New IV pump, software combo drives infusion safety

A new wireless medication management system from Cerner and Hospira may significantly reduce intravenous pump errors. The new system integrates Cerner's bar-code point-of-care (BPOC) system with Hospira's smart pump to ensure that the right patient is getting the right dose of the right drug at the right time by the right route of administration.

"It provides a real element of patient safety," said Jeffrey King, director of pharmacy at Our Lady of the Lake Regional Medical Center in Baton Rouge, La., which is the alpha test site for the new system. "It is very transparent to pharmacy, but if you let something go by that you shouldn't, you've got a system in the background to help catch it before it gets to the patient," he said.

The new system uses software and a hospitalwide wireless network to connect two existing products, Hospira's Plum A+ line of programmable infusion pumps and Cerner's CareGuard BPOC. Cerner is developing similar software for smart pumps from Alaris, Sigma, Medex, and B. Braun.

The joint system is a first for both companies. Hospira focuses on infusion pumps and other devices, while Cerner's strength lies in BPOC and other technology systems.

"This is, I think, the first time we have built a clinical work flow around a specific device," said Charles Fox, Cerner's director of enabling technology. "Somebody will undoubtedly figure out a way to defeat the system, but we think we have all of the existing safety holes in IV infusion covered." In practice, he said, the system is simple to use. The nurse administering an infusion scans the patient bar code, the IV bag bar code, and the pump bar code. A wireless link connects both the pump and the bar-code scanner to the main database, which matches patient, order, and pump.

If all three are correct, the order is checked against the hospital drug library that contains formulary, dosing guidelines, and dosing limits. The drug order can also be checked against patient weight, health status, lab values, and other parameters. Once patient, pump, and order are verified, the pump is automatically programmed and the infusion can begin.

An alarm is displayed if one or more parameters do not match. The error must be corrected before the pump can be programmed and the infusion given. The entire scanning process must be repeated every time a new bag is hung or a new order is written to prevent errors later.

How effectively the new system reduces errors is still an unanswered question.

Neither Cerner nor Hospira is willing to release preliminary performance data from the alpha test at Our Lady of the Lake. But performance is robust enough that the hospital expects to expand the pilot system across the entire hospital in 2006.

"The goal is to eliminate errors that result from pump programming," said Our Lady of the Lake's chief information officer Gary Jump. "We have been piloting the system in a medical/surgical unit for several months and hope to roll it housewide early in the new year."

Cost should not be a major factor in switching to the new system, Fox said. Hospitals using existing Plum A+ units can retrofit a wireless link to integrate current inventory into the system or buy new wireless pumps. Institutions with older pumps will have to buy the new models.

"The cost isn't that much more than a standard smart infusion pump," Fox said, declining to discuss dollars and cents. "Hospitals can save far more from reduction in medication errors than they can ever spend on the technology."

Possibly so, King said, but replacing the entire pump inventory at once still represents a substantial capital cost. Hospitals must also ensure that all patients, nurses, pumps, and IV products are properly bar-coded to work with the Cerner system.