Infusion Pumps Are Reducing Medication Errors

Research has shown that adversedrug events are knownto be the single leading causeof medical injuries, accordingto the National Patient SafetyFoundation. The greatest potential forharm lies with medication errors relatedto intravenous (IV) infusion.Hospitals are faced with the challengeof finding ways to reduce these seriousand life-threatening errors.

ALARIS Medical Systems Inc and B.Braun Medical Inc are 2 manufacturersthat have developed automated infusionpump systems. Referred to as"smart pumps" by the Institute for SafeMedication Practices, this evolvingtechnology automatically programsinfusion pumps with specific information,which differs depending on thesystem in place, and which ensuresthat programmed information correspondswith the drug orders.

ALARIS is committed to patient andcaregiver safety and to applying technologythat can reduce errors andpotential harm to patients. Nurses saythat administering IV therapy is verydifferent from administering oral medication."IV therapy is a whole process,but an oral medication is an event, andit is over. With an IV, you program andadjust throughout a shift," said TimVanderveen, PharmD, MS, executiveclinical director of the ALARIS Centerfor Medication Safety and ClinicalImprovement.

In 2001, the manufacturer introducedthe ALARIS Medley MedicationSafety System. This system is the nextgeneration of "smart" medication safetytechnology at the point of care. As acomputer-based modular system, itpermits the integration of administrationand monitoring on a single platform.The pump has the capability ofinterfacing with up to 4 different modules.The system is equipped with thecompany's dose-error-reduction systemcalled Guardrails Safety Software.This software is designed to detect IVmedication errors at the critical pointof infusion delivery to the patient. TheGuardrails Continuous Quality ImprovementEvent Tracker creates adatabase within the device that allowsa hospital to track programming errorsthat have been averted and could haveresulted in patient harm.

"We can take the data over a 3-monthperiod and get a real look at what happenedand provide a road map forfuture IV therapy," Dr. Vanderveen said.

The Signature Gold Infusion Systemis another product offering fromALARIS. Released 8 years ago, this systemis compatible with the GuardrailsSafety Software. The Signature EditionGold Infusion System consists of thesingle-channel Signature Gold InfusionModel 7130 and the dual-channelSignature Edition Gold Infusion SystemModel 7230. Both systems supportbroad clinical applications and IV setperformance, and they are designed formaximum reliability and ease of use.

Currently 70 US hospitals are usingthe Medley system with Guardrailssoftware, and 50 are using theSignature series. More hospitals are inthe process of installing systems, Dr.Vanderveen said.

Implementation of the ALARIS systemtakes about 3 months from thetime the hospital purchases the systemuntil it is up and running. "Hospitalshave to set up and agree on rules to beprogrammed into the infusion system,"he said. An example of theserules is "Are you a new patient?" If so,the system automatically clears out theold memory. The "Where am I?"option allows the nurse to program inwhich patient care area of the institutionit is being used (eg, pediatrics orthe intensive care unit). Another questionis "What medication am I aboutto infuse?" Dr. Vanderveen noted that,depending on the size of the hospitaland the number of different departments,the pump has a capacity for1000 different capabilities.

Once the rules are programmed,ALARIS conducts computer-based training,followed by a 1-on-1 training sessionwith all nurses to ensure that theyare comfortable with using the system.The hospital has "superusers" nurseswho are trained at a higher level andplay an important role in the system'simplementation. "In a 700-bed hospital,it only took 3 hours" to have thesystem running, Dr. Vanderveen pointedout.

ALARIS' job is not finished afterimplementation of the system. Projectmanagers and a support team helpmake sure that the system runssmoothly and address any questions orproblems. Hospitals using the ALARISinfusion systems will see immediateresults. "One hospital had an infusionpump that wasn't picking up an erroruntil ALARIS was in place. The errorhad been going on for 36 hours,"explained Dr. Vanderveen.

St. Joseph/Chandler Health Systemof Savannah, Ga, has seen results withthe ALARIS Medley System with continuousimprovement data capabilities.That health system is comprised of>600 beds. Prior to installing the systemin October 2002, "we spent sometime evaluating our drug-use processand looking at all steps criticallyinvolved in the medication-use process.We found that the point of greatestpotential for error was at the bedside,"said Ray R. Maddox, PharmD, directorof clinical pharmacy, research and pulmonarymedicine for the hospitals.

The St. Joseph/Chandler HealthSystem, which has >500 pumps installed,had them up and running inabout 65 days. Dr. Maddox said that 6weeks was spent building the druglibrary and developing the minimumand maximum doses, and severalweeks of training was given for thenurses and pharmacists. Within 48hours of implementation, the systemwas running smoothly, he noted.

Positive benefits of the system aretwofold. The first is intervention, becauseit stops potential serious errors,using the Guardrails software, fromoccurring. "In the first 9 months in thehospital, we saw [that] a significantnumber of errors were prevented," saidDr. Maddox. The second is the continuousquality improvement data,because "we can retool our medicationadministration."

"In my opinion of the technologiesbroadly available for health systems,this [infusion pumps] is the mostimportant technology in place becauseit does have a serious effect on reducingerrors," Dr. Maddox concluded.

