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Smart pumps—good for nurses as well as patients

While this is not as high as the rate for prescribing (56%), the detection rate before administration was alarmingly only 0–2% (Bates et al, 1995; Leape et al, 1995). A European study carried out in paediatric care reported that 56% of medication errors were associated with IV medication (Ross et al, 2000).


Medication safety, especially when administering injectable medicines, is a well-documented problem throughout all international healthcare systems (Kohn et al, 1999; Wirtz et al, 2003; Cousins et al, 2005; National Patient Safety Agency, 2007; McDowell et al,

Abstract Much has been made of the risks to patients, particularly from drug overdose, inherent in delivering medication via the intravenous route. The call for enhanced patient safety has fuelled the development of technological solutions to reduce the consequences of human error.

However, while patient safety is always paramount, does the technology bestow any benefi ts to the nurse administering the care?

This paper aims to explore the drivers behind the development of safety systems for IV infusion pumps, describe the so-called smart pump technology and its applications, and focus particularly on why these systems are good for nurses.

Authors: David Upton, Medication Safety Pharmacist, Director of Pharmacy and Medicines Management, Sheffi eld Children’s NHS Foundation Trust

Chris Quinn, Clinical Manager, CareFusion 4 CareFusion Supplement BJN July 2013

edication errors at the administration stage have long been recognised as a problem, accounting for 34% of adverse events (Bates et al, 1995).

2010; Westbrook et al, 2011). These reports and studies range from the landmark publication To Err is Human from the USA’s Institute of Medicine (Kohn et al, 1999) to an Australian publication, over 12 years later, that highlights many of the issues around IV administration previously mentioned in the US report (Westbrook et al, 2011). From this it could be concluded that, although there has been much learning internationally around medication management and safety, similar errors continue to occur and progress in making IV therapy safer has been slower than ideal.

In a survey of medication errors (Council of Europe, 2003), the range of factors contributing to adverse drug events included multiple formulations of the same drug leading to confusion; confusion caused by packaging and labelling; dosing errors (misplaced decimal points/zeros, calculation errors); drug administration errors (such as omission, wrong route, given too rapidly); and lack of knowledge or competence about drugs, formulations and procedures.

A number of initiatives have been introduced to address factors contributing specifi cally to injectable medication error. Strategies such as standardisation of equipment (Quinn et al, 2004), the use of smart pumps with dose error reduction software (DERS) (Snodgrass, 2005; Quinn, 2011), national recommendations for injectable medicines (National Patient Safety Agency, 2007) and the promotion of drug concentration standardisation (Borthwick et al, 2007). Each of these solutions attempts to address specifi c issues associated with injectable drug delivery. This also illustrates how complex the problem of medication risk management can be and that the answer does not lie in just one solution—multiple practice standards are required (Royal College of Nursing, 2010).

Historically, there has been far too little protection in place to prevent health professionals making a serious error when administering drugs by intravenous infusion.

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