scholarly journals The Impact of Smart Pump Interoperability on Errors in Intravenous Infusion Administrations

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jilian Skog ◽  
Sally Rafie ◽  
Kumiko O. Schnock ◽  
Catherine Yoon ◽  
Stuart Lipsitz ◽  
...  
Keyword(s):  
Intravenous Infusion ◽  
The Impact ◽  
Smart Pump

2 The impact of health information technology on medication errors in a paediatric intensive care unit

2018 ◽  
Vol 103 (2) ◽  
pp. e2.12-e2
Author(s):  
Moninne Howlett
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Medication Error ◽  
Medication Errors ◽  
Error Rate ◽  
Paediatric Intensive Care Unit ◽  
Electronic Prescribing ◽  
Novel Technology ◽  
The Impact ◽  
Smart Pump

AimsHealth information technology (HIT) is increasingly being promoted as a medication error reduction strategy. Electronic prescribing and smart-pump technology are examples of HIT widely advocated in the hospital setting. In critical care, the risks associated with paediatric infusions have been specifically addressed with calls for the use of standard concentration infusions (SCIs) in conjunction with smart-pump technology. Evidence on the benefits of HIT in the paediatric setting remains limited. This study aims to assess the impact of both electronic prescribing and a smart-pump drug library of SCIs on medication errors in paediatric critical care.MethodsA retrospective, observational study based on an interrupted time series design was conducted in the 23-bed paediatric intensive care unit (PICU) of a tertiary children’s hospital. 3400 randomly selected medication orders were reviewed over 4 epochs: pre-implementation of either technology (Epoch 1); post-implementation of SCIs (Epoch 2); immediate post-implementation of electronic prescribing (Epoch 3); and 1 year post-implementation of both (Epoch 4). Orders prescribed during the study period were included provided they had undergone clinical pharmacy review. Intravenous fluids, epidural/regional blocks, total parental nutrition, chemotherapy and patient/nurse controlled analgesia were excluded. Medication error rates were calculated applying pre-specified definitions and inclusion criteria.1 Novel technology-generated errors were identified and defined using a modified Delphi process. Errors were graded for severity using a combination of two validated grading tools.2,3ResultsOverall medication error rate based on all orders were similar in Epoch 1 and 4 (10.2% vs 9.7%; p=0.66). Altered error distribution was however evident. Incomplete and wrong unit errors were eradicated, but duplicate orders increased. Dosing errors remained the most common. 77% of pre-implementation errors were considered likely to be removed by the new technology. 24% of post-implementation errors were considered to be novel technology-generated errors. Examples included incorrect formulation selection and errors on altered electronic orders. In Epoch 2, the implementation of SCIs prior to electronic prescribing significantly reduced infusion-related prescribing errors (31.4% to 12.6%; p<0.01). An infusion error rate of 7.9% was reported post-implementation of electronically-generated standard infusion orders in Epoch 4.ConclusionThe overall medication error rate in PICU was largely unchanged by the introduction of electronic prescribing. Some errors disappeared but new errors directly attributable to the implemented technologies emerged. In the complex PICU environment, dosing errors remain common. A significant reduction in infusion-related errors was found as a consequence of the introduction of SCIs and smart-pump technology. The introduction of electronically-generated standard infusion orders brought further benefits. The results of this study show that the benefits of HIT in the paediatric setting cannot be assumed and highlight the need for further studies with increasing use of HIT in paediatric settings.ReferencesGhaleb MA, Barber N, Dean Franklin B, et al. What constitutes a prescribing error in paediatrics?BMJ Qual Saf2005;14(5):352–7.Dean BS, Barber ND. A validated, reliable method of scoring the severity of medication errors. Am J Health Syst Pharm1999;56(1):57–62.National Coordinating Council for Medication Error Reporting and Prevention. Taxonomy of medication errors1998. http://www.nccmerp.org/about-medication-errors

Impact of interoperability of smart infusion pumps and an electronic medical record in critical care

2020 ◽  
Vol 77 (15) ◽  
pp. 1231-1236
Author(s):  
Roy Joseph ◽  
Sang Weon Lee ◽  
Scott V Anderson ◽  
Matthew J Morrisette
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Infusion Pump ◽  
Medication Administration ◽  
Absolute Difference ◽  
Infusion Pumps ◽  
Adult Intensive Care Unit ◽  
Incremental Value ◽  
The Impact ◽  
Smart Pump

