Integrating Smart Pump Infusions with Electronic Health Records

Integrating smart pump infusions with electronic health records (EHR) results in fewer errors when administering medication but does not eliminate them entirely, according to a study presented during a poster session at the 2019 American Society of Health-System Pharmacists (ASHP) Summer Meetings & Exhibition in Boston, MA.

Jilian Skog of Sharp Healthcare and colleagues used a multidisciplinary team of nurses and pharmacists at a community health care center in San Diego, CA to collect infusion data between June 2017 and August 2017; and between August 2018 and September 2018. Using point prevalence methodology, investigators compared electronic orders with actual medication administration in patient care areas including emergency care, post-operative care, orthopedics, medical-surgical care, and critical care.

The investigators collected data on medication, dose, infusion rate, medication omissions, and EHR documentation accuracy. Medications that did not use smart pumps were not included in the study. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index for Categorizing Medication Errors was used to evaluate errors during the study.

One hundred thirty-five errors (48.4%) were recorded during the pre-implementation period for 279 active infusions. Investigators noted the most common errors were medication omission (31.9%), unauthorized medication (19.3%), bypassing library drug use (14.8%), and wrong rate (9.6%).

When smart pumps were integrated with EHRs, the error rate was reduced to 35%, for 102 errors in 289 infusions. Medication omission was once again the top error (41.2%), unauthorized medication (17.6%), documentation error (11.8%), and wrong rates 9.8%.

“Among these errors, 27 errors (20.0%) during pre-implementation and 18 errors (17.6%) during post-implementation involved high-risk medications including antiarrhythmics, anticoagulants, electrolytes, insulin, neuromuscular blocking agents, opioids, vasopressors, and parenteral nutrition,” investigators reported.

Overall, a 27% reduction was seen in the number of medication errors after integrating smart pump infusions with EHRs. However, investigators noted that errors continued despite the use of smart pump auto programming during IV administration, medication bar code scanning, and error reduction software.

Skog and colleagues said that further study is needed to determine why this is the case, and to “better understand practice improvement and technology optimization strategies to eliminate the remaining risks associated with infusion administration.”

RELATED ARTICLE

• Improving Patient Safety with Smart Pump-EHR Interoperability

Reference

Skog J, Lew P, Rafie S, Rizos A, Schnock K. Impact of smart pump and electronic health record (EHR) integration on infusion safety. Poster presented at: 2019 American Society of Health-System Pharmacists (ASHP) Summer Meetings & Exhibition (Session # 47-M; Abstr 93-94). June 8-10, 2019. Boston, MA.