Keeping Our Smart Pumps “Smart”
Susan Skledar, B.S., M.P.H., FASHP, Cynthia Niccolai, B.S., Pharm.D., Dennis Schilling, Pharm.D., Susan Costello, R.N., M.S.N., Nicolette Mininni, R.N., MEd, CCRN, Kelly Ervin, B.S., CPhT; Alana Urban, R.N., M.S.N., CCRN
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Multiple reports site the high frequency and degree of patient harm associated with intravenous (i.v.) medication administration. In 2007, we implemented smart-pump technology to assist in standardizing i.v. medication admixtures, dosing regimens, and administration guidelines. This technology, supported by a customizable drug “library” (called “Guardrails” [GDRs]), is designed to generate GDR alerts when the nurse programs an infusion outside preset drug administration safety limits. Continuous quality improvement (CQI) software is part of this technology, allowing for ongoing analysis of GDR compliance, alerts generated during programming, and nurse responses. CQI data is key to understanding the system-wide use of the smart-pumps and their impact on safety. Post-implementation, we were committed to developing a program encompassing the retrieval and interpretation of CQI data, system-wide dissemination of information, and translation of findings into meaningful GDR library revisions. Our goal was to assist with the continued growth and success of the smart-pump program demonstrated by sustained or increased GDR compliance rates, reduction of clinically insignificant GDR alerts, and reduction in i.v. medication administration errors (ADEs).
In January 2010, we initiated a smart-pump CQI program across 15 inpatient sites and multiple out-patient cancer clinics. Data retrieval, analytics, and report preparation were the responsibility of a team of two pharmacists and a data analyst pharmacy technician. Quality indicator metrics included aggregate GDR compliance, top 25 drugs ranked by alert frequency, drugs with a > 90% alert override rate, alert rates by infusion type and programming parameters, and nurse responses to alerts. Findings are posted quarterly to an interdisciplinary website along with recommended library revisions providing an opportunity for system-wide discussion and consensus. This information is a standing agenda item for our Safe Medication Practices Subcommittee, Pharmacy & Therapeutics Committee, and Total Quality and Patient Safety Council.
To date, we have released four GDR library updates including 607 revisions derived from CQI data, event reports, and site-specific requests. System-wide GDR compliance remains at 78% prompting nursing education initiatives. Updates released in January and November 2010, and May 2011 successfully reduced the rate of clinically insignificant alerts by 20%, 27%, and 10%, respectively. Of the original top 25 drugs generating alerts, only four remained as of June 2010. A 27% reduction in pump-related errors in 2008 and 43% reduction in 2009 were reported. GDR settings prompted nurses to reprogram or cancel infusions an average of 400 times per month, potentially averting i.v. medication events. The addition of a hard GDR limit for fentanyl pre-empted 193 potentially harmful infusion errors during January to June 2010.
Our smart-pump CQI program is an effective tool for ongoing GDR library refinement, development of meaningful interventions, and reduction of potential infusion ADEs. Most importantly, it promotes system-wide interdisciplinary collaboration for the shared purpose of optimizing i.v. medication administration safety.
View a pdf of the poster from the Midyear Meeting (2,904 KB)