It is not only the products, but theindividuals that are important at B.Braun Medical Inc. "The people componentis critical," said Rachel R.Vitoux, RN, MSN, CCRN, manager ofclinical and technical support for thecompany. "Products can only go so far,so by offering information and strategiesand looking at ways to close thegap we can avoid errors," she said.

More than half of the serious andlife-threatening errors are associatedwith IV therapy. "Programming is thenumber-1 error with infusion pumps,"Vitoux said.

Therefore, B. Braun has developedthe Outlook Safety Infusion System,available in 4 models, to help reducehuman errors. The system with doselimitstechnologies notifies the cliniciansif institution-defined dose limitsare exceeded. Patient safety is furtherenhanced with pump-based bar-codetechnology, featuring automatedchecks and balances that enhance themanual procedures already in use.

The Outlook 100 alerts clinicianswhen dose limits are exceeded, reducestitration errors, and provides set-basedfree-flow protection. "The Outlook 100is consistent with a lot of infusion systemsand ensures [that] the clinician isinfusing the medication within thehospital parameters," Vitoux said.

In addition to the DoseGuard error-reductionsoftware, the Outlook 200has DoseScan software that uses a barcodescanner. Outlook 200 featurespump-based bar coding that verifiesthe right drug, right dose, and rightpatient and authorized clinician automaticprogramming to improve safetyand reduce manual programmingerrors. It requires no wireless system toimplement bar coding.

"The Outlook 200 has a built-in barcodescanner and closes the loop of the5 medication rights," said Eric Melanson,product director, infusion systemsmarketing group, for B. Braun.

Bar-code technology leaves lessroom for error. "When titrating criticaldrugs, there is a lot of error ability, andit [the Outlook 200] alerts the clinicianto the incorrect rate. The goal is to pickkey areas where critical errors areoccurring. We're eliminating the stepsand allowing the clinicians to use theirexpertise. The expertise of cliniciansenables the industry to develop thesetechnologies," said Vitoux.

The Outlook 300 and 400 models arenot currently available. The Outlook300 will be released late in 2004, andthe Outlook 400 will be available inearly 2005, according to Melanson.The Outlook 300 has all the technologyof the 200 model plus remote accessto real-time infusion data and openarchitecture designed to help reducetime spent on manual charting and tohelp improve work flow. The mostadvanced Outlook 400 features all thebenefits of the Outlook 300 as well asan interface with existing bedside systems,wirelessly transmits up-to-dateIV orders to the infusion pump, andimproves management of patient data.

Implementation of any of the 4models takes about 5 weeks. B. Braunpersonnel spend 3 weeks with facilitypersonnel discussing which featuresthe facility wants and looking at theproduct mix to enhance safety. Regardingsafety features, Vitoux said,"We sit down with the client [representatives]and talk about which safetyfeatures to activate and the level ofsafety they want."

It takes B. Braun about 2 weeks forthe implementation phase. The facilitywill have support 24 hours a day 7 daysa week, with a team of clinical supportpersons who are experts with the system.Vitoux said that they use a 3-pronged approach for training the cliniciansusing the systems. B. Braunoffers classroom training concurrentwith unit-based in-service, which providesa bedside approach and handsontraining, and a clinical mentoringprogram. The mentoring program hashospital employees go through specialtytraining by B. Braun so that theyunderstand all the advanced featuresof the models and can provide assistanceand support for clinicians usingthe pumps, Vitoux stated.

"We take the ?Sharing Expertise'movement to heart. We come back infor follow-up service as well asadvanced feature offerings," she added.B. Braun's "Sharing Expertise" is anongoing initiative that promotes bestpractices for continuous improvementof health care products and services bysharing knowledge among its own personneland other experts.

Another educational program offeredby the company is "Ask the B. BraunSafety Expert." Launched in October2002, the free service is designed to provideclinicians and health care consumerswith answers to some of themost pressing safety issues such as medicationerrors. The panel of experts iscomprised of clinicians and nurses withpractical expertise in handling patientand clinician safety issues.

Children's Medical Center of Dallas,Tex, is very familiar with B. Braun'sOutlook system. In March 2004, thepediatric hospital installed >300Outlook 200 pumps. Personnel at the325-bed hospital spent about 6 yearsfrom researching to implementation ofa product. The hospital also has providedvaluable input in helping B. Braundevelop its pumps. "B. Braun was thefirst hospital to ask us about bar coding,"said John Tourville, RPh, PharmD,director of pharmacy for the hospital.

During the research process, Dr.Tourville said that, across the board,hospital officials continued to see that"40% of all significant errors had an IVpump attached to them."

The hospital officials decided on theOutlook 200 because "they wanted asystem they could control," he added.The Outlook 200 has many benefits."You can scan the drug and get to theright menu without having to do a lotof inputting or keystrokes. We like theverification because it works with ourhospital protocol," explained Dr.Tourville.

The hospital plans to implement theOutlook 400 when it becomes available.As for technology at the hospital,Dr. Tourville said, "Technology hasallowed us to be more clinically orientatedand allowed us to focus on pharmaceuticalcare and cut down on theturnover rate of pharmacists."

Experts in the field agree that infusionpump technology will continue toreduce medication errors. As the technologymoves forward and more advancedpumps enter the marketplace,hospitals will have more options availableto improve patient safety.