Abstract Purpose To describe the benefits of smart infusion pump interoperability with an electronic medical record (EMR) system in an adult intensive care unit (ICU) setting. Summary In order to assess the impact of smart infusion pump and EMR interoperability, we observed whether there were changes in the frequency of electronic medication administration record (eMAR) documentation of dose titrations in epinephrine and norepinephrine infusions in the ICU setting. As a secondary endpoint, we examined whether smart pump/EMR interoperability had any impact on the rate of alerts triggered by the dose-error reduction software. Pharmacist satisfaction was measured to determine the impact of smart pump/EMR interoperability on pharmacist workflow. In the preimplementation phase, there were a total of 2,503 administrations of epinephrine and norepinephrine; 13,299 rate changes were documented, for an average of 5.31 documented rate changes per administration. With smart pump interoperability, a total of 13,024 rate changes were documented in association with 1,401 administrations, for an average of 9.29 documented rate changes per administration (a 74.9% increase). A total of 1,526 dose alerts were triggered in association with 76,145 infusions in the preimplementation phase; there were 820 dose alerts associated with 48,758 autoprogammed infusions in the postimplementation phase (absolute difference, –0.32%). ICU pharmacists largely agreed (75% of survey respondents) that the technology provided incremental value in providing patient care. Conclusion Interoperability between the smart pump and EMR systems proved beneficial in the administration and monitoring of continuous infusions in the ICU setting. Additionally, ICU pharmacists may be positively impacted by improved clinical data accuracy and operational efficiency.

Impact of implementing smart infusion pumps in a pediatric intensive care unit

2013 ◽  
Vol 70 (21) ◽  
pp. 1897-1906 ◽  
Author(s):  
Silvia Manrique-Rodríguez ◽  
Amelia C. Sánchez-Galindo ◽  
Jesús López-Herce ◽  
Miguel Ángel Calleja-Hernández ◽  
Fernando Martínez-Martínez ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Infusion Pumps ◽  
Systematic Analysis ◽  
The Impact ◽  
Smart Pump ◽  
Programming Errors

Abstract Purpose The impact of smart infusion pumps on the interception of errors in the programming of i.v. drug administrations on a pediatric intensive care unit (PICU) is investigated. Methods A prospective observational intervention study was conducted in the PICU of a hospital in Madrid, Spain, to estimate the patient safety benefits resulting from the implementation of smart pump technology (Alaris System, CareFusion, San Diego, CA). A systematic analysis of data stored by the devices during the designated study period (January 2010–June 2011) was conducted using the system software (Guardrails CQI Event Reporter, CareFusion). The severity of intercepted errors was independently classified by a group of four clinical pharmacists and a group of four intensive care pediatricians; analyses of intragroup and intergroup agreement in perceptions of severity were performed. Results During the 17-month study period, the overall rate of user compliance with the safety software was 78%. The use of smart pump technology resulted in the interception of 92 programming errors, 84% of which involved analgesics, antiinfectives, inotropes, and sedatives. About 97% of the errors resulted from user programming of doses or infusion rates above the hard limits defined in the smart pump drug library. The potential consequences of the intercepted errors were considered to be of moderate, serious, or catastrophic severity in 49% of cases. Conclusion The use of smart pumps in a PICU improved patient safety by enabling the interception of infusion programming errors that posed the potential for severe injury to pediatric patients.

Perceptions of the Impact of “Smart Pumps” on Nurses and Nursing Care Provided

2008 ◽  
Vol 13 (2) ◽  
pp. 60-69 ◽  
Author(s):  
Marlene M. Rosenkoetter ◽  
Marilyn Bowcutt ◽  
Elena V. Khasanshina ◽  
Cynthia C. Chernecky ◽  
Jane Wall
Keyword(s):  
Medication Errors ◽  
Nursing Care ◽  
Tertiary Care ◽  
Medication Administration ◽  
Educational Background ◽  
Care Hospital ◽  
Pharmacy Staff ◽  
Sociotechnical System ◽  
The Impact ◽  
Smart Pump

Abstract Medication errors occur frequently in hospital settings, creating harmful consequences for patients and families, as well as tremendous financial losses. “Smart pump” technology is one means by which these errors can be reduced. The study reported here is a part of a three phase study and focused on the perceptions of nurses (n=512) in a tertiary care hospital regarding the impact of the implementation of “smart pump” technology and its impact on nursing care provided, medication errors, and job satisfaction. Sociotechnical System Theory and the Life Patterns Model were used to frame the study. The Infusion System Perception Scale was used to assess demographic information, and perceptions of nurses on a 30-item five-point Likert scale. Results indicate that nurses perceived the “pump” increased safe medication administration, did not decrease the perception of the punitive nature of reporting medication errors and did not increase the nurse's workload, but did make routines easier. The “pump” was perceived to increase self-confidence but had no effect on use of the pharmacy staff. Findings suggest that the “pump” could be implemented in a variety of settings, regardless of the age, gender, and educational background of the nurses. The “pump” offers an effective approach to the reduction of intravenous medication errors.

