Comparative analytics of infusion pump data across multiple hospital systems

Catlin, Ann Christine; Malloy, William X.; Arthur, Karen J.; Gaston, Cindy; Young, James B.; Fernando, Sudheera R.; Fernando, Ruchith

doi:10.2146/ajhp140424

Cited by 15 publications

(12 citation statements)

References 9 publications

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“…Analysis of clinical alerts produced by DERS is available with most infusion pumps by accessing infusion pump log data. Alert data can be stratified by type (soft vs hard and minimum vs maximum), drug, care profile, and clinician response (cancel, reprogram, or override) and analyzed using manual tools, pump vendor portals, or third‐party applications . It is also important to keep in mind that alert data can only be captured if clinicians do not bypass the DERS.…”

Section: Types Of Alerts and Alarmsmentioning

confidence: 99%

“…The DLL is updated, and updates are pushed to all smart pumps. A follow‐up analysis of alerts is recommended after the library update . Although alert rates vary widely by patient population, data sharing among hospitals and benchmarking may help hospitals develop and refine their DLL …”

Section: Strategies To Reduce Clinically Irrelevant Alerts and Alarmsmentioning

confidence: 99%

“…Potential Limitations Total number of alerts or alarms [17][18][19][20] Although this may be a measure of global burden, alert fatigue is likely specific to technology, care setting, drug, clinician, and patient Number of clinically irrelevant alerts or PPV 14,16,[21][22][23][24] Judging clinical relevance of an alert retrospectively is time intensive and prone to unavailable information Alerts overridden 5,23 Override is often an appropriate response if the alert is clinically insignificant or there is a legitimate clinical reason to give a dose that exceeds the threshold Low DLL compliance 5 Bypass DERS may be justified for rare drugs, rare doses, and emergencies when time constrained Nurse perceptions through survey 19,25,26 No validated tool exists Time to override 27 We do not know what an appropriate time is to override an alert Workarounds 5,25 Workarounds are more a symptom of fatigue, and several exist PPV = positive predictive value; DLL = drug limit library; DERS = dose error reduction software.…”

Section: Metricmentioning

confidence: 99%

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Strategies for Managing Smart Pump Alarm and Alert Fatigue: A Narrative Review

2018

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Although smart infusion pumps are intended to prevent medication errors by alerting users about doses that exceed set thresholds, a large number of clinically insignificant alarms and alerts create the potential for alert and alarm fatigue. We searched the PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for peer-reviewed literature (January 1, 2004-August 31, 2017) on managing smart pump alerts, alarms, and related fatigue. Twenty-nine articles that met the inclusion criteria were reviewed and organized into themes. Smart pumps give users two types of signals: alarms that indicate mechanical issues such as occlusion, air in the line, or low battery; and clinical alerts that indicate that a programmed dose exceeds a predefined safety limit. Mechanical alarms occur with greater frequency than clinical alerts, but alarms and alerts vary widely by pump model, patient population, time of day, month, and type of drug. Several causes of clinically insignificant alerts and alarms may be actionable, and strategies proposed in the literature include development of a multidisciplinary team to oversee the quality improvement effort with involvement of end users, standardization of medication administration practices, widening of drug limit library thresholds when clinically appropriate, maintaining up-to-date drug limit libraries, and interoperability. Whereas many strategies have been proposed, and case studies have been reported, none have been rigorously evaluated. In addition, more research is needed related to managing occlusion and air-in-line alarms, especially for complicated infusions. Future work should focus on the evaluation of specific and replicable alert and alarm reduction strategies with a greater emphasis on quantitative metrics.

