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Making smart pumps smarter, making IV therapy safer


n 2010 the UK’s National Patient Safety Agency (NPSA, 2010) reported a signifi cant year-on-year increase in the reporting of medication incidents.

The agency’s analysis indicated that errors in administration (42%) outweighed the number of errors related to prescribing (32%). Of the reported events that led to serious harm or death, 62% involved IV medicines (Quinn, 2011).

Processes such as computerised physician order entry (CPOE), formulary implementation by pharmacy and therapeutics committees, and premixing of medication in the pharmacy have all mitigated overall risk to some degree (von Laue et al, 2003), but administration errors remain stubbornly fi xed at an unacceptable level. Furthermore, it is far easier to identify prescription error, with its paper trail, than errors of IV administration. There is a signifi cant ‘iceberg phenomenon’ in IV medication administration error detection because documentation of medicine administration does not, in fact, imply correct administration.

One observational study of 113 intensive care units in 27 countries gave a rate of 74.5 parental drug administration errors per 100 patient days (Valentin et al, 2009). Three-quarters of these errors were classifi ed as errors of omission. Wrong timing, wrong dose, wrong drug and wrong route were also prevalent.

One of the challenges for smart pump development resulting from the above has been to ‘close the loop’. This means confi rming correct administration and providing guidance for clinicians at the point of delivery.

The CareFusion solution to the problem of unreported error and clinician misprogramming is to set ‘rules’ for every infusion administered within a facility using a dose error reduction software (DERS) drug library such as Guardrails®

and produces a range of reports to help inform clinical practice. CQI turns raw data into data-rich evidence, which allows teams to make informed changes in therapies (Schneider, 2004).

Smart pumps can help the right patient get the right drug at the right rate. But for this to occur across the range of clinical care settings consistently, risk managers, pharmacists and IV therapy nurses need tools that help them both understand and make manageable the enormous volume of data that smart pumps can produce.

Abstract Errors of IV drug administration outweigh errors related to prescribing and have remained stubbornly fi xed at an unacceptable level, with one study giving a rate of 74.5 errors per 100 patient days. A major challenge, therefore, in smart pump development has been ‘closing the loop’—confi rming correct administration and guiding clinicians at the point of administration.

CareFusion smart pumps set ‘rules’ for every infusion through the application of a drug library. The effectiveness of this library can be monitored through a reporting system, which allows teams to make informed changes to therapies and limits. Creating the drug library is a multidisciplinary undertaking which often involves confl ict and a rolling back of assumptions about current practices.

Integrating smart pumps with electronic health records, and using auto-population to ‘close the loop’ for IV drug administration, release the potential of smart pumps to protect patients against drug administration error.

. A DERS can monitor these rules to

check compliance. The CareFusion Continuous Quality (CQI) Reporter®

22 CareFusion Supplement BJN July 2013 system can identify system compliance

Author: James Waterson, Clinical Consultant, CareFusion Limited

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