New report finds smart pump safety gaps

Your smart infusion pumps-are they winners or also-rans? One of the first head-to-head technology comparisons by third-party consultants has some answers. Cardinal's Alaris system got top marks from leaders in pharmacy, nursing, information technology (IT), and other hospital departments. Out of a possible 100 points, Alaris got 89.8 for product technology, vendor service, product performance, business impact, and percentage of positive user comments. B. Braun's Outlook system came in second with 88.3, followed by Hospira's Plum A+/ MedNet at 85.9. Baxter's COLLEAGUE system ended a distant fourth at 61.2. Sigma missed the race entirely.

"Manufacturers claim that you can wirelessly update drug libraries and dosing safeguards across the entire hospital," Hess noted. "They claim that you can track every person who touched a pump for a complete and automatic medication administration record.

Smart pumps have become a hot topic for two reasons, Hess explained. One is the attention that has been focused on computerized order-entry systems and other healthcare information technologies. The other is the continuing focus on the reduction of medication errors as a National Patient Safety Goal set by the Joint Commission. Goals include steps to avoid patient misidentification, unsafe use of infusion pumps, medication mix-ups, and problems with equipment alarm systems.

"If you could send an order to a thousand different pumps on every floor of the hospital, it would be a pretty compelling patient safety scenario," Hess contended. "We don't see it happening on a large scale yet, but that's the way hospitals and manufacturers are moving."

Infusion pump safety measures are still relatively simple and easy to evade compared with bedside bar-code systems, Hess said. Bar-code systems generally require positive identification before a new order can be entered, a dose administered, or any other action that might affect the five rights is initiated.

Most pumps can be turned on or off, alerts and dosing guidelines overridden, or other settings changed without positive identification. Nurse A may begin an infusion, but nothing prevents Nurse B from stopping or reprogramming the pump either deliberately or by accident. If the pump gives an out-of-dose range or other error message, anyone who knows the control sequence can override the alert. Those two safety lapses make it impossible to ensure a closed-loop drug system and an accurate medication administration record. According to Hess, hospital technology deficiencies can affect pump safety.

Part of what makes an infusion pump smart is the ability to preload drug libraries and dosing guidelines to reduce the potential for medication error. Baxter pumps and many B. Braun pumps must be loaded and updated manually. Hess reported that hospital executives have complained that manual updates are virtually impossible. Most institutions lack sufficient staff to update hundreds of pumps. And without radio frequency identification or some other remote sensing system, it is impossible to locate every pump.