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Section: Types Of Alerts and Alarmsmentioning

confidence: 99%

Section: Strategies To Reduce Clinically Irrelevant Alerts and Alarmsmentioning

confidence: 99%

Section: Metricmentioning

confidence: 99%

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Strategies for Managing Smart Pump Alarm and Alert Fatigue: A Narrative Review

2018

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“…Medication libraries that are not well developed can generate nuisance alarms, creating alarm fatigue and frustration by the end user. 6,8 Maximal use of this technology safety potential requires full integration of the information technology (IT) platform within an organization, from computerized physician order entry (CPOE), to pharmacy workflow and dispensing, to point-of-care medication administration. 9 Data extraction from smart pumps can be voluminous and overwhelming.…”

Section: Challenges and Work-aroundsmentioning

confidence: 99%

“…Accessing data from the smart pump overrides can provide rich data as to how the current medication library is functioning for patient safety and provided pointed opportunities for dose/range adjustments. 5,6,8 Clearly identifying override behaviors may also point to changes that need to occur farther up the IT medication processing system, such as the accuracy of CPOE medication elements. Reviewing medication usage data is also helpful to the CNS to objectively identify practice trends with specific medications and make mediation library adjustments accordingly.…”

Section: Challenges and Work-aroundsmentioning

confidence: 99%

Maximizing Smart Pump Technology to Enhance Patient Safety

Makic¹

2015

Clinical Nurse Specialist

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SMART PUMP TECHNOLOGY Infusion pumps are defined by the US Food and Drug Administration as an external medical device used to deliver fluids into a patient's body in a controlled manner. 1 Smart pump infusion technology encompasses a variety of intravenous infusion devices with built-in computers containing electronic libraries of information on selected drugs and fluids with corresponding administration dose/rate limits. 2,3 Smart pump technology was introduced into clinical practice in the early 2000s and has continued to grow in the technology's role in reducing patient harm associated with medication administration. Strategies to mitigate errors across the medication pathway of prescribing, transcribing, dispensing, administration, and documentation have been implemented. However, more than half of reported medication errors occur during the final step of administration. 2 Thus, the emerging technology of a smart pump incorporates fluid/drug administration recommendations and alarms to alert the nurse to real or potential administration errors during the programming of the pump, assisting with the safety of that final step of medication administration. However, smart pumps are not very smart on their own 4 ; the technology depends on the active use of the medication libraries within the pump on a consistent basis. Maintaining an accurate medication library is an essential piece to the successful and complete adoption of smart pump infusion technology in practice. The clinical nurse specialist (CNS) plays a vital role in providing essential information to maintain the medication library, assisting with maximal smart pump technology use in practice, and obtaining reports demonstrating the effectiveness of the device in reducing patient harm. ADVANTAGES OF SMART PUMP TECHNOLOGYOne of the largest advantages of smart pump technology is the electronic database within the pump that provides instant drug administration information at the point of care. 3,5Y7 In addition, specific alarms and drug dosing limitations can be programmed into the device, facilitating medication safety. ''Soft'' limits can be set, alerting the nurse to the fact that the medication dosage is out of range for typical therapy. When a soft limit is sensed, the device will alarm and wait for the clinician to address the alert by either overriding the alarm or adjusting the dosing programming within the recommended medication library parameters within the smart pump. ''Hard'' limits are programmed to prevent dosing parameters beyond the recommended dose. 3,5Y7 When a hard limit alarm is triggered, the infusion will not initiate, and the nurse will need to either adjust the dose to be within the programmed limit or cancel the infusion. These 2 features are believed to be essential in preventing medication errors that may be caused by incorrect manual drug calculations or manual programming errors. 7 Another advantage of smart pump technology is the matching of medication bar coding and infusion pump drug identification. 7 Matching the medication b...

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Human‐Machine Interface and Patient Safety

Singh,

Malviya

2023

Human‐Machine Interface

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Comparative analytics of infusion pump data across multiple hospital systems

Cited by 15 publications

References 9 publications

Strategies for Managing Smart Pump Alarm and Alert Fatigue: A Narrative Review

Strategies for Managing Smart Pump Alarm and Alert Fatigue: A Narrative Review

Maximizing Smart Pump Technology to Enhance Patient Safety

Human‐Machine Interface and Patient Safety

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