Improving Patient Safety with Smart Pump-EHR Interoperability

Attendees at the 2019 American Society of Health-System Pharmacists (ASHP) Summer Meetings & Exhibition in Boston, MA got a look of the effect smart pumps can have on medication safety and administrator efficiency in a session presented by John Beyer, PharmD, of the University of Iowa Health Care, and Samuel Ubanyionwu, PharmD, of Mayo Clinic. The session emphasized the potential effects of smart pumps for patient safety.

`With at least 1.5 million preventable adverse drug events (ADEs) in the United States each year, Obanyionwu said linking smart pumps with electronic health records (EHRs) could drastically lessen the likelihood of an infusion-based ADE.

With auto-programming (the ability for a specific medication order to be transferred directly from the electronic health record to the patient’s smart infusion pump) and auto documentation (the ability to electronically send information such as start and stop times to a patient’s electronic documentation), Ubanyionwu said the smart pump has many benefits. He listed promotion of patient safety, improving the efficiency of medication administration workflows, and decreasing inconsistencies in nursing documentation as a few of those benefits.

Improving the workflow for nurses or other medication administrators was an important benefit which both Ubanyionwu and Beyer emphasized. Instead of a 17-step process to administer medications, Ubanyionwu said smart pump and electronic health record interoperability would reduce that to just 7 steps.

The use of this technology is growing, though Ubanyionwu said it still has a long way to go. In 2007, only about 45% of hospitals in the United States utilized smart pumps at all, and none had a bidirectional interface between the pump and the health records. As of 2017, however, the number of hospitals using smart pumps had reached nearly 90%, and about 10% have interoperability between their pumps and EHRs. According to a 2018 smart pump performance report by KLAS Research, 58% of hospitals in the United States have plans to go live with interoperability in the future and only 17% have no plans.

According to a study by Sharp Healthcare and funded by Becton, Dickinson and Company, errors among active infusions almost always decreased after implementation of smart pump and EHR integration. Presented in a poster session as the ASHP Summer Meeting, this study found that smart pump interoperability with EHRs could decrease errors by prepopulating smart pumps with infusion orders directly from the electronic medical records, rather than drug administrators programming them manually.

According to the Sharp Healthcare study's authors, unauthorized medication errors went from 19% (n=26) preimplementation to 18% (n=18) postimplementation, and bypassing drug library use dropped from 20 15% (n=20) to 1% (n=1). The 2 error types that increased were wrong library drug selection, which went from 9 7% (n=9) preimplementation to 10% (n=10) postimplementation, and documentation errors, which increased from 2% (n=2) to 12% (n=12).²

To make interoperability between smart pumps and electronic health records possible, Ubanyionwu emphasized the need for widespread standardization, including standardization of how to document infusion concentrations and dosing units as well as system-wide rate and weight-rounding rules.

Considerations for the medication administrator’s workflow include the impact of interoperability on biomedical engineering departments; proximity and availability of the patient, medication, workstation, and smart infusion pump at the bedside; and accessibility of wired versus wireless scanners for reaching the various barcodes linking machine to medication.

Beyer, like Ubanyionwu, emphasized the effects that smart pump interoperability can have on the nursing workflow, but added that they do come with challenges. There are frequently some delays between the medication’s implementation and the machine’s update in the EHR, which could potentially create confusion if a quick change is necessary. Frequently updating and managing drug libraries is also essential, although Beyer said it can be time consuming and logistically challenging.

Despite these hurdles, Beyer said his goal is to create a sense of urgency in hospital administration to implement smart pump-EHR interoperability, both for improved patient safety and more efficient workflows for medication administrators.

References

1. Ubanyionwu S. Beyer J. "Revolutionize Medication Safety with Smart Pump-Electronic Health Record Interoperability." 2019 American Society of Health-System Pharmacists (ASHP) Summer Meetings & Exhibition; June 8-12, 2019 in Boston, MA.

2. Skog J. Lew P. Rafie S. Rizos A. Schnock K. Impact of smart pump and electronic health record (EHR) integration on infusion safety. ASHP Summer Metings & Exhibition; June 8-12, 2019 in Boston, MA.