Standardizing IV pumps can reduce errors

May 21, 2007

Link between IV pumps and medication errors prompt hospitals, health systems to reevaluate IV infusion

The link between intravenous infusion pumps and medication errors is a major concern for hospitals and health systems. Serious adverse events and fatalities have prompted many institutions to reevaluate their IV infusion strategy.

One strategy being used by some larger health systems is standardizing on one vendor's product line in order to achieve continuity and ease of integration. The Health Alliance of Greater Cincinnati (HAGC), a seven-hospital health system, recently replaced all of its large-volume infusion pumps and standard IV pumps with state-of-the-art products from Chicago-based Hospira Inc.

Recently, Jewish Hospital in Cincinnati was the first in the HAGC system to implement the new Hospira products. Wiest said that HAGC is planning a rapid rollout of the new IV pumps in its other facilities throughout 2007.

Although it is more common to implement this kind of technology gradually, HAGC decided to introduce the IV products in the same fiscal year. "The pumps had to be replaced anyway," said L. Reuven Pasternak, M.D., chief medical officer and executive VP of HAGC. "But there was the safety perspective, too. There's nothing more intimately involved with safety than the device that delivers medications to patients." Pasternak said that a little more than 8,000 adverse drug events occur each year. While most of them are minor, 32% are related to medication administration.

HAGC is not alone its philosophy. Some medication safety experts have acknowledged that standardization can go a long way in addressing safety issues. "That's a philosophy that applies not only to the nature of the equipment we purchase, but now also to the implementation of more standardized care paths across the organization," said Pasternak.

One of the big advantages of the newer IV pumps is that safety technology is embedded in the devices. For example, they enable the nurse to program the pump accurately the first time. "It's great having systems in place that alert nurses to doses or infusion rates that are outside the normal expectations that we set as a clinical group," said Wiest. Pharmacists help establish reasonable limits with regard to dosing. And, if nurses have questions about a pump and are getting a warning about a dose, pharmacists are their resource for information.

At HAGC, R.Ph.s in the ICU conduct drip rounds, double-checking the nurse on program settings and making sure the pumps are running at the appropriate dose.

Although implementing a new IV infusion pump system across an entire health enterprise can be a costly endeavor, the benefits seem to offset the financial pains. "It was a purchase that had to be made," said Pasternak. The main driver, he noted, was the safety issue. "We needed to have a vehicle that reduced the chance of errors as much as possible, and that's not a hard sell despite the expense."

At a glance: The Health Alliance of Greater Cincinnati