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Smart Pumps, Smart Management, Safe Patients When Organizations and Clinicians Team Up, Patients Are Protected

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Smart Pumps, Smart Management, Safe Patients When Organizations and Clinicians Team Up, Patients Are Protected Smart pumps, smart management, safe patients When organizations and clinicians team up, patients are protected. By Dawn Berndt, DNP, RN, CRNI®, and Marlene Steinheiser, PhD, RN, CRNI® MEDICATION administration errors are among the most vexing and costly events in health- care. For the patient, errors related to thera- peutic infusions can present grave conse- quences, including therapy disruption, over- or underdosing that reduces the therapeutic ef- fect, debilitating injury, or death. In 2020, the Institute for Safe Medication Practices (ISMP) published Guidelines for Optimizing Safe Im- plementation and Use of Smart Infusion Pumps. This resource, compiled and reviewed by clinical experts, outlines the components necessary for developing an organizational in- Bi-directional benefits and challenges Bi-directional smart infusion pumps raise frastructure that promotes safe patient care us- the standard of care but also present some challenges. ing smart infusion pump technology. In April 2021, The Joint Commission released a Sen- Benefits tinel Event Alert on smart infusion pumps that Bi-directional smart infusion pumps • also contains useful strategies. remove the human factor from manually Smart infusion pumps are sophisticated programming the infusion pump computer systems that communicate within a • connect the pump channel, medication or- der, and patient network, using software and hardware de- • promote safe medication administration signed to send the exact amount of medica- based on the provider’s order tion at a precise rate to each patient. At the in- • facilitate consistent and timely documenta- terface between the infusion pump and the tion of each infusion in the patient’s elec- nurse, critical decisions are made, presump- tronic health record. tive actions are performed, and successful or Challenges deleterious outcomes are initiated. Bi-directional smart infusion pumps Although smart infusion pumps have re- • can be cost-prohibitive duced I.V. infusion errors, continuing lapses • are available only with select infusion pump (programming, pump setup, channel/line brands mix-ups) coupled with known smart pump • rely on a sound wireless infrastructure. technology limitations require ongoing efforts to protect patients from harm. MyAmericanNurse.com May 2021 American Nurse Journal 17 Organizational responsibilities Organizations must be fully engaged in • Education Organize a collaborative oversight developing infrastructure that leads and • To ensure patient safety, clinicians committee supports safe smart infusion pump use. must show competence in the use • Involve clinician end users in the of smart pump equipment, includ- evaluation of VAD and infusion Choose appropriate smart infusion ing knowledge of indications, con- products, equipment, and technolo- pumps traindications, and manufacturers’ gies, including clinical application, Use smart infusion pumps for therapies instructions. The organization performance, infection and compli- that require precise flow-control for safe should provide: cation prevention, safety, efficacy, administration. • • smart pump operation and man- acceptability, reliability, and cost. Pump selection agement education to all clinicians • Oversight committee • Base selection on the prescribed in- during orientation and before us- • Create a committee of pharmacists, fusion therapy, rate control require- ing any device in the patient care nurses, prescribers, risk managers, ments, infusion-related risks, patient setting medication safety personnel, bio- care setting, and available organiza- • ongoing training to address medical engineers, information sys- tional resources. changes in drug library entries, us- tems personnel, human factors engi- • Standardize the types of pumps ability issues, and avoiding neers/experts, and others deemed used to promote user familiarity. workarounds and to assess routine essential to ongoing oversight for • Use separate, designated pumps users and new staff members. the smart infusion pump system. for epidural infusions, enteral infu- • Assessment • Members should meet routinely to: sions, and irrigations to differenti- • Establish policies to ensure CQI data • review CQI data from infusion ate from vascular access infusions. are retrieved, analyzed, and used to pumps (good catches, overrides, • Choose devices with anti-free-flow improve patient safety. percentage of basic functions [in- protection, air-in-line detection, and • Institute regular bedside assessment fusions programmed without us- pressure and occlusion alarms. • checks to validate DERS use. ing the drug library or safety soft- Bi-directional