Karen K. Giuliano: Addressing Technology Deficits to Make IV Smart Pumps Safer, Smarter

Intravenous (IV) smart infusion pumps, which are designed to deliver prescribed doses of IV solutions and medications, are among the most frequently used technologies in healthcare. An estimated 90% of hospitalized patients receive IV medications via infusion pumps. However, as highlighted in my article in the fall issue of Horizons (available open-access at http://www.aami.org/horizons), even with the widespread use of embedded drug libraries and dose-error reduction systems, these devices continue to be associated with important and well-recognized safety issues.

A recent review of the FDA infusion device recall database indicated an unprecedented total of 24 Class I recalls for IV infusion devices, spanning virtually every infusion device manufacturer. Class 1 recalls are defined by the FDA as a situation in which a reasonable probability exists that the use of a product may cause serious adverse health consequences or death. Reasons for these recalls include incorrect dosing due to technical issues, unintended drug delivery during priming, and numerous technical issues leading to increased and serious risk of drug overdose. Overall, the general designs of current IV devices are antiquated, do not meet user needs, are not intuitive for the upcoming generation of clinical users, and have numerous safety issues. Known deficits in the technology must be improved in order to make IV smart pumps smarter and safer.

As nurses are the primary end users of IV smart pumps, considering their perspectives is fundamental to improving the overall design and usability of smart pumps. Unfortunately, nurses may not appreciate the potential risk associated with current IV smart pump devices. One study (Comput Inform Nurs. 2013;31[3]:142–9) looked at nurses’ trust and found that overall, nurses generally had a high degree of trust in their IV smart pump technology. These findings may suggest that nurses perceive that drug libraries and dose-error reduction systems provide more inherent safety than they were ever designed to provide. Nurses also may underappreciate the risk for medication administration error associated with the use of IV smart pumps.

The recent Horizons study found that numerous differences in both programming times and error rates existed when comparing various programming tasks across different IV smart pumps. Because the time it takes to program an IV smart pump is one of the primary reasons that end users bypass the drug library and dose-error reduction system during pump programming, these findings provide practical guidance and direction for consideration in future IV smart pump design.

Karen K. Giuliano, PhD, RN, MBA, is a postdoctoral fellow in the School of Nursing at Yale University in New Haven, CT.

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