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VanHorn T, Harris J, Mayes S, Infanti LM, Kennedy A. Evaluation of the Effect of Smart Pump Interoperability on Infusion Errors in the Pediatric Hospital Setting. J Pediatr Pharmacol Ther 2024; 29:323-330. [PMID: 38863851 PMCID: PMC11163903 DOI: 10.5863/1551-6776-29.3.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/12/2023] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Smart pump interoperability is a newer technology integrating intravenous medication -infusion instructions from the electronic medical record into a smart pump. This technology has demonstrated significantly decreased medication errors in the adult population; however, this has not been reported in pediatrics. The purpose of this study was to compare the frequency and severity of infusion related errors before and after the implementation of smart pump interoperability at a pediatric institution. METHODS This was a retrospective study conducted at multiple institutions within the same health care system to assess the effect of smart pump interoperability on infusion errors. Data were retrospectively analyzed for a 6-month period prior to (January-June 2020) and after (January-June 2022) smart pump interoperability implementation. All who received medications via a smart pump were included in the analysis. Infusions were excluded if administered via a patient-controlled analgesia pump, epidural pump, or intravenously pushed without using a smart pump. RESULTS A total of 143,997 versus 165,343 infusions were administered in the before versus after interoperability group. There were significant decreases in mild, moderate, and severe harm averted events once interoperability was implemented (p < 0.001). Errors caught before administration decreased after interoperability implementation from 197 events to 20 events because of fewer overall errors (p < 0.001). The number of guardrail alert overrides was significantly reduced, from 23,751 to 5885 (p < 0.001), as was the number of high-risk overrides, from 5851 to 207 (p < 0.001). CONCLUSION Implementing smart pump interoperability significantly reduced the frequency and severity of infusion errors and high-risk overrides at a pediatric institution.
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Affiliation(s)
- Tracie VanHorn
- Department of Pharmacy Services, Norton Children's Hospital, Louisville, KY
| | - Jordi Harris
- Department of Pharmacy Services, Norton Children's Hospital, Louisville, KY
| | - Shannon Mayes
- Department of Pharmacy Services, Norton Children's Hospital, Louisville, KY
| | - Lisa M Infanti
- Department of Pharmacy Services, Norton Children's Hospital, Louisville, KY
| | - Amy Kennedy
- Department of Pharmacy Services, Norton Children's Hospital, Louisville, KY
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Howlett M, McCarthy S, Silvari V, Franklin BD, Laaksonen R. Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study. Eur J Hosp Pharm 2024:ejhpharm-2023-004065. [PMID: 38604615 DOI: 10.1136/ejhpharm-2023-004065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES Medication errors (MEs) are a leading cause of morbidity and mortality in the healthcare system. Patients admitted to intensive care units (ICUs) are potentially more susceptible to MEs due to severity of illness, the complexity of treatments they receive and the challenging nature of the ICU setting. The European Association of Hospital Pharmacists established a Special Interest Group (SIG) to undertake a programme of work to develop and prioritise recommendations to support medication safety improvement in ICUs across Europe. METHODS Initial policy recommendations for medication safety within the ICU environment were developed following reviews of the literature and engagement with relevant stakeholders. A Delphi panel of 21 members of the SIG, that comprised healthcare professionals (HCPs) with expertise in ICU and/or medication safety, was convened in 2022. We conducted two rounds using a modified Delphi technique whereby participants anonymously ranked on a 9-point Likert Scale the policy recommendations according to their priority for implementation. RESULTS In total, 32 policy recommendations were developed. In Delphi Round 1, 19 HCPs participated; consensus was achieved on most recommendations and partial consensus on six. In Delphi Round 2, 18 HCPs participated. After two Delphi rounds, consensus was achieved on all 32 recommendations. All recommendations were considered 'high priority' except one that was considered 'medium priority'. CONCLUSIONS Through this study it was possible to develop and prioritise evidence-based policy recommendations to enhance medication safety, which may contribute to reducing MEs in ICUs across Europe. All recommendations were considered 'high priority' for implementation except one, indicating the perceived value of these recommendations in improving medication safety through preventing MEs in ICUs.
