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ARE PRESCRIBED INFUSIONS RUNNING AS INTENDED? 55 35


Data The log fi les analysed for this study came from 139 Smiths Medical Graseby 500 volumetric infusion pumps used in a large acute NHS hospital in Wales. The hospital has 500 beds and 178 infusion pumps and the log fi les represent snapshots of device usage between January 2008 and March 2011. In total, 348 log fi les were analysed, which came from seven different departments and a variety of wards within the hospital.


16 6 1 Oncology Medical Midwifery Anaesthetic Surgical Paediatrics


Figure 1: A distribution by department of infusion pumps used for the study


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Figure 1 shows the distribution of pumps and in which departments they belong. The oncology department was the main contributor to this study, providing 43% of the pumps. Each infusion pump kept a record of its last 200 events.


703 508 313 83 28 Oncology Medical Midwifery Anaesthetic Surgical Paediatrics Figure 2: Number of infusions per department


mode changes in the status of the pump, such as starting or stopping an infusion, or when an alarm occurs. Some pumps keep longer logs and some also record the user’s actions. It is important to remember that in the case of problems like key bounce or using a delete key, the user’s actions and what the actual pump does may be different, and ideally both should be recorded in the log.


The present study was performed to understand the use pattern of infusion pumps in a typical hospital with the aim of identifying and hence proposing improvements possible to inform organisational strategies for training, purchasing or managing resources, as well as to provide insights into possible improvements in the design of infusion pumps.


16 CareFusion Supplement BJN July 2013


A new intended infusion was inferred from the logs whenever an infusion was started and the volume infused had been reset to zero. We defi ne two types of events that signal the end of an intended infusion. Whenever an infusion successfully transitioned to a ‘keep vein open’ (KVO) rate, then the infusion had delivered its intended volume and consequently completed. Second, an infusion ends if it was stopped and then restarted with a cleared volume setting. Note that within the start and end times of an intended infusion, the therapy may be stopped and resumed any number of times.


Based on the rules defi ned above, a total of 4125 intended infusions were extracted from the logs. We limited our study to standard infusions using fl uid bags up to 1000 ml. Similarly, infusions resumed with the same settings after more than 24 hours of inactivity were removed from the study, as these were presumed to indicate pumps being used for training or testing in


A total of 77 log fi les that contained events signifying hardware faults were removed from the analysis.


Method Because of the nature of the logs recorded, the analysis performed in this paper is based on the 200 most recent events. Each event logged contained information about the description of the event, the date and time of the event (to the nearest minute), the rate, volume to be infused (VTBI) and the total volume infused on the pump at the time the log was captured. Lee et al (2012) have analysed logs from the same infusion pump model, but their analysis focused on the cumulative frequency of events and alarms logged in each fi le and not the infusion performance of each device.


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