Smart pumps have huge potential to cut errors

Given that errors involving intravenous medications may carry the greatest risk of morbidity and mortality, health professionals are welcoming the advent of smart pumps with programmable safety features that alert hospital staff to potential errors in IV infusions. Implementing such systems involves getting technology vendors, along with pharmacy, nursing, and medical staffs, to communicate with each other so that infusion systems and medical records systems work together.

"We looked at where harm and damage was in patient care," said Steve Smith, MBA, Entity Chief Information Officer with the Hospital of the University of Pennsylvania (HUP) in Philadelphia and chief technology officer with University of Pennsylvania Health System (UPHS). UPHS has 1,500 beds, with 725 of those at HUP. Smith spoke at the recent Healthcare Information Management Systems Society meeting in Dallas.

Most medication errors resulting in patient deaths occurred with IV infusions, Smith said. Some errors were as simple a mistaken decimal point or a missed pump reading-mistakes that are easy to make in a busy nursing unit. It became clear that intravenous infusion was an area where the most effective change could be made in the shortest period of time, he added. "Smart" infusion pumps that can be programmed to alert users to mistakes in pump settings are available. Buying new infusion pumps to replace old ones can be done quickly, he noted. "It is expensive, but it is quick."

The makers of the infusion pumps and the CPOE system were encouraged to talk with each other to ensure that their technologies were compatible, Smith said. The system chosen at UPHS provides immediate feedback to both nurses and pharmacy about what infusion is being given-where and to whom, he said.

According to William Spooner, senior VP and CIO with Sharp Healthcare, a similar smart infusion pump system has been put in place at Sharp, which has 1,800 beds in seven hospitals in five locations in San Diego. Spooner also spoke at the HIMSS meeting. Staff members from the information technology and biomedical departments must talk with each other, he said. Pharmacy, materials, and nursing people must be involved.

Sharp's system has been in place for two years, and like UPHS' system, operates wirelessly. Wireless operation was first put in use in a smaller hospital within Sharp so the details could be worked out, then instituted in the rest of the organization, Spooner said. "What was exciting from the pilot was that we started to get data immediately."

At HUP, the infusion pumps are programmed with a database of information about medications and parameters for correct dosages and infusion rates, said Sarah Erush, Pharm.D., director of drug information service, University of Pennsylvania Health System, in Philadelphia. The hospital pharmacy creates the database of information that goes into the pump. The pumps can then alert the nurse if he or she is incorrectly programming the pump for a given drug.

There are two levels of alerts in the pumps: a soft stop and a hard stop. If the system detects a minor error, Erush said, the pump warns the user, but will allow the user to override the alert. If a more serious problem is detected, the pump shuts down and will not permit an override. The system tracks soft and hard stops for continuous quality improvement, she added.

At HUP, the system has been in place since March 2002 and has undergone a few upgrades, Erush observed. Before wireless communication was available, there had been some problems ensuring that new database information was put into all the pumps at the same time. Now, all new information is wirelessly downloaded to all pumps at the same time. Although there are several "dead zones" where wireless transmission does not reach, the pumps receive new data the next time they are wheeled out of a dead zone and into an area where they can receive transmission, she noted.

The infusion system being used at UPHS is the Alaris Medley Medication Safety System with Guardrails Safety Software, Erush told the audience.

Valerie DeBenedette is a writer based in New York.