Use of Intravenous Smart Pumps for Patient Safety☆☆☆

Article Outline

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The smart technology intravenous (IV) medication administration pump (ie, the smart pump) is currently the best modality available to deliver IV medications or fluids. However, the use of smart pumps does not guarantee that a medication error will not occur. Human intervention in pump design, programming, establishment of the IV therapy library (the “smart technology” feature), and the actual interface with the pump when administering IV therapy are required. These human interventions strengthen the ability of the smart pump to provide more process-oriented IV therapy administrations.

Smart pumps are truly the best method for preventing catastrophic injury to the patient that may result from IV therapy administration process errors. Examples of calculation errors (eg, a 100-mg vs 10-mg dose) and rate errors (eg, 100 mL/hr vs 10 mL/hr) are abundant in health care literature and the popular press. The IV therapy library is a tailored list of medications and fluids of certain concentrations and volumes specific to the institution utilizing the IV smart pumps. For each of these IV therapies, a “soft” and “hard” limit can be established. A “soft limit” is a dose (ie, rate) that is out of range for typical therapy. A soft limit alarm forces the nurse to touch the smart pump and approve the dose before administering the infusion to the patient. The nurse can decide to change the rate of administration or override the soft limit to administer the dose. Conversely, “hard limits” are doses of IV therapy that are beyond any recommended amount to be administered. The smart pump will not allow the nurse to override this alarm. It is the hard limits that reduce the risk of catastrophic harm to the patient.

Although the IV smart pump alarms can be annoying, they are intended to protect our patients. The alarms can be subverted by not using the “therapy library” feature available in smart pumps but by using the “rate-based programming” feature. Using the rate-based programming feature is not recommended because it is an unsafe practice. Rate-based programming entails bypassing the IV therapy library (therefore the “smart technology”) with the specific limit warnings and manually entering the rate without selecting and identifying the medication being administered. Rate-based programming eliminates the ability of the IV smart pump to warn the nurse administering the IV therapy of any potentially harmful doses before they are administered.

IV smart pump alarms may sound when specific medications have not been entered into the IV therapy dictionary or drug dosing rates do not reflect standard dosing of practice protocols. To begin to eliminate unnecessary and annoying alarms that occur with smart pump use, begin to think about which method of recording and communicating the “annoying alarms” will be effective within your emergency department. Some suggested tracking methods include initiating a list on the automated medication dispensing cabinet (eg, Pyxis or Omnicell), using the incident reporting system, sending an e-mail message to your nurse manager or clinical pharmacist, calling the pharmacy, and contacting your department representative to the nurse practice council or your mentor. Any of these methods can be used to record and share your suggestions to improve care of patients receiving IV therapy. You may need to be persistent. For example, if the concentration of heparin you use for patients experiencing acute coronary syndrome (ACS) is not available in the smart pump IV therapy library, record and share that information. You know that eventually another patient will come to the emergency department with the same ACS diagnosis and will be in need of the same concentration and dose of medications. It is safer and best practice to have the medication available in the smart pump for selection rather than manually calculating the drug administration rate or locating the drip chart to tape to the pump.

Therefore I call every nurse to action! When you experience a “limit” warning on the smart pump that you believe is unnecessary, please report it. If you administer IV therapies to patients that are not available either in any form or in the correct concentration or volume, please report it. If you are unsure how to use any of the features of the smart pump, seek appropriate guidance. The importance of involvement by direct care providers (ie, smart pump end users) in the development of the smart pump IV therapy libraries cannot be overstated. When the ideas of “culture of safety,” “never events,” “pay-for-performance,” “evidence-based practice,” and “shared governance” are very prominent, direct care nurses are empowered to speak up and provide a safer work and patient care environment. Take control of your own practice by using the safety devices provided as recommended, and be an advocate or change agent for the adaptations necessary at your institution to administer IV therapies as safely as possible to your patients when using IV smart pumps.