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› Low bandwidth wireless transmission that minimises traffi c on the hospital’s wireless network while maintaining seamless bi-directional communication, even during patient transfer through the facility.

The CareFusion Alaris® system is the only commercially

available system that fulfi ls all the above criteria. It is used throughout the USA and Asia. The problem facing many European facilities is that their infusion infrastructure, developed before the wireless revolution, traps data in various infusion devices or produces data that cannot be assimilated into usable information. Extending the life of infusion devices and making them capable of integration with HIT is fi nancially important. The CareFusion Alaris Gateway® Guardrails®

system with software data upgrades, along with third-

party software, are capable of integrating older systems with HIT and allowing CQI Reporter®


It is important to note also that Alaris smart pumps are not dependant on a wireless network for service continuation. The drug library and Guardrails®

All of the above is vital but what is truly signifi cant about the model of CPOE drug administration linking via HIT and smart pumps is that a record of correct administration can return to the EHR and administered infusions can be viewed in near real-time using a CareFusion Pharmacy Viewer®

system. At the beginning of this paper, the

point was made that documentation of practice should refl ect what actually occurred. This is one of the biggest challenges in IV therapy. The above process helps to close the safety loop by realising the potential of smart pumps to protect patients against drug administration error.

References. ECRI Report (2012) Which smart pumps are smartest? Ratings for six large volume infusion pumps. ECRI 41: 378–90

Fields M, Peterman J (2005) Intravenous medication safety system averts high- risk medication errors and provides actionable data. Nurs Admin Q 29(1): 78–87

Graham L, Lakamp J, Kohorst J et al (2010) Optimization of smart infusion device technology reduces alert fatigue in a multi-hospital health system. Presentation at the American Society of Health-System Pharmacists Conference.


is held locally on each pump and all data collected by the pump will be stored until download to the central server can occur. Therefore even in hospitals where wireless connection is ‘patchy’ patient safety can be maintained.

Barcode labelling of all human drugs and biological products has been a US Food and Drug Administration requirement since 2004 (Taxis and Barber, 2003). This requirement grew out of several fi ndings that indicated rates as high as 57% of all delivery errors for wrong dose and wrong drug events. Handheld barcode scanners can be used to match data from the patient’s wristband, the nurse’s ID badge and the drug barcode with the list of medications on the facility’s HIT. The smart pump can also be auto-populated during scanning with predefi ned dose limits, compatibility information, special infusion directions and other relevant information. The smart pump will then not allow any infusion that does not meet the medication ‘rights’ to go ahead.

Obviously the potential for error is lower when fewer actions are required in any programming sequence and the smart pump also acts as a further validation of the infusion order (physician, pharmacist, nurse and the auto- programme). Applying James Reason’s ‘Swiss cheese’ model (1997), this effectively adds a further barrier of defence to prevent errors in either prescription or administration from reaching the patient as the smart pump makes a test of ‘reasonableness’ to the encoded order.

Husch M, Sullivan C, Rooney D et al (2005) Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Qual Saf Health Care 14(2): 80–6

Lee PT, Thompson F, Thimbleby H (2012) Analysis of infusion pump error logs and their signifi cance for health care. Br J Nurs 21(8): S12–20

Miller J, Cross M, Gerrett D, Webb D (2006) A prioritisation of the most effective interventions for reducing medication errors in UK hospitals as perceived by senior pharmacists. The European Journal of Hospital Pharmacy Science 12(2): 23–8

National Patient Safety Agency (2010) Design for patient safety. A guide to the design of electronic infusion devices. NHS, London. (accessed 2 July 2013)

Quinn C (2011) Smart practice: the introduction of a dose error reduction system. Br J Nurs 20(8 Suppl): S20–5

Reason J (1997) Managing the Risks of Organizational Accidents. Ashgate, Aldershot

Rothschild JM, Keohane CA, Cook EF et al (2005) A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Crit Care Med 33(3): 533–40

Schneider PJ (2002) Using technology to enhance measurement of drug-use safety. Am J Health-Syst Pharm 59(23): 2330–2

Schneider PJ (2004) Putting the ‘I’ into ‘IT’: The critical importance of information in the use of information technology. Proceedings from the Fourth Conference for Safety and Clinical Excellence. Supplement to Health Leaders Conference Report. Center for Safety and Clinical Excellence. San Diego, CA

Taxis K, Barber N (2003) Ethnographic study of incidence and severity of intravenous drug errors. BMJ 326: 684–7

Thimbleby H, Cairns P (2010) Reducing number entry errors: solving a widespread, serious problem. J R Soc Interface 7(51): 1429–39

Thompson B (2003) The transforming effect of handheld computers on nursing practice. Nursing Administration Quarterly 29(4): 308–14

Trbovich PL, Jeon J, Easty A (2009) Smart Medication Delivery Systems: Infusion Pumps. Healthcare Human Factors Group, Toronto

Trbovich P, Pinkney S, Cafazzo J, Easty A (2010) The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit. Qual Saf Health Care 19(5): 430–4

Valentin A, Capuzzo M, Guidet B et al (2009) Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 338: b814

Von Laue NC, Schwappach DL, Koeck CM (2003) The epidemiology of preventable adverse drug events: a review of the literature. Wien Klin Wochenschr 115(12): 407–15

BJN July 2013 CareFusion Supplement 27

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