New 'smart pumps' reducing IV medication errors

August 22, 2005

The next generation of "smart" IV pumps is getting smarter. The new systems that are in place are designed to guard more rigorously against errors of administration, dosing, drug interactions, and other issues.

The next generation of "smart" IV pumps is getting smarter. The new systems that are in place are designed to guard more rigorously against errors of administration, dosing, drug interactions, and other issues.

In separate interviews with Drug Topics, representatives of two of the leading smart-pump companies, Baxter and Hospira, spoke about their newest developments and those that are in the pipeline. Art Mollenhauer, general manager of infusion systems at Baxter's Global Infusion Systems, and Glennie Browne, R.N., M.S., director of global marketing, discussed Baxter's Guardian software that is used with the firm's infusion pump.

"This software allows the hospital to preconfigure appropriate dosing limits for intravenous drugs," Browne said. "Those would typically be high-alert drugs such as heparin or morphine and would be part of an agreed-upon list of high-alert drugs that varies minimally from hospital to hospital." The implementation of this program involves the pharmacist in a critical manner, she added. "The pharmacist's role is key because this individual helps guide the physician and the nursing team to develop the appropriate limits for high-alert drugs to be infused," she said. "You would always want a pharmacist to check them off and sign off on them."

Mollenhauer pointed out that no system is exempt from staff hanging the wrong medication bag on a pump or administering a drug to the wrong patient. Noting that the Guardian software builds on the "smart pump," he added that 20% to 25% of infusion pumps in the United States have been converted to smart pumps, and that several hospitals' buying agents recommend that hospitals use only smart pumps. However, the conversion is not a revolution. "Approximately 15% to 20% of our base will convert per year," he said. "This is more of a gradual change, an increasing trend that will continue over time."

Laura Brennan, manager of Hospira's medication management systems, discussed her company's MedNet system. The system consists of "a hospital-programmable software system designed to help improve medication management at the hospital patient's bedside and offer additional protection against medication errors," she said. "The system helps hospitals define medication dose limits and track intravenous drug delivery to help prevent errors."

MedNet works with Hospira's smart-pump system, the Plum A+ infusion system, said Brennan. Like Baxter's Guardian, the Plum A+ system involves hospital pharmacists with the rest of the hospital team to develop and program best-practice dose recommendations for the infusion of drugs into a database that can then be transferred to the pump.

"Pharmacists can also customize the clinical decision rules for up to 18 different clinical areas of the hospital, such as the intensive care unit, the emergency department, anesthesia, and pediatrics," she said. "The software allows each clinical area to prioritize drugs by usage so that the most frequently used drugs can be listed at the top." A wireless version can interface with the pumps and with the hospital information system network, she said.

"We know that our customers have been focusing increased attention on how to prevent medication errors," said Brennan. "And Hospira MedNet provides a way to help reduce the likelihood of medication errors during intravenous therapy, the phase most associated with these types of errors."

Like Baxter, Hospira is developing a bar-code-enabled point-of-care system. The new system, Brennan said, will also use the "five-rights"-right patient, drug, time, dose, and route of administration-checking system to protect against medication errors.

Paula Moyer is a clinical writer based in Minnesota.