PATI ENT SAFE T Y
Driving improvement in infusion safety
Reports suggest that smart pumps reduce but do not eliminate drug infusion errors. So, how can the risks associated with smart pump use be effectively managed and patient safety improved?
Infusion pumps have contributed to improvements in patient care, allowing for a greater level of control, accuracy, and precision in drug delivery – thereby reducing medication errors. The latest smart infusion pumps, are designed to alert the user when there is a risk of an adverse drug interaction, or when the user sets the pump’s parameters outside of specified safety limits.1 However, should their use be mandated or increased in the UK, and what is the evidence to support their use? Are there risks associated with smart infusion pumps and how could the technology be implemented more effectively? This article provides an insight into key reports and expert opinion, in a bid to highlight some of the important issues that need to be understood and addressed.
Why is there a need for ‘smarter’ pumps? We know that drug infusion errors have the potential to cause harm and unnecessary deaths, but just how much of a problem are infusion-related incidents in UK hospitals? There is a lack of accurate data in the UK on the rates of intravenous medication errors and studies vary widely.
One prospective audit, by Cousins et al looked at intravenous drug errors at six hospital departments in the UK, Germany and France. A total of 824 doses were prepared and 798 doses administered. The product was either not labelled or incorrectly labelled in 43%, 99%, and 20% of doses administered in the UK, German and French hospitals, respectively. The wrong diluent was used in 1%, 49% and 18% of cases and the wrong rate of administration was selected for 49%, 21% and 5% of doses observed, respectively. At least one deviation from aseptic technique was observed among 100%, 58%, and 19% of cases in the three countries.2 A systematic review by Sutherland et
al also aimed to estimate the number of intravenous medication errors per 1,000
MAY 2021
administrations in the UK NHS and their associated economic costs. The authors concluded that approximately 10.1% of IV medication administrations are associated with an error. The most common administration error identified in the review was ‘wrong rate’ errors, which accounted for 57.9% of reported errors. ‘Wrong time’ errors were the second most common with 20.4% of reported errors. However, insufficient data were available to estimate the severity of these errors, and there were no studies of the economic impacts.3
Importance of dose checking Due to the risks associated with drug infusion, the National Patient Safety Agency (NPSA) previously recommended the use of “double checking systems, such as an independent check by another practitioner, and dose checking software in ‘smart’ infusion pumps and syringe drivers,” to reduce the risk of drug infusion errors.4 The US-based Institute of Safety Medicines Practice (ISMP) 2018/19
‘Targeted Medication Safety Best Practices for Hospitals’, Best practice 8, recommends that hospitals: “Administer high-alert intravenous (IV) medication infusions via a programmable infusion pump utilising dose error-reduction software,” and states: “Ensure that dose error-reduction software is employed on all pumps with this feature (i.e., smart pumps). Specifically, ensure that drug libraries are built and installed on all smart pumps and that staff are using the error reduction software.”5
Benefits and negative effects There have been a number of studies and papers published that highlight the potential of smart infusion devices to improve patient safety. A UK-based study by Cousins et al, for example, demonstrated that a substantial number of potentially serious adverse events or deaths from high-risk drugs (e.g. insulin and potassium), were prevented with smart pumps. From 265,880 infusions over 12-months, 317 infusions were reprogrammed, 478
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