1. Jacobs, Barbara RN, BSN, CCRN

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Another technology to keep medication safety at the heart of safety-centric nursing practice is the smart infusion pump. While we understand the technology's ability to improve the safety of intravenous medication administration, some institutions that invest in smart infusion pumps can be daunted by the process of managing the wealth of data the devices produce. A brief yet focused review of data on an ongoing basis, as well as a healthy dialogue between nursing and pharmacy, allows institutions to continually improve processes and stop medication errors in their tracks.


Last year, George Washington University Hospital, a large metropolitan medical center and teaching facility in Washington, D.C., conducted a retrospective study on smart pump technology, examining the effect of the pumps' bar-coding and dose error reduction systems on patient safety. We also implemented a proactive plan to use pump data in benchmarking for future quality improvements.


Just 6 months later, we see a clear benefit in establishing an ongoing review of our smart pump data. Our analysis identified three areas that highlight the need for continued examination of data and practices when using safety infusion systems:


[white diamond suit] Dosing at the decimal level. Ongoing review of our dose alert logs confirmed that drugs dosed at the decimal level (i.e., 0.1 mg/mL or 0.01 mg/mL) present the highest potential for error versus drugs that are dosed at the whole integer level (i.e., 1 mg/mL or 10 mcg/mL). In fact, the more decimal places, the more likely an error will occur. While we're not certain of the root cause, this underscores the need for dosing limits and careful monitoring, since many of the drugs dosed at this level are potent agents that are physiologically active at low amounts of drug per concentration or weight.


[white diamond suit] Maintaining dosing limit range for safety. After review and discussion between nursing and pharmacy, we continue to observe a modest frequency of alerts and manual limit overrides for certain drugs that are dosed to effect, such as sedatives and pain medication. While the data could indicate an opportunity to increase upper limits to and reduce the number of alerts, we choose to maintain dosing limits where we feel additional vigilance is necessary. The alerts continue to serve as a double-check system and provide optimal safety, while also providing a more complete picture of patient dose responses in our high-acuity patient population.


[white diamond suit] Reviewing repeated dosing errors of same drug. By careful review of our data, we were able to identify a significant educational opportunity for staff regarding the safe administration of a particular drug. When we analyzed the errors for this medication, we clearly saw that staff, both nurses and physicians, needed additional education in the drug's appropriate dosing. Continued review of this data will allow us to see the impact of our educational programs.



Regularly examining this data with a multidisciplinary team increases communication among unit leaders and focuses leadership attention on areas of potential concern or improvement. With an ongoing review of smart pump data, institutions can make significant progress in improving patient safety.