A Comparison of Automated Infusion Device Technology to Prevent Medication Errors in Pediatric and Adult Intensive Care Unit Patients

Abstract

Objective: To compare possible differences in the proportion of medication errors associated with high-risk medications that were avoided by the use of automated infusion device (AID) technology in pediatric and adult intensive care unit (ICU) patients. A secondary purpose was to investigate the number of serious adverse drug events (ADEs) identified by root-cause analyses (RCA). Method: The study included pediatric and adult patients receiving high-risk medications by continuous infusion in an academic medical center with mixed medical-surgical ICUs. A retrospective evaluation of 1 year's data collected prospectively in an AID database was used to compare the proportion of medication errors avoided based on reprogramming events (2.5 times limit as a low threshold) and overrides (10 times limit as high). Information obtained from RCAs was used to compare the proportion of serious ADEs that occurred during the 5-year periods before and after AID implementation. Results: The pediatric population was 1.68 times (95% confidence interval [CI], 1.18 to 2.38) more likely to require a reprogramming event than the adult acute care population for all high-risk medications combined. Significantly more reprogramming events occurred in the pediatric patients with potassium (relative risk [RR], 2.77; 95% CI, 1.15 to 6.68) and insulin (RR, 2.73; 95% CI, 1.15 to 6.45) infusions. Additionally, there were more overrides in the pediatric compared to the adult population for the high-risk medications (RR, 1.82; 95% CI, 1.32 to 2.53). The number of serious adverse or sentinel events as identified in RCAs decreased from six before (four deemed preventable by AID technology) to three (zero preventable) after AID implementation. Conclusions: This study demonstrates that AID technology when properly used leads to reductions in medication errors and possibly serious ADEs in critically ill patients receiving high-risk medications. The technology appears to be particularly beneficial in pediatric patients with weightbased dosing strategies. However, the potential for clinicians to override the alerts remains a concern.

Interventions to reduce medication errors in neonatal care: a systematic review

“…Identified studies were grouped according to their intervention type and are presented in Table 1, together with an example of an intervention within that group. The six intervention types included: technology ( n = 38), 18 –55 organizational ( n = 16), 56 –71 personnel ( n = 13), 72 –84 pharmacy ( n = 9), 85 …”

“…Hennings and colleagues identified that neonatal ICU staff were almost twice as likely (RR 1.68; 1.18-2.38) to reprogramme pumps than adult ICU staff. 20 Whether this was just due to staff ignoring or overriding the alerts or because the medication library and associated functions were not sufficiently programmed for use in the neonatal unit is unclear. However, these examples highlight the importance around thorough implementation strategies and the requirement to constantly monitor and evaluate the use of new technologies as they are implemented within the neonatal unit.…”

“…Online parenteral nutrition calculator [23][24][25][26][27][28][29][30] IV administration technology (n = 4) Auomated infusion devices [19][20][21][22] Barcoding (n = 3) Barcode medication administration system [31][32][33] Organizational (n = 16) Guidelines, policies, and procedures (n = 9)…”

Measures to prevent medication errors in intensive care units

“…However, there were certain limitations: the results were based on self-reporting of errors and a BCMA system was introduced at the same time. The AID technology is mainly recommended in pediatric units where patients are at a higher risk of inadequately ordered/set care (Hennings et al, 2010). Nicholas and Agius (2005) explain that smart pumps may warn nurses of errors in the process (not the right patient, amount, drug, time or route).…”

Direct Observational Study of Interfaced Smart-Pumps in Pediatric Intensive Care

“…Hennings et al reported increased limit overrides and 1.68 times more reprogramming events for pediatric compared with adult patients in intensive care. 20 Benefits may be increased due to the particular advantages smart-pumps offer in this complex setting, such as supporting the programming of weight-band and care-unit specific SCIs. 34,35 The extensive and highly customized nature of the library and the strong safety culture in our PICU are likely contributors to the low error and high compliance rates identified.…”