Increasing the Use of ‘Smart’ Pump Drug Libraries by Nurses

Harding, Andrew D.

doi:10.1097/01.naj.0000410360.20567.55

Cited by 17 publications

(17 citation statements)

References 10 publications

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“…Another institution's experience showed smart pump library usage in only 37% of infusions after initial implementation despite a benchmark goal of 90% defined by the hospital. Four months of active interventions such as drug library amendments and nursing education resulted in an increase in library usage to only 70.5%, still well short of the defined benchmark (Harding, 2012).…”

Section: Implementation Of Smart Pump Technologymentioning

confidence: 98%

Utilizing Electronic Health Record Information to Optimize Medication Infusion Devices: A Manual Data Integration Approach

Chuk¹,

Maloney²,

Gawron³

et al. 2016

J Healthc Qual

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Health information technology is increasingly utilized within healthcare delivery systems today. Two examples of this type of technology include the capture of patient-specific information within an electronic health record and intravenous medication infusion devices equipped with dose error reduction software known as drug libraries. Automatic integration of these systems, termed intravenous (IV) interoperability, should serve as the goal toward which all healthcare systems work to maximize patient safety. For institutions lacking IV interoperability, we describe a manual approach of querying the electronic health record to incorporate medication administration information with data from infusion device software to optimize drug library settings. This approach serves to maximize utilization of available information to optimize medication safety provided by drug library software.

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Section: Implementation Of Smart Pump Technologymentioning

confidence: 98%

Utilizing Electronic Health Record Information to Optimize Medication Infusion Devices: A Manual Data Integration Approach

Chuk¹,

Maloney²,

Gawron³

et al. 2016

J Healthc Qual

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“…It is also important to keep in mind that alert data can only be captured if clinicians do not bypass the DERS. Thus, high DLL compliance is often the first goal of any smart pump quality improvement project …”

Section: Types Of Alerts and Alarmsmentioning

confidence: 99%

“…Clinician education, compliance auditing, and refinement of drug libraries were successful in increasing DLL compliance at one community hospital from 33% to 98% over 3 years . Another multifaceted quality improvement effort involving gathering feedback, an email campaign to disseminate compliance reports, and improving the usability of the library increased compliance from 37% to 70.5% over 5 months …”

Section: Strategies To Reduce Clinically Irrelevant Alerts and Alarmsmentioning

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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“…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.…”

mentioning

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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Increasing the Use of ‘Smart’ Pump Drug Libraries by Nurses

Cited by 17 publications

References 10 publications

Utilizing Electronic Health Record Information to Optimize Medication Infusion Devices: A Manual Data Integration Approach

Utilizing Electronic Health Record Information to Optimize Medication Infusion Devices: A Manual Data Integration Approach

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

Maximizing Smart Pump Technology to Enhance Patient Safety

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