Smart Pumps Save Lives

December 30, 2015    |   By: Calevir

SMART PUMPSIntravenous infusion pumps have been used for many years to deliver medications at precise rates or in specific amounts. However, “smart” pumps that have software that calculates doses and alerts users to potential errors are becoming more prevalent. They include a library of medications that includes dosing guidelines, dose limits and clinical advisories. The pumps collect data about medication administration, which allows organizations to analyze pump use, identify opportunities to provide safer care, and proactively take action. While smart pumps are not fool-proof, they have been known to decrease the likelihood of harm caused by incorrect medication dosage calculations.[1]

Citizens Memorial Hospital (CMH) is an 86 bed acute care facility with Medical-Surgical, ICU-Telemetry, The Birth Place and Geriatric Psychiatric inpatient units. CMH adopted smart pumps more than three years ago, but utilization had deteriorated over time to about 50%. In early 2014, Lesa Stock, Chief Clinical Officer, asked Pharmacy Director Renee Trewyn to analyze utilization to understand what could be done to increase smart pump usage across the organization. Stock felt strongly that the decreased use of the pumps could be compromising patient safety. At that time, utilization rate of pumps was dependent primarily on the nursing staff, with pharmacy’s role having evolved into editing the library at the request of nursing. It was a reactive versus proactive process, which frustrated Trewyn.

 

WHAT CHANGED?

Pharmacy decided to adopt increasing utilization of smart pumps as a performance improvement project in FY 2014. Pharmacists had been providing routine clinical oversight for PCA pumps and heparin drip utilization, but now expanded that role to identify missed opportunities for utilizing the smart pump drug library. Pharmacists interviewed nursing staff in each unit to understand why smart pumps were not used for some medications and which drug entries in the drug library were problematic with routine use. Pharmacists addressed the nurses’ concerns about specific medications and dosages routinely used in each department making edits to the drug library, and continued to re-emphasize the increased safety afforded when smart pumps are appropriately and consistently used. Focused education that all infusions should be administered utilizing the smart pump by choosing the drug from the appropriate drug library, and making minor edits such as allowing for overfill with biologics resulted in a 40% increase in compliance on two nursing units, but at year end the system overall compliance remained below goal.

In the second year of the project, reducing unnecessary alerts was identified as a strategy to increase smart pump utilization and increase patient safety. Pharmacists worked with each unit to review the drugs and dosages routinely used for their patients and to set alert levels appropriately, which decreased annoyance. Review of monthly detail reports by physicians, nurse managers and pharmacists allowed identification of medications for which hard and soft limit hits resulted in alarms. Records for the infusions demonstrating hard limit hits were examined to see if a simple edit was required, such as weight based dosing limits that were edited to allow for heavier patients than expected, or if a potentially serious adverse event may have been averted.

Pharmacists reviewed the parameters for drugs demonstrating multiple soft limit alerts and reset those limits to alarm at safe, reasonable levels where possible. Adding an entry with higher limits and restricting its use to cardiac cath lab allowed safe use of dobutamine throughout the rest of the hospital while reducing alerts when used for stress testing. In this second year of the project, the overall compliance with smart pump utilization demonstrated a sustained and steady increase, reaching the interim goal at six months. It is expected that the reduction in numbers of alarms will lead to increased attention to those that do alert.

According to Trewyn, possibly the most significant contributor to the success of the project is that the project is important to so many stakeholders. CMH utilizes outcome report cards across the organization, and the CCO directed that unit smart pump utilization be added as a safety metric for all hospital nursing managers. The overall utilization rate is reported on the pharmacy director’s report card. Individual pump utilization rate has been added to performance evaluations for nurses on some units. Overall utilization rate and “Good Saves” are reported to the Pharmacy and Therapeutics Committee and by the CCO to all medical and nursing staff. Hospital-wide focus on utilization and transparency of results has driven increased use.

UTILIZATION INCREASES—LIVES SAVED!

Smart pump utilization is measured on a monthly basis at Citizens, and is routinely addressed with medication events by the Medication Administration Committee. Utilization has increased to about 70% hospital wide, with some departments scoring higher. Clinical staff is confident that the pumps are more often used appropriately. When an alert goes off because the hard limit is reached, staff knows action must be taken, avoiding a medication error and potential harm to the patient. Kudos is given to the pharmacy and nursing staff who now work more collaboratively to provide a safer environment for their patients. Increased focus and team work have paid off!

 

RENEE TREWYN is the Pharmacy

Director at Citizens Memorial Hospital in

Bolivar, Missouri. You can reach her at

renee.trewyn[email protected]

[1] http://www.ismp.org/Tools/guidelines/smartpumps/default.asp#general

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