By Christina Orlovsky Page, contributor
July 16, 2013 - In today’s high-tech times, new technology is often seen as the answer to many of our problems. In hospitals, however, no technology can possibly be a panacea to all the intricacies of patient care. Smart infusion pumps--medication administration devices that include dose error prevention software and drug libraries that assist providers in calculating dose and delivery rates--are a perfect example of “smart” technology that isn’t independently intelligent; it still requires clinicians to make critical decisions to ensure patient safety.
“Smart pumps are only as smart as we make them,” said Susan Paparella, RN, MSN, vice president at the Institute for Safe Medication Practices (ISMP), a Horsham, Pennsylvania-based nonprofit organization dedicated to medication error prevention and safe medication use.
“When a hospital buys one, the drug library does not come with the product, so it has to be built internally,” she explained, adding that roughly 72 percent of hospitals across the country have adopted smart pump technology. “There are a couple of areas of alerts: soft alerts, which allow nurses to bypass them, and hard alerts that won’t allow them to proceed. When smart pumps were first adopted, we saw a good use of the soft stop, but not a lot of the hard stop. Now, we’re trying to get organizations to look not just at smart pump compliance, but also at soft stops and hard stops and how often alerts are being overwritten.”
Paparella also advises that nurses pay close attention to alerts for low concentration, which the ISMP calls “a perfect storm for patient harm.” This is one area, she says, that should require a hard stop.
Smart pumps are only one among several technologies in use in hospitals aimed at reducing medication errors. Barcoding, computerized physician order entry (CPOE) and certain compounding devices all come complete with alerts that support clinical decision making; however, each is able to be bypassed, leading Paparella to conclude that clinicians--not technology--still hold the key to medication safety.
“None of the technology is foolproof,” she said. “Humans can override alerts or work around the technology, so you really have to pay attention to what an alert is telling you. We all have a lot of time pressures, but we really have to stop and take the time to ask and investigate why we’re getting an alert.”
According to the U.S. Food and Drug Administration (FDA), which released a 2011 report on the selective intelligence of smart pumps, “When used properly and in coordination with clinical practices, institutional policies and vigilant patient monitoring, they help reduce medication errors and prevent patient injury.” The report also included a comprehensive list of recommendations for all providers using smart pumps to ensure they maintain medication safety at all times.
The recommendation list reads:
• Before starting an infusion or changing an infusion setting, confirm that the infusion pump is programmed correctly;
• When infusing high-risk medications, have a second clinician perform an independent double check of infusion pump settings according to your facility's policy;
• If the infusion pumps at your facility contain a drug library feature, use it according to facility policy;
• When a patient is receiving multiple infusions, consider labeling the infusion pump channels and corresponding tubing with the name of the medication or fluid to avoid programming the wrong channel or infusion pump;
• Don't rely solely on the pump to identify problems. Monitor the patient and infusion according to nursing best practices and your facility's policies and procedures;
• Pay attention to displayed alerts and cautions, and investigate them appropriately;
• When multidisciplinary teams are tasked with implementing and revising smart pump technologies and drug libraries, these teams should include members of each discipline that interfaces with the device;
• Continuously reevaluate drug library settings and modify them to align with the standard of care and facility policies and procedures. This should include implementing and altering soft and hard limits (when clinically relevant) as well as standardizing concentrations, dosing configurations, and names of high-risk medications throughout your institution;
• Make sure you're properly educated to manage all infusion pumps used on your unit;
• Facility policies and procedures should be readily available, and clinicians should be promptly notified of changes or updates.
“All [of the recommendations] are important, and many speak directly to clinicians at the bedside using the pumps,” says Susan Laine, FDA spokesperson. “However, all precautions, including proper training and education of multidisciplinary teams that interface with the devices, as well as access to the facility’s most updated policies and procedures, need to be in place to ensure the safe and effective use of these devices.”
For more information, visit the ISMP or FDA online.
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