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Affiliation(s)
- Moninne Howlett
- Departments of Pharmacy and Digital Health, Children's Health Ireland, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Virginia Silvari
- School of Pharmacy, University College Cork, Cork, Ireland
- Pharmacy Department, Cork University Hospital, Cork, Ireland
| | - Bryony Dean Franklin
- School of Pharmacy, University College London, London, UK
- Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Raisa Laaksonen
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Edwards H. Infusion pump innovation: Embracing change for patients and bottom lines. Healthc Manage Forum 2024; 37:45-51. [PMID: 38334105 DOI: 10.1177/08404704241232045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Within the infusion delivery landscape, significant room exists for an improved experience with more intuitive and interoperable solutions. The majority of smart infusion pumps still rely on technology developed more than a decade ago. Many Canadian healthcare institutions regularly undergo a comprehensive re-evaluation of infusion fleets, to modernize infusion delivery for patients across the country. Amid the availability of new technologies with evidence demonstrating their ability to elevate the current standards of care, this article argues for the need for healthcare systems to prepare for, and embrace, change when it comes to new technologies. Clinical informatics consultant, Helen Edwards, delves into why new technologies are needed now more than ever. She shares her experience with the Ivenix Infusion System, capturing how it can help redefine clinical workflows, reduce costs across the entire healthcare continuum, and better support patient care. She also offers insights on how to effectively introduce new technologies and cultivate an environment that is likely to be open and adaptive to the change. As the Canadian healthcare landscape continues to evolve, the proactive adoption of new technologies will be a step towards advancing the outcomes for patients and the sustainability of Canadian healthcare infrastructures.
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Affiliation(s)
- Helen Edwards
- Clinical Informatics Consultant, Mississauga, Ontario, Canada
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Giuliano KK, Mahuren RS, Balyeat J. Data-based program management of system-wide IV smart pump integration. Am J Health Syst Pharm 2024; 81:e30-e36. [PMID: 37804239 PMCID: PMC10727471 DOI: 10.1093/ajhp/zxad245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Indexed: 10/09/2023] Open
Abstract
PURPOSE Smart pump bidirectional interoperability offers automated infusion programming and documentation that can improve patient safety and workflow efficiency. This technology has been poorly implemented across US hospitals, and there is little guidance on the tracking or monitoring of interoperability systems. The purpose of this report is to describe the successful implementation of intravenous (IV) smart pump interoperability in a large health system. SUMMARY Bidirectional IV smart pump interoperability and compliance monitoring were implemented across a large Midwestern health system using ICU Medical's Plum 360 and LifeCare PCA devices and Smith Medical's MedFusion 4000 Syringe Pump devices. The hospital system's experience in implementing and monitoring IV smart pump compliance using automated reports and a dedicated medication safety integration nurse is described. Compliance trends suggest that the implementation of IV smart pump interoperability has achieved a reduction in programming outside of the dose error reduction system, manual overrides, and IV medication administration error rates. CONCLUSION The monitoring of smart pump compliance has had demonstrated benefits in investigating usability concerns, recognizing system errors, and identifying increased needs for nurse training. This program can serve as an example for other healthcare systems adopting IV smart pump interoperability.
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Affiliation(s)
- Karen K Giuliano
- Elaine Marieb Center for Nursing and Engineering Innovation, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Jacob Balyeat
- Parkview Regional Medical Center, Fort Wayne, IN, USA
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Hult A, Zholobova I, Bäcklin E, Nydert P. Flow Rate Deviation in Infusion Pump: Infusion Set Defect Enables Pump Malfunction and Considerable Accuracy Deviation. JOURNAL OF INFUSION NURSING 2024; 47:30-35. [PMID: 38211612 DOI: 10.1097/nan.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Volumetric infusion pumps are used together with infusion sets to deliver medication to patients. Flow rate errors leading to overinfusion or underinfusion are known problems with these devices. Recently, numerous underinfusion flow rate errors were reported at a Swedish hospital. This experimental study reports on the investigation of these errors and specifically investigates the effect of operating the pump with a defective infusion set that has a visible elongation of the silicone segment of the set. Pump flow rate accuracy testing was performed using a gravimetric method. Experiments included a manipulated infusion set and a defective infusion set used in clinic. The use of a defective infusion set resulted in considerable accuracy deviations. The pump reported an infused amount greater than what was infused and did not provide any alarm or information indicating a reduced output. Using an elongated infusion set, the pump can be brought into an erroneous operating state where the infused amount delivered by the pump is considerably less than what has been programmed and what is shown on the pump display. This could put the patient at risk of not receiving the intended medication within the appropriate time.
