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Infusion pump operation critical to ICU safety

Pharmacy Regulation Resource, November 9, 2005

The intensive care unit (ICU) is busy enough, and nurses and physicians must care for the sickest of all hospital patients.

Imagine having the added burden of needing to know how to operate eight different infusion pumps.

That problem presented itself in one organization, and it is one of a number of issues contributing to adverse drug events in ICU patients every year, patient safety experts said during a November 4 teleconference sponsored by the Cardinal Health Center for Medication Safety and Clinical Improvement.

A common error in the ICU is entering the wrong dose into a patient's infusion pump, said Jeffrey Rothschild, MD, an assistant professor of medicine at Harvard Medical School and associate physician at Brigham and Women's Hospital in Boston. Most involve tenfold errors, such as accidentally entering 70 mcg/kg/minute of dopamine instead of 7, or 1 unit/minute of vasopressin instead of 0.1.

Many "smart" pumps allow hospitals to preprogram limits that nurses cannot override, Rothschild said. The hospital can evaluate data from the pumps to understand nursing practice when using a pump.

From that data, hospitals can conduct education if necessary to improve infusion practices, Rothschild said.

Standardizing the models of infusion pumps at an organization can streamline operations, reducing the number of errors staff could make by having to operate each pump differently, Rothschild said.

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