Devices & Technology

Smart Pumps Get Smarter


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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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