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Affiliation(s)
- Axel Hult
- Karolinska University Hospital Huddinge, Stockholm, Sweden (Hult, Zholobova, Bäcklin); Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden (Nydert)
- Axel Hult, MSc, holds an MSc in medical engineering from KTH Royal Institute of Technology. He currently works as a biomedical engineer at Karolinska University Hospital, where his main area of expertise is infusion pumps. His previous experience includes quality engineering and regulatory compliance during medical device development. His interests include medical devices and device safety
- Irina Zholobova, MSc, works as a biomedical engineer at Karolinska University Hospital. Her tasks include periodic maintenance of various medical equipment used in intensive care, surgery, and day care. Her duties also include technical advice to care operations, support in purchasing, and participation in the hospital's improvement work and quality assurance
- Emelie Bäcklin, MSc, works as a biomedical engineer at Karolinska University Hospital and has extensive experience with medical devices used in intensive care and surgery. She received an MSc in biomedical engineering from KTH Royal Institute of Technology in 2014
- Per Nydert, MSc Pham, PhD, works as a medication safety officer at Astrid Lindgren Children's Hospital at Karolinska University Hospital. He is a registered pharmacist with a PhD based on drug safety in pediatrics. Dr Nydert has developed the Swedish database for pediatric drug information
| | - Irina Zholobova
- Karolinska University Hospital Huddinge, Stockholm, Sweden (Hult, Zholobova, Bäcklin); Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden (Nydert)
- Axel Hult, MSc, holds an MSc in medical engineering from KTH Royal Institute of Technology. He currently works as a biomedical engineer at Karolinska University Hospital, where his main area of expertise is infusion pumps. His previous experience includes quality engineering and regulatory compliance during medical device development. His interests include medical devices and device safety
- Irina Zholobova, MSc, works as a biomedical engineer at Karolinska University Hospital. Her tasks include periodic maintenance of various medical equipment used in intensive care, surgery, and day care. Her duties also include technical advice to care operations, support in purchasing, and participation in the hospital's improvement work and quality assurance
- Emelie Bäcklin, MSc, works as a biomedical engineer at Karolinska University Hospital and has extensive experience with medical devices used in intensive care and surgery. She received an MSc in biomedical engineering from KTH Royal Institute of Technology in 2014
- Per Nydert, MSc Pham, PhD, works as a medication safety officer at Astrid Lindgren Children's Hospital at Karolinska University Hospital. He is a registered pharmacist with a PhD based on drug safety in pediatrics. Dr Nydert has developed the Swedish database for pediatric drug information
| | - Emelie Bäcklin
- Karolinska University Hospital Huddinge, Stockholm, Sweden (Hult, Zholobova, Bäcklin); Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden (Nydert)
- Axel Hult, MSc, holds an MSc in medical engineering from KTH Royal Institute of Technology. He currently works as a biomedical engineer at Karolinska University Hospital, where his main area of expertise is infusion pumps. His previous experience includes quality engineering and regulatory compliance during medical device development. His interests include medical devices and device safety
- Irina Zholobova, MSc, works as a biomedical engineer at Karolinska University Hospital. Her tasks include periodic maintenance of various medical equipment used in intensive care, surgery, and day care. Her duties also include technical advice to care operations, support in purchasing, and participation in the hospital's improvement work and quality assurance
- Emelie Bäcklin, MSc, works as a biomedical engineer at Karolinska University Hospital and has extensive experience with medical devices used in intensive care and surgery. She received an MSc in biomedical engineering from KTH Royal Institute of Technology in 2014
- Per Nydert, MSc Pham, PhD, works as a medication safety officer at Astrid Lindgren Children's Hospital at Karolinska University Hospital. He is a registered pharmacist with a PhD based on drug safety in pediatrics. Dr Nydert has developed the Swedish database for pediatric drug information
| | - Per Nydert
- Karolinska University Hospital Huddinge, Stockholm, Sweden (Hult, Zholobova, Bäcklin); Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden (Nydert)
- Axel Hult, MSc, holds an MSc in medical engineering from KTH Royal Institute of Technology. He currently works as a biomedical engineer at Karolinska University Hospital, where his main area of expertise is infusion pumps. His previous experience includes quality engineering and regulatory compliance during medical device development. His interests include medical devices and device safety
