous infusions was not high, alerts clustered around specific patients and medications, and a small portion (17%) of infusions generated the majority of alerts. Soft maximum alerts were often overridden (79%), consistent with low alert salience. Conclusions: Smart pumps have the ability to improve neonatal medication safety when compliance with dose error reducing software is high. Numerous attempts to administer high doses were intercepted by dosing alerts. Clustered alerts may generate a high alert burden and limit safety benefit by desensitizing providers to alerts. Future efforts should address ways to improve alert salience.

show abstract

Smart pumps and random safety audits in a Neonatal Intensive Care Unit: a new challenge for patient safety

Cited by 19 publications

References 22 publications

Smart Pumps Improve Medication Safety but Increase Alert Burden in Neonatal Care

Smart Pumps Improve Medication Safety but Increase Alert Burden in Neonatal Care

Real-Time Safety Audits of Neonatal Delivery Room Resuscitation Areas: Are We Sufficiently Prepared?

Smart Pumps Improve Medication Safety but Increase Alert Burden in Neonatal Care

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