Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis

Abstract

Background Smart infusion pumps affect workflows as they add alerts and alarms in an information-rich clinical environment where alarm fatigue is already a major concern. An analytic approach is needed to quantify the impact of these alerts and alarms on nursing workflows and patient safety. Objectives To analyze a detailed infusion dataset from a smart infusion pump system and identify contributing factors for infusion programming alerts, operational alarms, and alarm resolution times. Methods We analyzed detailed infusion pump data across four hospitals in a health system for up to 1 year. The prevalence of alerts and alarms was grouped by infusion type and a selected list of 32 high-alert medications (HAMs). Logistic regression was used to explore the relationship between a set of risk factors and the occurrence of alerts and alarms. We used nonparametric tests to explore the relationship between alarm resolution times and a subset of predictor variables. Results The study dataset included 745,641 unique infusions with a total of 3,231,300 infusion events. Overall, 28.7% of all unique infusions had at least one operational alarm, and 2.1% of all unique infusions had at least one programming alert. Alarms averaged two per infusion, whereas at least one alert happened in every 48 unique infusions. Eight percent of alarms took over 4 minutes to resolve. Intravenous fluid infusions had the highest rate of error-state occurrence. HAMs had 1.64 more odds for alerts than the rest of the infusions. On average, HAMs had a higher alert rate than maintenance fluids. Conclusion Infusion pump alerts and alarms impact clinical care, as alerts and alarms by design interrupt clinical workflow. Our study showcases how hospital system leadership teams can leverage infusion pump informatics to prioritize quality improvement and patient safety initiatives pertaining to infusion practices.

Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review

“…Of the 22 included studies, three identified potential problems associated with the use of IV medication infusion devices [ 26 , 32 , 35 ], and four described the application of interventions or explored the effects of the intervention developed to reduce errors that occur when using IV medication infusion devices [ 24 , 27 , 34 , 39 ]. IV medication infusion devices, such as infusion pumps and smart pumps, are widely used in healthcare environments and allow more rigorous control in the process of administering medications that are continuously infused [ 45 ]. Smart pumps are recognized as useful devices for providing safe and effective nursing care [ 15 ].…”

Mapping Injection Order Messages to Health Level 7 Fast Healthcare Interoperability Resources to Collate Infusion Pump Data

“…We then verified whether the infusion pump settings could be matched with the injection order information. This was not a study of a "smart pump" [7][8][9][10][11] that automatically adjusts the drug speed and dosage; instead, we collected information from the infusion pump and used it for a injection order matching process. Although the linkage of data with smart pumps is innovative, it is not practical to obtain approval from the Japanese regulatory agency, the Pharmaceuticals and Medical Devices Agency.…”

Clinical Decision Support Stewardship: Best Practices and Techniques to Monitor and Improve Interruptive Alerts

“…The contribution of physiologic monitor and device-based alarms is well described. 48 49 These alerts have long comprised the aural tapestry of many inpatient wards and intensive care units and have been a source of concern for more than a decade, including contribution to alarm fatigue and workflow interruptions. 4 50 However, health care systems have proceeded apace with additional vehicles for delivering interruptive alerts.…”