Improving Infusion Pump Safety Through Usability Testing

Usability of smart infusion pumps: A heuristic evaluation

Although smart infusion pumps were built to eliminate medication errors, new types of usability errors have arisen. The purposes of this study were to determine potential risks when using smart pumps during secondary medication administration and to identify opportunities for design improvements. We observed and analyzed nurses when they interacted with smart pumps and heuristically evaluated the smart pump to identify usability problems. Forty-three usability problems were identified with the smart pump. The usability problems have the potential to create high cognitive burden on nurses and to increase the likelihood of mistakes. We discuss design and process improvement recommendations for each major finding from this study.

Human factors and ergonomics methods for pharmacy research and clinical practice

BACKGROUND

Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work.

OBJECTIVE

To review select HFE methods well suited to address pharmacy challenges, with examples of their application in pharmacy.

METHODS

We define the scope of HFE methods in pharmacy as applications to pharmacy settings, such as inpatient or community pharmacies, as well as medication-related phenomena such as medication safety, adherence, or deprescribing. We identify and present seven categories of HFE methods suited to widespread use for pharmacy research and clinical practice.

RESULTS

Categories of HFE methods applicable to pharmacy include work system analysis; task analysis; workload assessment; medication safety and error analysis; user-centered and participatory design; usability evaluation; and physical ergonomics. HFE methods are used in three broad phases of human-centered design and evaluation: study; design; and evaluation. The most robust applications of HFE methods involve the combination of HFE methods across all three phases. Two cases illustrate such a comprehensive application of HFE: one case of medication package, label, and information design and a second case of human-centered design of a digital decision aid for medication safety.

CONCLUSIONS

Pharmacy, including the places where pharmacy professionals work and the multistep process of medication use across people and settings, can benefit from HFE. This is because pharmacy is a human-centered sociotechnical system with an existing tradition of studying and analyzing the present state, designing solutions to problems, and evaluating those solutions in laboratory or practice settings. We conclude by addressing common concerns about the implementation of HFE methods and urge the adoption of HFE methods in pharmacy.

Usability of volumetric infusion pumps in pediatric intensive care

OBJECTIVE

To analyze the usability of two infusion pump models in a Pediatric Intensive Care Unit.

METHOD

This is a cross-sectional study of exploratory descriptive quantitative approach. A task was carried out in a controlled environment using infusion pump with 72 nursing staff members from August to September 2018. The Methodological Guideline for Medical Care Equipment Assessment Studies and the quality model proposed by NBR ISO/IEC 9126-1 were followed. Descriptive statistical analysis was used applying Fisher's exact test, binomial test and Mann-Whitney test.

RESULTS

91.7% of tasks were completed. The infusion pump-2 model was associated (p < 0.001) with operationalization, tasks accomplished with non-conformities, use of a manual calculator (measure effectiveness) and task accomplishment time (measure efficiency).

CONCLUSION

Efficacy and efficiency measures can evidence a better context of usability of IPs and identify interaction failures with the nursing staff to be improved in care practice.

Risk of Medication Errors With Infusion Pumps

The risk of medication errors with infusion pumps is well established, yet a better understanding is needed of the scenarios and factors associated with the errors. Our study explored the frequency of medication errors with infusion pumps, based on events reported to the Pennsylvania Patient Safety Reporting System (PA-PSRS) during calendar year 2018. Our study identified a total of 1,004 events involving a medication error and use of an infusion pump, which occurred at 132 different hospitals in Pennsylvania. Fortunately, a majority of medication errors did not cause patient harm or death; however, we did find that 22% of events involved a high-alert medication. Our study shows that the frequency of events varies widely across the stages of medication process and types of medication error. In a subset of our data, we manually reviewed a free-text narrative field in each event report to better understand the nature of errors. For example, we found that a majority of wrong rate errors led to medication being infused at a faster rate than intended, and user programming was the most common contributing factor. Overall, results from our study can help providers identify areas to target for risk mitigation related to medication errors and the use of infusion pumps.

Influence of technique used to attach the infusion set to peristaltic finger smart-pumps on dispensing time: an experimental study

Background

Infusion sets designed for peristaltic finger smart pumps (PFSPs) are necessary for the pumps’ accurate handling. We previously found that medication dispensing is occasionally incomplete following the calculated infusion time when using certain combinations of PFSPs and infusion sets at a Japanese hospital. Thus, in this study, we investigated the cause of this observed delay by determining the effect of infusion set attachment technique on dispensing time using a combination of three kinds of PFSPs and five kinds of polyvinyl chloride (PVC) and polybutadiene (PB) infusion sets.

Methods

PFSPs with their exclusive infusion sets were used. The PVC and PB infusion sets were either not stretched or stretched to 1–3 cm and attached to the PFSP’s liquid delivery system. PFSP dispensing rates were set at 25–400 mL/h. The primary outcome was the time required to dispense 100 mL of saline in a volumetric flask.

Results

The complete dispensing time correlated with the input time for all equipment combinations when the infusion sets were not stretched before attachment to the PFSP (R² = 0.9998–1.0000). When stretched, the complete dispensing time was longer than the input time (P < 0.01–0.05, analysis of variance with Tukey-Kramer multiple comparisons). The maximum dispensing time extension ratio for the PVC and PB infusion sets was 141.8% and 113.0%, respectively.

Conclusion

Certain attachment techniques for infusion sets can adversely prolong drug dispensing time. As such, pharmacists should provide medical staff with information about the devices used to administer drugs, as well as about the drugs themselves.

Efficacy evaluation of syringe pump developed for continuous drug infusion

BACKGROUND

In dental intravenous sedation, continuous intravenous infusion of a low-dose drug requires an infusion pump such as a syringe pump. To develop a new syringe pump for clinical use, the functions of the pump must meet certain international standards. Various safety and efficacy tests must be performed on the syringe pump, as stipulated by these standards, and an approval must be received from the approving agency based on such test results.

METHODS

The authors of the present study developed a novel syringe pump and performed efficacy evaluation by testing its infusion speed at 1 and 25 ml/h, and infusion performance testing at 2 and 24 h. Moreover, performance evaluation was conducted by comparing the novel pump to an existing pump with the infusion speed varied from 1 to 5 ml/h.

RESULTS

In the efficacy testing on the newly developed syringe pump, infusion with the infusion speed initially set to 1 ml/h resulted in infusion speeds of 1.00 and 0.99 ml/h in the 2- and 24-h assessment, respectively. Changing the infusion speed setting to 25 ml/h resulted in an infusion speed of 25.09 and 23.92 ml/h in the 2- and 24-h assessment, respectively. These results show no significant differences when compared with other commercially available pumps.

CONCLUSIONS

The efficacy testing of the newly developed syringe pump showed the accuracy to be within tolerance. Based on these findings, we believe that the newly developed syringe pump is suitable for clinical use.