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ARE PRESCRIBED INFUSIONS RUNNING AS INTENDED?


Are prescribed infusions running as intended? Quantitative analysis of log fi les from infusion pumps used in a large acute NHS hospital


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nfusion pumps are common in hospitals and appear to be a simple medical device. Indeed, setting up an infusion takes relatively little time in comparison


with the time required to monitor and attend to any external factors that might interfere with the smooth running of an infusion. A clinician must be attentive to alarms that may occur during an infusion due to


Abstract Quantitative analysis of event logs from 127 infusion pumps used in a large acute NHS hospital in Wales are presented and discussed.


The logs record a snapshot of 3681 infusions, accounting for a total of 9048 hours of intravenous medication delivery. The pumps were used over seven departments throughout the hospital. The study shows that 44% (n=1637) of infusions are interrupted at least once.


The analyses provide insights into how pumps are actually used in practice. There are important implications for staff training, pharmacy, procurement, equipment management and — in the longer run — improved device design.


Authors: Carlos Monroy Aceves, Patrick Oladimeji and Harold Thimbleby, Future Interaction Technology Lab, Swansea University, Wales


Paul Lee, Medical Physics and Clinical Engineering Department, Singleton Hospital, Swansea, Wales


possible occlusion or air bubbles in the infusion line or low batteries and many other alarms, as well as changes in the patient’s physical conditions, to act accordingly to maintain what is best for the patient.


Other factors that might adversely affect the setup and administration of an infusion include complicated user interfaces, poor training, long working shifts, or the use of different brands and models of infusion pump in the same ward (which will be set up or used in different ways). All these issues may lead to confusion and even error at the moment of setting up an infusion (National Patient Safety Agency (NPSA), 2004).


Computerised interactive infusion devices are now used for the majority of delivery of intravenous medication through the use of volumetric infusion pumps or syringe pumps. These devices improve the accuracy of the fl ow of infusion, generally provide better feedback of the status of an infusion and provide a more precise setup procedure for users.


Although technological advances have brought about various improvements, intravenous medication delivery remains a higher risk for error in comparison with other types of medication delivery (Barber and Taxis, 2004; NPSA, 2007; Medicines and Healthcare products Regulatory Agency (MHRA), 2010; Westbrook et al, 2011).


The computerisation of infusion pumps means some pumps can keep a log of how they are used. These logs are typically limited to the last few hundred events that occurred on the pump. Events are signals of signifi cant


BJN July 2013 CareFusion Supplement 15


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