Intelligent infusion device . . . decision support infusion . . . smart pump . . . regardless of the name used, what makes this equipment so smart? These pumps provide clinical decision support at the point of care, employ a library of medications customized to meet an organization’s needs, and are able to calculate weight-based infusion rates. Patient safety is enhanced through alerts or hard-stops when pumps are set outside the established dosage ranges in the library. The addition of analysis software to smart pump technology will enhance quality improvement (QI) activities.
However, these pumps are not smart on their own—humans must choose to use the safety features of the pump to reap the benefits. In the quest to reduce error and prevent patient harm, this is a critical point of understanding. Whether beginning or continuing the smart pump journey, here are some helpful tips for improving patient safety.
Library Development is a Team Sport
The library must be accurate and comprehensive in order to best use the smart features of the pump for patient safety. Incomplete or poorly designed libraries can lead to workarounds and defeat safety efforts. To avoid this, team players should include pharmacists, nurses, and physicians, as well as other potential pump users. Their expertise and experience will be needed to complete the following tasks:
Data Review—Unleash the Power!
Implementing smart pump technology is only part of your safety armory—the library features must be used in clinical practice to reap the benefits. Routine review and assessment of QI data will help keep the pump safety system running smoothly.
Be a Catalyst for Change
In April 2010, the FDA launched an infusion pump improvement initiative in response to numerous reports of pump-related adverse events and device recalls.1 This project will undoubtedly facilitate device improvements, increase user awareness, and establish additional requirements for infusion pump manufacturers.
Smart pump users can contribute to this progress by sharing experiences and suggestions with vendors, the FDA, and professional organizations. The FDA has stated that many infusion pump problems are related to issues with device design and engineering, and pump users can provide valuable insight to improve these problems.
While it is easy to see the powerful potential for patient safety improvements in connecting infusion pumps with various medication management technologies, few of these interfaces currently exist. Efforts to design, build, and test interfaces and new functionalities will lead us to the next generation of “smartness.”
Deb Saine, MS, RPh, is the medication safety manager at Valley Health/Winchester Medical Center in Winchester, Virginia. She has authored numerous articles and has presented internationally on the topic of medication safety, serves as chair of the ASHP Council on Pharmacy Practice, and is the past-chair of the ASHP Medication Safety Section Advisory Group. Deb received her BS in pharmacy from the University of Toledo and an MS in management from Antioch University.
Smart Pump Selection Tips
Identify stakeholders and involve them in the selection process. Be sure to invite clinical personnel (nurses, pharmacists, physicians), representatives from purchasing and distribution (central supply, finance), biomed, information technology, risk management, quality improvement, transportation, and an administrator for project support.
Ask who, what, where, when, why, and how? For example, consider the hospital’s patient population. Will the pump serve adults only or pediatrics as well? Define the intended use of the pump—will it encompass large volume infusions, PCA, epidurals, the NICU, pediatric patients, palliative care, and anesthesia? Will it be used for bolus doses as well as infusions? These important distinctions will influence pump choice.
Determine criteria for assessment and create an evaluation tool. This will guide an objective assessment to compare pumps. Invite all the stakeholders to weigh in. Examples of criteria include battery life, number of concentrations allowed per drug, display features, wireless capabilities, and vendor support/customer service. The more comprehensive and detailed, the better the assessment—which will help avoid surprises later on in the process.
Once pump choices have been narrowed, invite vendors to demonstrate their products’ capabilities for all stakeholders. Use the evaluation tool created to document the pros and cons of each pump.
Research the pumps being considered. Seek out information using publications, the experience of colleagues, GPO resources, independent research evaluations (eg, ECRI Institute, KLAS), and site visits.
Conduct a hands-on evaluation of top choices by users. Develop scenarios for the front line staff to use for evaluation and feedback.