Implementation of 2D barcode medication labels and smart pumps in pediatric acute care: Lessons learned

Abstract

Background: In pediatric intensive care, prescription, application, and interpretation of drug doses are highly weight-dependent. The use of standardized concentrations simplifies the preparation of drugs and increases safety. For the safe application as well as easy interpretation of intravenous drugs with standardized concentrations, the display of weight-related dose rates on the infusion device is of pivotal significance.Objectives: We report on challenges in the implementation of a new information technology supported medication workflow. The workflow was introduced on eight beds in the pediatric heart surgery intensive care unit as well as in the pediatric anesthesia at the University of Bonn Medical Center. The proposed workflow utilizes medication labels generated from prescription data from the electronic health record. The generated labels include a 2D barcode which enables the infusion devices to display weight-related dose rates.Methods: Clinical and technical processes were agilely developed. The technical reliability of the system under real-life conditions was monitored. User satisfaction and potential for improvement were assessed. In addition, a structured survey among the nursing staff was carried out. The questionnaire addressed both usability as well as perceived effects on patient safety. Results The workflow has been applied 44111 times during the pilot phase. A total of 114 known failures in the technical infrastructure were observed. A survey of the nursing staff showed good ratings for usability and safety (median "school grade" 2 or B for patient safety, intelligibility, patient identification and handling). The medical management of the involved acute care facilities rated the process as clearly beneficial regarding patient safety, suggesting a rollout to all pediatric intensive care areas.Conclusions: A medical information technology-supported medication workflow can increase perceived safety and user satisfaction in pediatric acute care. The successful implementation benefits from an interdisciplinary team, active investigation of possible associated errors, and technical redundancy.

Technische Unterstützung bei der i. v.-Medikation

“…Die Umstellung verlief unkompliziert und schnell, sodass der Support nach zwei Wochen eingestellt werden konnte. Im Anschluss wurde der Prozess auf der kinderherzchirurgischen Intensivstation (KHITS) unter den Pflegefachpersonen mit einem Fragebogen evaluiert [6].…”