interoperability • Care and maintenance ware]), evaluate DERS use goals, • Consider implementing infusion sys- • After each patient use, clean and dis- and take steps to improve them tems that incorporate medication infect infusion equipment (accord- • review reported I.V. medication er- orders, a drug library, EHR, barcode ing to the manufacturer’s directions) rors, including reporting medica- medication administration, and re- with products that have antimicro- tion and biologic agent adverse porting. bial activity against pathogens likely events and discrepancies to the • Smart pumps with EHR interoper- to contaminate the equipment. appropriate department and au- ability reduce manual programming • Inspect infusion equipment and thoritative reporting organiza- errors. • supplies for integrity and function tions; regularly review medication Labeling before, during, and after use. Look errors and identify and share les- • Use medication labels on the infu- for damage before use; ensure pack- sons learned; determine if an error sion reservoir and health record doc- aging is clean, dry, and intact; and requires education, drug library re- umentation that are consistent in verify the expiration date. vision, or pump hardware or wire- format and content with the smart • Remove defective pumps, associat- less network repair infusion pump drug library. ed supplies, and administration sets • review national error reports and from patient use and label them as determine if the organization is at Establish policies and procedures such. Report the problem to the ap- risk for similar errors The use, education, assessment, and main- propriate department, the manufac- • review usability issues that inter- tenance of infusion equipment are estab- turer, and the reporting organiza- fere with safe practice and clini- lished in organizational policies, proce- tions as required. cian workflow dures, and practice guidelines. • • review infusion-associated pump Use Design infusion pump drug library recall notifications and develop a • Establish the use of smart infusion using DERS plan to manage them pumps with DERS for I.V. administra- • Initial drug library development • standardize communication tion of medications and solutions • Establish an interprofessional team processes to inform end users of (for example, continuous, intermit- to design and test the drug library. changes made to the drug library. tent, secondary infusions, PCA, and • Ongoing drug library development epidural, spinal, and nerve block in- • To avoid unnecessary alerts, update CQI = continuous quality improvement data, DERS = dose error reduction systems, EHR = electronic health fusions) throughout the acute care drug libraries regularly (to address setting, including ambulatory set- record, ISMP = Institute for Safe Medication Practices, new drugs, new drug protocols, and PCA = patient-controlled analgesia tings (perioperative/procedural/radi- drug shortages), and involve end ology care areas, emergency depart- users in the library design. Sources: Gorski et al., Institute for Safe Medication Practices ments, infusion centers). • Use a smart pump oversight team to • Set an organizational compliance assess CQI data and organizational goal for using DERS with all I.V. med- I.V. medication error reports. ications (ISMP recommends ≥ 95%). 18 American Nurse Journal Volume 16, Number 5 MyAmericanNurse.com Clinician responsibilities Clinicians must maintain their competency and adhere to the solution level of each container (bag, glass bottle), organizational guidelines for managing smart infusion pump I.V. pole height, and pump position. planning and administration. • High-risk medications • When high-risk medications are administered via the pri- Maintain clinical competency mary infusion system along with the primary infusion, at- • To ensure patient safety, stay current in infusion equip- tach the administration set below the smart infusion pump ment use and maintain your knowledge of indications, controlling the primary fluid flow and use a separate smart contraindications, and manufacturers’ instructions. pump to control the rate of the high-risk medication. Adhere to organizational guidelines Use appropriate accessories • Remain current in practice, and adhere to organizational • Use only accessory devices (administration sets, syringes, policies, procedures, and guidelines. filters) that are designed to work with the smart infusion Use patient safety technology pump according to the manufacturer’s instructions for use. • Use the drug library in accordance with organizational pol- • Use only administration sets with anti-free-flow mecha- icy, and avoid manual programming and overriding drug nisms with smart infusion pumps. library alerts. Syringe pump safety Select an appropriate infusion plan for each medication • If using syringe pumps to deliver small-volume infusions, • Identify medications
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