By Suzi Birz, principal, HiQ Analytics, LLC
Driven by patient safety, caregivers continue to look for ways
to eliminate medication errors during drug administration. One major
breakthrough since the landmark 1999 Institute of Medicine Report, “To Err Is
Human,” came with the introduction of dose error reduction software built into
intravenous infusions devices, known as “smart pumps.”
Another medication safety technology has appeared: barcode
medication administration. Recently, hospitals have been using barcoded
medications for non-infusion drugs. Now, a seamless system is available to help
achieve safety benefits for drugs delivered intravenously. These infusion pumps
include barcode medication administration as a built-in component of a
computerized infusion pump with a dose error reduction system.
“Absolutely, ‘smart pump’ technology should be a required
standard for care,” said Christopher A. Woodruff, R.Ph., pharmacy project lead,
barcoding/patient safety for Bon Secours Health System Inc., in Suffolk,
Virginia. “If auto-programming from barcodes can remove key pad errors caused by
human interactions, this should be assessed as the next step.”
Tim Vanderveen, PharmD, MS, vice president of the Cardinal
Health Center for Medication Safety and Clinical Improvement, in San Diego,
California, explained that infusion devices are not new to hospitals. In fact,
they have been around for at least 40 years.
“What is new is the ability to use barcoded labels on the IV
bags and on the patient wrist band to address errors made by giving the wrong
drug or concentration to a patient or giving the right drug to the wrong
patient,” Vanderveen said.
And, he added, there are new developments on the way.
Connecting infusion devices to the hospital’s wireless network
will allow direct communication from the pharmacy information system, enabling a
physician’s order for IV medications to be transmitted directly to a patient’s
infusion pump.
“This further reduces manual programming and helps to prevent
errors by pre-programming the dose and by automatically completing the required
documentation,” Vanderveen said.
Intravenous Infusion Devices with Barcode Medication
Administration
The Alaris System from Cardinal Health combines barcoding with
dose error reduction software.
“The Alaris Auto-ID module streamlines the clinical workflow
by providing confirmation of patient, clinician and drug information via the
same user interface used for programming infusions, without ever having to wait
to establish a wireless connection,” Vanderveen explained.
Vanderveen outlined the steps for using these devices:
- Step 1: Pharmacy software adds a barcode to the IV
medication label. (A manufacturer-applied NDC barcode can also be used.)
- Step 2: Clinician scans the ID badge to gain access to the
pump programming.
- Step 3: Clinician scans the patient wristband, associating
the patient to the pump. (This step only needs to be done when the device is
powered on, not with every patient encounter.)
- Step 4: Clinician scans medication, identifying the drug
and concentration.
- Step 5: System automatically pre-populates the infusion
parameters.
- Step 6: Clinician starts infusion after verifying the
information displayed on the pump.
- Step 7: System relays documentation to the electronic
medication administration record (eMAR).
Vanderveen explained that there are three ways to implement
the system, depending on the technology available in the hospital.
“The Alaris Auto-ID module can be implemented in a
non-networked environment,” he said. “Hospitals without a comprehensive wireless
network can still gain the safety benefits of IV barcoding to ensure the
medication is administered to the right patient and the correct medication and
concentration are automatically selected from the pump’s extensive library.”
Vanderveen asserted that wireless is the wave of the future.
“Adding the wireless connectivity helps hospitals manage the
drug library in each pump and simplify the documentation of the IV infusions by
providing patient-specific data,” he said. “Using the Alaris server and gateway,
hospitals can relay information to third-party eMAR systems to eliminate
error-prone and time-consuming paperwork.
“Ultimately, the combination of wireless, barcoding, order
transfer with automatic programming and completion of the eMAR will transform IV
therapy and add significant safety advances to the medications most associated
with the risk of harm,” Vanderveen added. “With 60 percent of the potential
adverse drug events and 70 percent of the drug costs associated with IV
medications, focusing on IVs is critical.”
Impact on Pharmacy and Nursing
“These features add a comfort level and sense of safety for
the clinicians,” Woodruff explained. “The barcode eliminates the need for the
clinician to use the keypad and page through the drug and profile selection.
Also, the display feature on the pump assists at change of shift with the drug,
dose and override information readily available on the pump.”
Woodruff added that another feature of these pumps that is
often undersold is the reporting capability.
“Monitoring is no longer dependent on voluntary
admission—there is full disclosure from the pumps,” he noted. “Questions can be
addressed, such as, are the drug therapies being administered as the physician
intended and at a safe rate, as well as what drug doses are being overridden.
This provides for the first time a true representation of what occurs at the
bedside in regards to IV medication administration. Traditionally errors would
not have been found until an adverse affect to the patient was discovered.”
Learning to Use the New Pumps
“It’s simple for a nurse in a patient care area because it was
designed to fit into the existing workflow,” Vanderveen stated.
“Training time will depend on the system being implemented.
But, more importantly, it depends on the environment from which the hospital is
migrating,” Woodruff added. “When first moving to smart pump technology, the
nurse training might take an hour and include the programming the pump as well
as use of the supplies with the pump, such as the tubing. If the hospital has
the smart pump already, learning to use the barcode reader to identify the
clinician, the patient and the drug would take 30 minutes or less.”
Both Vanderveen and Woodruff extol the training of “superusers,”
nurses in the patient care areas that receive more extensive training.
Take-away Message
“Smart pump technology allows nurses a sense of comfort that
if they accidentally program the pump outside the range, the pump will not allow
the infusion,” said Lori Schultz, RN, Risk Manager at SSM St. Mary’s Health
Center in St. Louis, Missouri. “However, nurses should remember that the
technology cannot replace their experience and critical thinking.”
For more information, visit the Alaris Products Web site.
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