Using Data to Improve Smart Intravenous Infusion Pumps
Vanderveen, Timothy W. (2010). Biomedical Instrumentation & Technology: Human Factors, 44: s1, 57-63.
http://www.aami.org/publications/HFHorizons/pdfs/HF2010_Smart_Pumps.pdf
Abstract
In 2002, Alaris Medical Systems, Inc., now part of CareFusion, launched a new era in intravenous (IV) infusion therapy with its introduction of so-called “smart” (computerized) pumps for large-volume and other IV infusions.1 These new devices were designed to improve medication safety by making it harder for clinicians to do the wrong thing and easier for them to do the right thing in programming the administration of high-risk IV medications. The dose-error reduction software (DERS) in the new smart pumps included drug libraries with dosage-limit and other alerts that helped intercept potentially fatal medication programming errors. Continuous quality improvement (CQI) logs in the software automatically collected data that previously were not available either to individual hospitals or to the pump manufacturer, including the programming that led to an alert and the user’s response to the alert.
To understand the need for post-introduction, iterative smart pump improvements, one should keep in mind that early usability testing was conducted with nurses who for the most part had never seen a smart pump. The idea that an infusion pump could identify doses that were out of range was well received, and in simulation testing the nurses responded as anticipated by reprogramming doses that were out of range. The usability testing did not include every possible IV drug or real patients. Once a significant number of the pumps were in clinical use, retrospective review of the CQI logs revealed a number of issues that were not previously identified. These included compliance issues in using the DERS safety system, frequent overrides of soft minimum and maximum dose alerts, and drug administration practices that often were not in compliance with established hospital policies.