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Why are smart pumps good for nurses? The introduction of smart pump technology provides a technology-based fi nal check of an infusion rate that creates a safe environment for care. This has to be good for patient safety and good for nurses too. It has been suggested that the adoption of this infusion technology should be regarded as a minimum safety standard for intensive care (Murdoch and Cameron, 2008).

The groundwork required for successful implementation, while considerable, confers many secondary benefi ts to safe nursing practice. Much of this benefi t is centred around the requirement to standardise practice to facilitate the operation of DERS. This starts with the initial requirement to standardise infusion equipment, which removes the otherwise ever-present risk of unfamiliarity as nurses and equipment move around the hospital, and facilitates an effective devices training and competency assessment programme. Standardisation of practice is continued through the adoption of a limited range of standardised concentrations in the drug library that is uploaded into the pumps. Construction of the library is a multidisciplinary process to which nursing input is vital.

Aside from economic considerations, a major obstacle to more intravenous drug infusions being pre-prepared in purpose-built facilities by either commercial manufacturers or the hospital pharmacy service has been the historical practice of preparing individual drug solutions for patients based on their body weight. Standardised concentrations would facilitate large- scale commercial production, making many solutions available as a ready-to-administer presentation, with consequent saving of nursing time currently spent on drug preparation. Large-scale production would also give the nurse the benefi t of administering a quality- assured product, avoiding many of the potential errors inherent in the preparation of IV medication (Parshuram et al, 2008). Wheeler et al (2008) studied the variability in the concentrations of intravenous drug infusions prepared on a critical care unit. The majority of infusions differed from the expected concentration by more than 10%, indicating that accuracy in drug preparation at ward level could have signifi cant implications for patient outcome.

› Drug calculations continue to pose a signifi cant challenge ‹

6 CareFusion Supplement BJN July 2013

Commercially produced drug infusions have the potential to be barcoded, bringing into play another technology that is gradually being adopted to enhance safety in the healthcare environment. Finally, experience has shown that adopting standardised drug concentrations also confers the benefi t of simplifying the prescribing process, discouraging prescribing in millilitres (ml) rather than drug mass units, and rendering the prescription clearer and easier for the nurse to follow.

Modern infusion devices are much more than just pumps and are now often regarded as part of the organisation’s information technology capability. The ability of smart pumps to calculate automatically the volumetric infusion rate required to deliver a prescribed dose of drug per kilogram over time presents a major benefi t to the nurse administering the drug. Drug dosing calculations continue to pose a signifi cant challenge to health professionals and it can be argued that the most effective means of minimising risk is to remove the need completely for a given calculation to be performed by personnel in favour of using the technology at our disposal.

The ability of smart pumps to capture averted event data helps to inform practice development and training. Voluntary reporting systems are known only to capture a small percentage of actual events, so to date ‘we haven’t known what we haven’t known’. Smart pumps are able to yield detailed information on near-miss events that is essential to ongoing learning and risk minimisation.

However, there are two caveats that must be recognised. First, nurses have to observe their responsibility to use the systems effectively. One of the obstacles to the research efforts attempting to demonstrate and quantify the increase in patient safety was the tendency for nurses to bypass the safety software on infusion devices where the manufacturers had made its use optional (Rothschild et al, 2005). The temptation to follow so-called ‘workarounds’ must be resisted if the potential benefi ts to patients and health professionals are to be realised.

Second, it is universally recognised that any new technology brings with it some new areas of risk. Predictably, in the case of smart pumps, the potential for picking error when selecting the required drug from the pump library poses a very real new risk that has been borne out in practice (authors’ personal experience).

If they’re so good, why aren’t we all using smart pumps? Despite recommendations such as the statement issued by the National Patient Safety Agency (2007) that

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