Infusion device standardisation and dose error reduction software

Abstract

In 2004, the National Patient Safety Agency (NSPA) released a safety alert relating to the management and use of infusion devices in England and Wales. The alert called for the standardisation of infusion devices and a consideration of using centralised equipment systems to manage device storage. There has also been growing interest in smart pump technology, such as dose error reduction software (DERS) as a way to reduce IV medication errors. However, questions remain about the progress that has been made towards infusion device standardisation and the adoption of DERS.We report on the results of a survey investigating the extent to which the standardisation of infusion devices has occurred in the last 10 years; how far centralised equipment libraries are being used in practice; and about the prevalence of DERS use within the UK.The findings indicate that while reported standardisation levels are high, the use of centralised equipment libraries remains low, as does DERS usage. 2 Key phrases1. Infusion device standardisation, the use of centralised equipment libraries and DERS have all been suggested as ways to improve patient safety but there has been little research on establishing the prevalence of all three on a national level.2. Progress has been made towards infusion device standardisation, however "standardisation" does not always mean that only one type of device is being used, and there is still some variability in the devices used across whole organisations.3. Due to specific clinical areas requiring different devices or alternative configurations of the same device centralised equipment libraries are not the most common method of device storage management across entire hospitals.4. Due to the significant practical and organisational challenges that face institutions wishing to implement DERS, only a small number of hospitals are using this technology, especially across entire trusts and health boards.5. Obstacles to the implementation of DERS include existing device contracts, the significant time and resources required, not being convinced of the technology, and complications related to a lack of standardisation.3

Intravenous infusion practices across England and their impact on patient safety: a mixed-methods observational study

“…Although such pumps have been widely implemented in the USA, take-up in England has been patchy and, even where smart pumps have been introduced, drug libraries may be only partially implemented. 5 There have been few studies of the role of infusion devices in ensuring safe medication administration practices, and most previous studies have taken place in the USA. 6,7 The overall aim of the study, referred to as ECLIPSE (Exploring the Current Landscape of Intravenous Infusion Practices and Errors), was to better understand current intravenous (IV) infusion practices in England and the possible role of smart pumps in managing patient safety.…”

“…Although smart pumps were in use in 68% of US hospitals in 2011, 19 a figure now likely to be much higher, their use is not yet as widespread in the UK. 5 Such technology can potentially identify and prevent some kinds of medication errors, but cannot prevent all possible errors. Smart pump use also comes at a cost, both financially and in terms of the changes needed to make their use effective.…”

“…Expressions of interest were sought from English NHS hospital trusts through the National Institute for Health Research Clinical Research Network, NAMDET and contacts from a previous study. 5 Interested parties were then invited to complete an online survey to provide an overview of their hospital, capacity to take part, infusion pump types and practices. Eighteen NHS trusts responded to the survey, providing information about 26 potential hospital sites.…”

Medical equipment libraries: implementation, experience and user satisfaction

“…Examples given of the benefits of introducing a library are cost reductions, standardization, safer storage, improved access for maintenance and help in facilitating training. Recent surveys have shown that adoption of centralized libraries has not increased markedly since 1999, with between 7-34% uptake, depending on clinical specialty [4].…”

Paediatric Standardised Concentration Infusions – A National Solution

“…Implementation rates in European hospitals fall far below those in the United States, where for the last decade accreditation has been linked to implementation 1 2. Multidisciplinary collaboration is essential, with pharmacy input and the creation of a smart pump drug library recognised as often being limiting, yet crucial factors, to implementation 3.…”