AimInfusion pumps are commonly used to administer medicines by intravenous infusion. Traditionally, pumps are programmed by simply entering the required number of millilitres (mL) per hour, and there has been no mechanism whereby the pump can alert the operator to a programming error e.g. the wrong mL/hour rate being entered.More recently, ‘smart’ infusion pumps have become available which have in-built drug libraries. For each drug, defined dosing limits are set. Users are required to reconfirm the selected infusion rate when ‘soft’ limits are overridden and the infusion cannot be commenced if ‘hard’ limits are exceeded. Soft and hard limits can also be set for the administration of boluses from continuous infusions. This study aimed to evaluate the introduction of smart syringe pumps into a UK PICU by objective assessment of compliance with drug library use, and by obtaining direct feedback from nursing staff.MethodsData was collected over a 4 week period, immediately following the introduction of new Alaris CC smart syringe pumps. Objective assessment of drug library use utilised a piloted data collection form. One form was completed for each infusion running at the time of daily data collection. The prescription, syringe label, and programmed pump parameters were checked for each infusion and any discrepancies noted. Where the drug library was not being used, reasons for non-use were recorded. Nursing views on the benefits and potential risks of the new smart syringe pumps were determined through individual and group interviews, each following the same pre-prepared format.Results79 individual drug infusions were observed. 4 (5%) were being given without using the drug library, i.e. just in terms of mL/hour; in all cases, the explanation was the fact that the drug was not included in the library. 73 (92%) of the infusions observed were continuous, the remainder intermittent. 13 nurses were interviewed: the unanimous view was that the new smart pumps improved patient safety. One nurse described a situation where the smart pump had prevented a 10-fold paracetamol overdose. Many nurses commented that pre-defined sedation boluses were a definite patient-safety benefit, both in terms of preventing incorrect dosing or the bolusing of the wrong drug. Nurses, in general, felt that the safety benefits of smart pumps applied equally to intermittent and continuous infusions. Nurses found the drug libraries easy to use, and whilst infusion set-up may take marginally longer with the drug libraries than without, this was offset by patient safety benefits. It was noted that the longer time taken to programme the pumps may diminish as familiarity increases. A small number of minor issues with the drug library were identified through nursing feedback, though none of them were patient-safety critical. This has allowed the drug library to be modified before the same pumps are also introduced to general wards across the Children’s Hospital.ConclusionThe drug libraries in the new smart syringe pumps were being routinely and correctly used throughout the study period. Nursing staff had embraced the new technology, seeing clear patient safety benefits.
Reducing errors in the administration of medication with infusion pumps in the intensive care department: A lean approach