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MAKING SMART PUMPS SMARTER, MAKING IV THERAPY SAFER 1200 1064 1002 1000 800 600 400 200 0 958 902 876 724 717 648 509 498


Reprogramming


Overrides


Cancelled Infusion


All Other Alerts


Total


Figure 3: Chronograms can be of value to risk managers and nurse managers. Alert spikes in the chronogram may indicate a need to change workfl ow and reduce multitasking to promote safety during the critical task of IV drug administration


the keystrokes made and options that were either accepted or rejected at the point of care.


Closing the loop In the last decade smart pumps have fostered the development of drug dose limits, uncovered a high degree of variation in infusion practices, documented many ‘good catches’, prevented harm and provided a wealth of data identifying human and system factors related to risk management. However, they have not been able to prevent drug mix-ups or incorrect library selection (Trbovich et al, 2010).


For smart pumps to be capable of ‘enforcing’ right patient, right drug, right dose and right time IV drug administration, they need to be integrated through bi-directional wired or wireless systems with hospital information technology (HIT), electronic health records and with CPOE.


Husch et al (2005) stated:


‘Currently available smart pumps will fail to generate meaningful improvements in patient safety until they can be interfaced with other systems such as the electronic medical record, computerized prescriber order entry, barcoded medication administration systems, and pharmacy information systems.’


26 CareFusion Supplement BJN July 2013


Miller et al (2006) delineated the most effective risk- reduction strategies that hospitals can introduce. These included barcode identifi cation and rationalisation of pumps.


The above recommendations are now possible if the right communication infrastructure is in place within a facility—this starts with the infusion devices the facility selects. The ECRI Institute (2012) suggests the following basic questions are asked before the purchase of any infusion devices:


› How easy is it to integrate the pump with other hospital systems, either now or in the future?


› What tools are provided to support analysis of infusion pump log data?


The report also describes an ideal smart pump solution for a facility as one that has:


› One drug formulary data set for all modalities: large volume pump, syringe driver and patient-controlled analgesia with integrated end-tidal CO2 SpO2


monitoring


› One standard interface that meets the Integrating the Healthcare Enterprise industry standard of HL7 interface ‘language’


monitoring and


Number of Alerts


VANCOmycin


propofol (DIPRIVAN)


AMPicillin


HYDROmorphone PCA


POTASSIUM chloride


..IVF


magnesium sulfate


heparin


morphine


HYDROmorphone


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