After more than 30 years of infusion pump use with no safety system involving the actual programming (i.e., any infusion rate between 0.1 and 999 was OK), the development and use of dose error reduction software (DERS) was a huge step forward. Creating limits around programming of rates and doses that are specific to individual drugs and their therapeutic uses added a level of safety to infusion pump use. And, based on the retrospective data analysis of the DERS alerts, it was clear that unintentional as well as intentional pump programming was impacted positively. In addition, the availability of DERS forced hospitals to create best practices in IV therapy for areas that previously were overlooked as significant sources of potential errors, such as dealing with multiple concentrations or administering high-dose bolus infusions by increasing the pump rate.
In looking back over the past decade since the so-called “smart” IV pumps with DERS became a standard of practice in a high percentage of U.S. hospitals, it is amazing that this major advance came about with no impact on the traditional “five rights” of medication safety: right patient, right drug, right dose, right route, and right time. We could add a couple more “rights” that are missing: right response and right documentation. How much more could be accomplished if the infusion system was able to know that it had the correct drug and ordered dosage, that the entire infusion order had been reviewed by a highly trained clinical pharmacist, and that any dose adjustments would be compared to both the physician’s order and the hospital’s best practice limits? Taking advantage of the barcode-scanning system eliminated the manual selection of the drug and concentration; automatically populating the drug rate or dose from the electronic medical record (EMR) eliminated the potential for a dosing error; and automatic documentation from the infusion pump to the EMR eliminated delays, missing documentation, etc.
In February of 2002, the Institute for Safe Medication Practices ( ISMP) stated in a newsletter that computerized physician entry order (CPOE) and barcode medication administration (BCMA) systems , coupled with smart infusion pumps, represented a “solid defense against the most serious medication errors.” In retrospect, that comment needed an additional decade of development to become a reality.
Interoperability does not solve every infusion issue and opportunity for error, but it does take IV infusions to a new level that we would otherwise never attain.
Tim Vanderveen, PharmD, MS, is vice president of CareFusion’s Center for Safety and Clinical Excellence. He and Dan Pettus, vice president of IT and connectivity at CareFusion, are coauthors of “Worth the Effort? Closed-Loop Infusion Pump Integration with the EMR,” an article published in the November/December 2013 issue of BI&T, AAMI’s peer-reviewed journal.