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Smart IV pumps reduce medication errors

Accreditation Connection, April 5, 2004

A patient is supposed to receive 5.1 mcg/kg/minute of dopamine through an intravenous (IV) feed. The nurse, in a hurry, accidentally programs the IV pump to give the patient 51 mcg/kg/minute of dopamine.

Without any alert from the pump, the patient could receive a fatal dose, all because the nurse simply missed the decimal point.

The Institute of Medicine's Keeping Patients Safe: Transforming the Work Environment of Nurses, published in November 2003, noted that 34% of preventable adverse drug events occurred while administering the drug. Many of those errors were caused by nurses miscalculating drug doses because of stress and fatigue, according to the report.

"The highest level of severity in medication errors generally occur with IV medications. When something is wrong with an IV, it can result in a sentinel event," says Elaine Levy, RPh, system pharmacy director at Sharp HealthCare in San Diego. "If the error slips through the pharmacy and gets up to the nurse at the bedside, it's probably going to get to the patient."

Smart infusion pumps are one way to solve IV dosing problems, says Timothy Vanderveen, PharmD, MS, executive clinical director of San Diego-based ALARIS Medical Systems Center for Medication Safety and Clinical Improvement.

Smart pumps allow the hospital to establish minimum and maximum dose ranges for medications. The pump will alert nurses if the dose they program into the pump is outside the hospital's range.

ALARIS Medical Systems developed the MedleyT Medication Safety System in 2001, and approximately 75 hospitals in the country now use it. Using ALARIS' Guardrails® Safety Software, the Medley Medication Safety System allows hospitals to create drug libraries with minimum and maximum dose ranges programmed into the pump.

The pharmacy can download data to see how many times the pumps alert nurses that the doses they entered were outside the acceptable range.

"The pharmacy has a responsibility for medication safety practices," says Claudia Russell, RN, MBA, ALARIS vice president for marketing and strategic development.

"At the point of care, the impact of pharmacy is immediately felt. The pharmacy now has access to clinical data at the point of care."

Pharmacy and therapeutics (P&T) committees establish upper and lower dosage limits based upon their hospitals' practices, says George Reid, PharmD, pharmacy director at Spartanburg (SC) Regional Medical Center. Nurses may override those limits if an alert occurs while programming the pump, but they must call the physician to alert him or her that the order is outside of the hospital's parameters. "It puts that extra safety factor in there," Reid says.

The P&T committee can look at that information to see whether the minimum and maximum dose range needs to be changed for certain medications, Levy explains.

For example, she says if nurses continually override an alert saying that 10 units/ml of heparin is too high, the P&T committee might consider either more education for the nursing staff or raising the concentration level in the pump's drug library.

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