Smart Agent is a web-based solution for establishing bidirectional communication between an infusion pump and an electronic health record (EHR). It eliminates the need for clinician double check of medication administration using an infusion pump. Because the clinician already is using the EHR to review patient health information and update status, the addition of the web service would help eliminate the potential for human error when using a manual system. The Smart Agent process encompasses the reading of pertinent patient data from the EHR, determination of a new medication dosage based on an internal protocol, input of the dosage into an infusion pump, confirmation of the medication dosage acceptance at the infusion pump, and recording the medication change back into the EHR. The widespread use of Smart Agent–type algorithms with bidirectional communication capabilities would result in safer, more efficient provision of care, as well as better value.
The administration of high-alert medications requires the use of enhanced systems to prevent errors. One commonly used system relies on independent verification of dose changes by a second clinician, a human double check. This system is inefficient, and while it may reduce, it does not eliminate error. We postulate that the ability to integrate interoperable medication infusion pumps and electronic medical records systems with existing dose adjustment algorithms can improve the safety and efficiency in the delivery of high-alert and other medications. We followed step-wise systems engineering practices to develop and build a novel system, the Smart Agent, to semi-autonomously administer intravenous insulin according to our hospital’s protocol for nurse-managed insulin infusion in the intensive care units. The prototype system used a commercial medication infusion pump and our existing electronic health record. We believe that this model of interoperable systems integration can be incrementally and broadly developed in the future to improve the safety and workflow of medication infusions.
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