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Table 1. Number and type of infusion starts, DERS alerts and responses Measure

Infusion starts in ml/hour Infusion starts with DERS Total infusion starts

Dose rate, above hard maximum Dose rate, above soft maximum Below soft minimum

Total DERS alert messages Cancelled


Reprogrammed Not recorded

Total responses to DERS alerts

39 154 76 295

150 431 497

811 788

2096 284

1372 167 273


trained and assessed. A folder was placed in each area, with device directions for use, quick reference guides, administration set descriptions and order codes, local assessors and supplier nurse contact details, along with the infusion library data set for the infusion devices. The rollout programme was completed in 2010, by which time the Trust had introduced into practice 221 CareFusion volumetric infusion pumps with Guardrails® 179 CareFusion syringe pumps with Guardrails®

(DERS) and .

Method All new infusion devices introduced into use in the hospital Trust maintained a log of all DERS alerts displayed to the users. Data was collected for two 6-month periods, 6 April 2010–6 October 2010 and 2 December 2010–28 June 2011. This information was manually downloaded from individual infusion devices to a computer and the data pooled in a database.

The infusion library data set stored in individual pumps could be upgraded at the time DERS alerts were downloaded. Nursing staff in all areas using the DERS infusion devices and the relevant lead pharmacists were approached a few months before the download date and asked to complete a form with any suggested data set changes. A few weeks before the download date these suggestions were reviewed with the current data set details and incorporated into a revised data set ready for upload.

Reports for analysis were generated from the database off-site by CareFusion and sent to the Trust. Included in these reports were the number of infusion starts

115 449 334

520 750

1604 194

1080 150 180


06/04/2010–06/10/2010 28/12/2010–28/6/2011 52 835 97 596

Total % 91 989 34.6 173 891 65.4 265 880 100


1331 1538 3700


2452 317 453


0.3 0.5 0.6 1.4

12.9 66.3 8.6

12.2 100

by category and DERS alerts triggered in each clinical area. These reports were reviewed by members of the multidisciplinary team and data indicating attempted serious infusion errors were investigated with the relevant senior ward staff. The reports were also used to identify changes required to the infusion library data set of agreed standard infusions, and hard and soft infusion rate limits.

Reports from each data collection period were issued to individual wards and clinical departments. The reports were then discussed at team level to understand the impact of the DERS software on practice—for example, where hard limits had been breached and where an infusion may have been started in the absence of such software. Local teams also used the reports to refi ne the local data sets of standardised infusions, hard and soft limits, and identify practice issues and training needs for drug profi les or treatment regimes, which might result in additional training, audits of practice, changes to policy and procedure.

Results A record of 265 880 infusion starts were recorded in the infusion device logs for the two data collection periods over 12 months (Table 1). The DERS double- checking system does not operate when infusions are started outside the infusion library data set, i.e. using ml per hour. The DERS system only operates when a specifi c infusion in the drug library is selected and the rate of administration is set. This is then automatically checked against the hard and soft limits pre-programmed for the selected infusions. The

BJN July 2013 CareFusion Supplement 11

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