IMPLEMENTING AND EVALUATING DOSE ERROR REDUCTION SOFTWARE
which case they cannot be overridden, or ‘soft’, where the limit alert can be overridden (Upton, 2012).
Analysis of infusion device event recording logs, when an alert has been triggered, provide evidence that the use of this technology can identify and prevent serious patient safety incidents from medicines infusion therapy in different healthcare settings (Manrique-Rodriguez et al, 2011; Kastrup et al, 2012; Lee et al, 2012).
The National Patient Safety Agency (2007, 2010b) recommended the use of DERS to help minimise the risk of harms from injectable medicines; and others have followed (Murdoch and Cameron, 2008; NHS Purchasing and Supply Agency, 2008; Quinn, 2011).
In a survey of hospitals in the USA in 2011, 68% were using infusion devices with DERS (Pedersen, 2012). There has been no similar survey of hospitals in the UK, but infusion device manufacturers have indicated the use of infusion devices with DERS is relatively low in the NHS (Cousins, 2013). Some NHS hospitals may have purchased infusion devices with DERS but have failed to use these systems in practice (Upton, 2012).
The aim of this paper is to describe a successful implementation of DERS and the evaluation of patient safety benefi ts from the use of this technology in an NHS hospital.
Implementation of infusion devices with DERS In 2005, the infusion device stock in Basingstoke and North Hampshire NHS Trust was becoming outdated. New devices were required to meet clinical needs better. A business case was prepared from an audit of infusion devices and a Structured What If Technique (SWIFT) analysis, which allowed stakeholders involved in all stages of medication infusions to make suggestions based on observations and experience of the type of problems that occur, the consequences of these problems, current safeguards and possible additional solutions. The main themes and recommendations to emerge from the review were that:
› This technology can identify and prevent serious patient safety incidents ‹
10 CareFusion Supplement BJN July 2013
› Existing safeguards placed an emphasis on the use of guidance such as policies, protocols, formularies and other paper- or electronic-based guidance. Although these safeguards were felt to be appropriate, they did not actually prevent incidents and relied on clinicians to remember to adhere to the guidance and did not take human factors into consideration
› More use was recommended of solutions that remove key elements of risk, such as calculation, needle- stick injury, preparation error (wrong concentrations/ infection) and delivery (rate) errors
› Examples of solutions to minimise risk include the use of prefi lled syringes, barcode technology, needleless systems and DERS. Adopting such solutions was also expected to improve effi ciency in terms of the time required for these practices.
The Trust established a multidisciplinary team (MDT) to oversee the implementation of infusion devices with DERS in June 2006. The business case to purchase new infusion devices was successful and new devices with DERS capability were introduced into the Trust from 2007.
An implementation plan was developed that identifi ed key stakeholders and clinical leads to help with the development of the infusion library data set of standardised concentrations for infusions, as well as hard and soft limits. By April 2008, the infusion library data set was completed and formally signed off by the MDT.
All training and assessments for infusion devices with DERS were completed by trainers from the infusion device manufacturer. The rollout started in critical care, then surgical wards and operating theatres, oncology, maternity and gynaecological wards followed. The medical, elderly care wards and coronary care unit were next, followed by the medical assessment unit. This was to ensure that patients were not transferred to areas from the assessment unit where staff were not yet trained and evaluated as being able to use the new infusion devices safely. For similar reasons, the emergency department was the last area in the Trust to introduce the new devices.
Ward sisters, matrons, stores, housekeepers, equipment library staff and portering staff were kept up to date with how well the training and assessment were going, and also in which areas the infusion devices with DERS were in use. A database of staff who had been trained to use the infusion devices with DERS in each ward area was updated daily and emailed weekly to ward sisters, matrons and assessors to keep everyone informed of progress, showing the latest percentage of those
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