- Irina Zholobova, MSc, works as a biomedical engineer at Karolinska University Hospital. Her tasks include periodic maintenance of various medical equipment used in intensive care, surgery, and day care. Her duties also include technical advice to care operations, support in purchasing, and participation in the hospital's improvement work and quality assurance
- Emelie Bäcklin, MSc, works as a biomedical engineer at Karolinska University Hospital and has extensive experience with medical devices used in intensive care and surgery. She received an MSc in biomedical engineering from KTH Royal Institute of Technology in 2014
- Per Nydert, MSc Pham, PhD, works as a medication safety officer at Astrid Lindgren Children's Hospital at Karolinska University Hospital. He is a registered pharmacist with a PhD based on drug safety in pediatrics. Dr Nydert has developed the Swedish database for pediatric drug information
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Erdfelder F, Ebach F, Zoller R, Walterscheid V, Weiss C, Kappler J, Görtzen-Patin J, Schmitt J, Freudenthal NJ, Müller A, Ksellmann A, Grigutsch D, Külshammer M, Füssel M, Zenker S. Implementation of 2D Barcode Medication Labels and Smart Pumps in Pediatric Acute Care: Lessons Learned. Appl Clin Inform 2023; 14:503-512. [PMID: 37075805 PMCID: PMC10322227 DOI: 10.1055/a-2077-2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/19/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In pediatric intensive care, prescription, administration, and interpretation of drug doses are weight dependent. The use of standardized concentrations simplifies the preparation of drugs and increases safety. For safe administration as well as easy interpretation of intravenous drug dosing regimens with standardized concentrations, the display of weight-related dose rates on the infusion device is of pivotal significance. OBJECTIVES We report on challenges in the implementation of a new information technology-supported medication workflow. The workflow was introduced on eight beds in the pediatric heart surgery intensive care unit as well as in the pediatric anesthesia at the University of Bonn Medical Center. The proposed workflow utilizes medication labels generated from prescription data from the electronic health record. The generated labels include a two-dimensional barcode to transfer data to the infusion devices. METHODS Clinical and technical processes were agilely developed. The reliability of the system under real-life conditions was monitored. User satisfaction and potential for improvement were assessed. In addition, a structured survey among the nursing staff was performed. The questionnaire addressed usability as well as the end-users' perception of the effects on patient safety. RESULTS The workflow has been applied 44,111 times during the pilot phase. A total of 114 known failures in the technical infrastructure were observed. The survey showed good ratings for usability and safety (median "school grade" 2 or B for patient safety, intelligibility, patient identification, and handling). The medical management of the involved acute care facilities rated the process as clearly beneficial regarding patient safety, suggesting a rollout to all pediatric intensive care areas. CONCLUSION A medical information technology-supported medication workflow can increase user satisfaction and patient safety as perceived by the clinical end-users in pediatric acute care. The successful implementation benefits from an interdisciplinary team, active investigation of possible associated risks, and technical redundancy.
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Affiliation(s)
- Felix Erdfelder
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Fabian Ebach
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Richard Zoller
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
| | - Verena Walterscheid
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Claudia Weiss
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Jochen Kappler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Jan Görtzen-Patin
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
- Department of Internal Medicine I - Gastroenterology and Hepatology, Nephrology, Infectious Diseases, Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany
| | - Joachim Schmitt
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Noa J. Freudenthal
- Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
| | - A. Müller
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Anne Ksellmann
- Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
| | - Daniel Grigutsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Manuel Külshammer
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Maike Füssel
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Sven Zenker
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
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