Formation of Lunar Craters and Bright Rays as a Result of Meteorite Impacts

1962 ◽  
Vol 14 ◽  
pp. 415-418
Author(s):  
K. P. Stanyukovich ◽  
V. A. Bronshten
Keyword(s):  
Explosive Charge ◽  
The Moon ◽  
Meteorite Impacts ◽  
The Earth ◽  
Lunar Craters ◽  
The Impact

The phenomena accompanying the impact of large meteorites on the surface of the Moon or of the Earth can be examined on the basis of the theory of explosive phenomena if we assume that, instead of an exploding meteorite moving inside the rock, we have an explosive charge (equivalent in energy), situated at a certain distance under the surface.

The Geosciences Applied to Lunar Exploration

1962 ◽  
Vol 14 ◽  
pp. 169-257 ◽  
Author(s):  
J. Green
Keyword(s):  
Lunar Surface ◽  
Probable Mechanism ◽  
Point Of View ◽  
Lunar Exploration ◽  
Geological Model ◽  
Apply Geophysics ◽  
Surface Features ◽  
The Impact

The term geo-sciences has been used here to include the disciplines geology, geophysics and geochemistry. However, in order to apply geophysics and geochemistry effectively one must begin with a geological model. Therefore, the science of geology should be used as the basis for lunar exploration. From an astronomical point of view, a lunar terrain heavily impacted with meteors appears the more reasonable; although from a geological standpoint, volcanism seems the more probable mechanism. A surface liberally marked with volcanic features has been advocated by such geologists as Bülow, Dana, Suess, von Wolff, Shaler, Spurr, and Kuno. In this paper, both the impact and volcanic hypotheses are considered in the application of the geo-sciences to manned lunar exploration. However, more emphasis is placed on the volcanic, or more correctly the defluidization, hypothesis to account for lunar surface features.

Asteroid and Comet Impact Speeds upon Mars: Significance for Panspermia and the Supply of Organics

1997 ◽  
Vol 161 ◽  
pp. 197-201 ◽  
Author(s):  
Duncan Steel
Keyword(s):  
Probability Distributions ◽  
Regions Of Interest ◽  
Significant Fraction ◽  
Organic Chemicals ◽  
Impact Speed ◽  
The Mean ◽  
The Impact

AbstractWhilst lithopanspermia depends upon massive impacts occurring at a speed above some limit, the intact delivery of organic chemicals or other volatiles to a planet requires the impact speed to be below some other limit such that a significant fraction of that material escapes destruction. Thus the two opposite ends of the impact speed distributions are the regions of interest in the bioastronomical context, whereas much modelling work on impacts delivers, or makes use of, only the mean speed. Here the probability distributions of impact speeds upon Mars are calculated for (i) the orbital distribution of known asteroids; and (ii) the expected distribution of near-parabolic cometary orbits. It is found that cometary impacts are far more likely to eject rocks from Mars (over 99 percent of the cometary impacts are at speeds above 20 km/sec, but at most 5 percent of the asteroidal impacts); paradoxically, the objects impacting at speeds low enough to make organic/volatile survival possible (the asteroids) are those which are depleted in such species.

Organic Syntheses During the Impact of a Comet with a Gaseous Planet

1997 ◽  
Vol 161 ◽  
pp. 189-195
Author(s):  
Cesare Guaita ◽  
Roberto Crippa ◽  
Federico Manzini
Keyword(s):  
Polymeric Material ◽  
Molecular Form ◽  
Parent Compound ◽  
Blue Filter ◽  
Organic Syntheses ◽  
The Impact

AbstractA large amount of CO has been detected above many SL9/Jupiter impacts. This gas was never detected before the collision. So, in our opinion, CO was released from a parent compound during the collision. We identify this compound as POM (polyoxymethylene), a formaldehyde (HCHO) polymer that, when suddenly heated, reformes monomeric HCHO. At temperatures higher than 1200°K HCHO cannot exist in molecular form and the most probable result of its decomposition is the formation of CO. At lower temperatures, HCHO can react with NH3 and/or HCN to form high UV-absorbing polymeric material. In our opinion, this kind of material has also to be taken in to account to explain the complex evolution of some SL9 impacts that we observed in CCD images taken with a blue filter.

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