Developing Strategic Recommendations for Implementing Smart Pumps in Advanced Healthcare Systems to Improve Intravenous Medication Safety

Abstract

Avoidable harm associated with medication is a persistent problem in health systems and the use of preprogrammed infusion devices ('smart pumps') and data monitoring is seen as a core approach to mitigating and reducing the incidence of these harms. However, smart pumps are costly to procure, configure and maintain (in both human and financial terms) and are often poorly implemented. Variation in the manner in which medicines are prepared and used within complex modern healthcare systems exacerbates these challenges, and a strategic human-centred approach is needed to support their implementation. A symposium of 36 clinical and academic medication safety experts met virtually to discuss the current 'state of the art' and to propose strategic recommendations to support the implementation of medication administration technology to improve medication safety. The recommendations were that health systems (1) standardise infusion concentrations to facilitate the development of ready-to-administer formulations of frequently used medicines, and support 'out of the box' programming of infusion devices; (2) develop and implement drug libraries using human-centred approaches and the aforementioned standard concentrations, with a theoretical understanding of how devices are used in practice; (3) develop standardised metrics and outcomes to support the interpretation of data produced by infusion devices; (4) involve all stakeholders in the development of drug libraries and metrics to ensure broad understanding of the devices, their benefits and limitations; and (5) leverage input into device design, working with manufacturers and users. Using this strategic approach, it is then possible to envisage and plan real-world implementation studies using a uniform approach to quantify improvements in safety, efficiency and cost effectiveness.

Using Video to Describe the Patient-Controlled Analgesia Pump Programming Process

“…We stopped the video after each theme to discuss the leader's impressions and suggestions for improvement. Their suggestions aligned with recent recommendations to improve medication safety as described in the Discussion section 16…”

“…Their suggestions aligned with recent recommendations to improve medication safety as described in the Discussion section. 16…”

“…Recommendations for implementing PCA pumps to improve medication safety have recently been published 16. These include the following: ( a ) standardizing infusion concentrations; ( b ) developing drug libraries that use human-centered approaches and standard infusion concentrations; ( c ) standardizing metrics and outcomes to facilitate interpretation of data produced by infusion devices; ( d ) involving all stakeholders in the development of drug libraries and metrics; and ( e ) having input into device design that would involve manufacturers and users 16. All of these recommendations would be applicable in our setting and were suggested by the nursing leaders.…”

Development of smart infusion pumps: state of the art and future perspectives

“…The Institute For Safe Medication Practices (ISMP) in the United States has proposed guidelines such as “Building a Smart Infusion System Drug Library 31 ” and “Guidelines for Optimizing Safe Implementation and Use of Smart Infusion Pumps 25 .” A national investigation by the Healthcare Safety Investigation Branch (HSIB) in the United Kingdom regarding smart IPs revealed the need to establish a nationally consistent drug library 32 . Sutherland et al 11 proposed strategic recommendations such as involving all stakeholders in the development of drug libraries and data measurement standards. In addition to the construction of the standard library, the expansion and optimization of the care area subset can more directly improve the complianc\e and satisfaction of medical staff with the use of drug libraries 33,34 , and reduce the medication error rates.…”

“…Infusion pumps overcome small changes in flow resistance or human body back pressure and liquid position changes 10 , allowing health care personnel to set the infusion rate and volume per hour, improving the accuracy of intravenous infusion. Smart IPs usually refer to preprogrammed infusion devices equipped with dose error reduction software (DERS), built-in predefined drug, concentration, and administration limit parameters (referred to as a "drug library"), as well as cross-checking and alarm functions to prevent accidental dose or concentration deviations 11 . In 2010, the Food and Drug Administration (FDA) launched the Infusion Pump Improvement Initiative 9 , which promoted the rapid development of smart IPs.…”