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hospitals should use double checking systems such as an independent check by another practitioner, and dose checking software in smart infusion pumps and syringe drivers, uptake of smart pump technology in Europe remains low compared with the USA (Pederson et al, 2012). Even allowing for the fact that the technology originated in the USA, the difference in rates of use is still profound nearly a decade after it became available in Europe.

Manufacturers vary in their estimates, one reporting single-fi gure percentage of pumps being sold with DERS in Europe versus approximately 80% in the USA (Gokhani, 2011). Another quoted 65–75% of large volume pumps and 50–60% of syringe pumps being smart in the USA versus a ‘low, and in pockets’ uptake in Europe (Berglund, 2011). The waters can be muddied by the fact that pumps are often sold with the technology installed but it is up to the user whether or not to upload the drug library in order to activate the full functionality. In the UK, it is estimated by one manufacturer that while the number of smart pumps sold is constantly rising, the proportion currently providing full DERS protection remains under 10% (Dawe, 2011). While the authors have previously attempted to provide published guidance and support (Quinn, 2011; Upton, 2012) to those wishing to introduce smart pump technology, it has to be recognised that the implementation process still poses a signifi cant challenge.

Suggested reasons why smart pump technology is not more widely used in Europe include (Upton, 2011):

Lack of standardisation of equipment It is not feasible for different safety software systems to be adopted within an organisation so there is a heightened requirement for infusion equipment to be standardised. Progress in some areas has been slow while existing long-term contracts run their course.

Low, or poorly targeted, investment in new equipment Health care has generally lagged behind the commercial sector in terms of investment in technological safety strategies. In addition, new equipment generally goes into intensive care units fi rst and there is a delay while expertise is developed and cascaded through the organisation.

Resistance to change, particularly adopting standardised concentrations US practice involves more extensive use of standardised concentrations, whereas the traditional European model

is based on practices inherited from an era when pumps were not as reliable, accurate, or sophisticated as today. Then, it was safer to infuse at a fi xed rate of, for example, 1 ml per hour and vary the dose of drug administered to the patient by varying the concentration of drug solution.

The adoption of standardised concentrations seems to form the major sticking point because for many it presents a major change in practice. In certain areas, particularly paediatrics, the concept can be extremely diffi cult to put into practice.

Lack of robust evidence for effectiveness Manufacturers have not invested adequate resources in support of high-quality research. Does smart pump technology really make a signifi cant difference to patient safety? Does the risk avoidance afforded by this system justify the level of investment required? These key questions have yet to be answered and to date there is insuffi cient evidence in the literature to demonstrate clear benefi t. While there are papers showing achievement of a reduction in IV errors, at the same time some published studies from respected medication safety researchers have failed to demonstrate signifi cant benefi t (Husch et al, 2005; Rothschild et al, 2005), although a major factor was lack of use of the software when it was set up as an option.

Lack of promotion by manufacturers Given the claims made by the manufacturers, it was surprising that smart pump technology arrived in Europe with rather understated promotion. Even now, professionals responsible for delivering infused therapy often give the impression that there is a widespread lack of awareness.

Hospital pharmacist involvement A signifi cant obstacle to the implementation of error reduction software seems to be the availability of pharmacist time to build the drug library. Pharmacists also do not seem to be championing the benefi ts of both this technology and of standardising drug solution concentrations. Considerable work is involved in constructing the drug library for upload onto the infusion devices, plus the ongoing commitment required to review and upgrade the systems in the light of data feedback. It is a multidisciplinary process, but the involvement of the pharmacist is vital.

Conclusion Smart pumps have been around for a long time now, but uptake on this safety technology across Europe has been low. While they do not provide the total answer

BJN July 2013 CareFusion Supplement 7

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