1. Steingass, Sharon K. RN, MSN, AOCN

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When seeking to improve patient safety, your goal is to change the system, making it easier to do the right thing; build high-reliability organizations; and prevent individuals from committing errors or doing harm. Technology proves essential to reducing risk in medication delivery. 1,2 Prioritizing technology investments should focus first on the phase of medication delivery most vulnerable to error-administration. 3 Then, consider this: High-risk medication infusion errors are most likely to cause harm. 4-6


Medication delivery technologies include CPOE, bar code technology, and "smart" intravenous (I.V.) medication safety systems. Compared to the other technologies, an I.V. medication safety system is associated with lower costs and more rapid implementation, and it provides the most immediate positive bedside impact. 7 The Institute for Safe Medication Practices and the Emergency Care Research Institute recognize I.V. medication safety systems as vital to reducing medication-related errors. 8,9


In the past, I.V. infusion systems didn't include dosing limits. Traditional I.V. pumps allow a nurse to program infusions anywhere from 0.1 to 999 mL/hr. But the newest I.V. medication safety systems alert clinicians if a programmed dose exceeds institution-established limits before infusion begins, reducing the risk of over- or under-infusing critical medications.


Smart I.V. medication safety systems allow for software customization to achieve the greatest impact on optimizing I.V. medication administration. Software customization requires a team approach. Nurses, pharmacists, and prescribers should review and evaluate current organizational I.V. practices and establish best-practice standards for the delivery of I.V. medications.


An infusion system becomes "smart" when the customized data set is incorporated into the software that guides the nurse at the point of administration. Modular-based smart infusion systems guide the nurse through various types of I.V. administration (large volume, syringe, and patient-controlled analgesia) off a single platform. More than "just a pump" or "smart pump," an I.V. medication safety system becomes an information technology (IT) component that impacts care delivery hospital-wide and reports back to a central server. View selection and implementation of I.V. medication safety technology as a long-term decision.


I.V. medication safety systems also provide previously unavailable data on the numbers and types of averted errors ("near misses"), for example, peak times for errors in administrating high-risk medications such as potassium, or sedation overuse in the ICU. Data analysis can help an organization reevaluate workflow, adjust high-risk medication delivery, and revise policy to reflect evidence-based best practices. Recently introduced networking capabilities allow real time data collection and monitoring.


Conventional error reporting through convenience samples or case reports usually doesn't clearly identify risk-reduction opportunities. The ability to continuously collect data throughout the organization is what truly differentiates an I.V. medication safety system from a pump or smart pump. Computerized infusion systems become a repository of ongoing quality data about I.V.-related practices, which allows your organization to easily identify and implement strategies to reduce high-risk-of-harm errors.




1. Wilson, K., and Sullivan, M.: "Preventing Medication Errors with Smart Infusion Technology,"American Journal of Health-Systems Pharmacology. 61(2):177-183, 2004. [Context Link]


2. Eskew, J., et al.: "Using Innovative Technologies to Set New Safety Standards for the Infusion of Intravenous Medications,"Hospital Pharmacology. 37(11):1179-1189, 2002. [Context Link]


3. Leape, L., et al.: "Systems Analysis of Adverse Drug Events,"Journal of the American Medical Association. 274(1):35-43, 1995. [Context Link]


4. Wilson, K., and Sullivan, M.: loc cit. [Context Link]


5. Eskew, J., et al.: loc cit. [Context Link]


6. Hatcher, I., et al.: "An Intravenous Medication Safety System: Preventing High-Risk Medication Errors at the Point of Care,"Journal of Nursing Administration. 34(10): in press, 2004. [Context Link]


7. Wilson, K., and Sullivan, M.: loc cit. [Context Link]


8. "'Smart' Infusion Pumps Join CPOE and Bar Coding As Important Ways to Prevent Medication Errors,"ISMP Medication Safety Alert. Huntington Valley, Pa. February 6, 2002. [Context Link]


9. ECRI Evaluation: "General-Purpose Infusion Pumps,"Health Devices. 31(10):352-387, 2002. [Context Link]