An estimated 90 percent of hospitalized patients receive intravenous (IV) medications, most of which are delivered via an infusion pump1. Nurses program infusion pumps to deliver IV medications to the patient at prescribed doses and rates. Most U.S. hospitals use ‘smart’ infusion pumps, which are designed to help make infusions safe by checking the programming accuracy before the infusion is delivered to the patient.
The pump compares the drug name, dose and rate of delivery that is entered into the pump to a drug library file that is housed within every pump. The drug library is the hospital’s specific list of infusion medications and their dosing ranges. If an infusion is programmed to run outside the pre-determined dosing range, the pump will post an alert. The alert prompts the nurse either to OK the programming as is, if the programming is correct, or to cancel it and reprogram the pump if necessary. This infusion pre-check is designed to help prevent the patient from receiving an infusion that may have been incorrectly programmed.
Nearly all U.S. hospitals have adopted smart pump technology and developed a unique drug library to match their infusion practices. Because of this, one might assume that every infusion programmed is checked before it starts. However, the use of the pre-check safety feature is inconsistent2.
Bypassing the pre-check puts patients at risk of receiving an IV medication at an incorrect dose or rate. If a hospital has a 70 percent drug library compliance (use of the safety pre-check) rate, three out of every 10 initial infusions are unprotected. Even at 90 percent, one in 10 infusions is at risk. So why would the pre-check ever be bypassed?
The main reason is pump design. Some infusion pumps make it easier to bypass the safety feature than to use it.
Not all smart pumps automatically start up in the pre-check safety feature. Some pumps force the nurse to search for and select the pre-check safety feature after turning on the pump. This one extra step to turn on the drug library before programming the pump can easily be skipped.
A complete and accurate drug library also supports more consistent use of the pre-check safety feature. There are many reasons why a hospital’s drug library should be updated on a regular basis. Infusion protocols may change, which can change the dosing limits for a particular drug. A new infusion medication may need to be added to the library. If a specific medication is not listed in the pump’s drug library, the pump will be unable to check the infusion before it starts. Hospitals that routinely study their infusion pump programming data reports are able to identify drug library improvements that would support consistent use of the pre-check safety feature.
Hospitals can do two things to establish and continually improve safety pre-check compliance. First, hospitals should focus on ease of use when assessing infusion technology. Prioritize pumps designed to provide effortless access to the pre-check safety feature. Select the pumps that support the consistent use of the safety features provided by the pump.
Hospitals can also maintain a high level of infusion programming through the safety pre-checks by studying their infusion pump data reports and making regular improvements to the drug library. They should consider establishing a multi-disciplinary committee and scheduling regular infusion data reviews to identify corrections and additions to the drug library. These process changes provide for the consistent checking and updating of the drug library, consistent with current infusion practices.
Simply implementing smart pumps does not reduce or eliminate infusion programming errors. Committing to effectively and consistently using and maintaining the key safety features are critical steps to advancing infusion safety.
Timothy Hoh, B.Sc.Phm. is a Senior Manager of Global Medical Affairs at Baxter International Inc. and has been in that role since 2012 and with the company since 1990. In his current role, Hoh is responsible for research and development to enhance Baxter’s infusion systems. He also has expertise in best practices for continuous quality reporting; drug library development for infusion devices in support of hospitals’ patient safety initiatives; expertise in aseptic compounding and pharmacy cleanroom designs for hospitals across Canada. Hoh earned his pharmacy degree from the University of Toronto.