In the fourth quarter of 2023, nurses at Texas Children’s Hospital reported an increase in the frequency of IV pump errors, significantly affecting confidence in the existing equipment's ability to safely deliver medications. In response, a meeting with our IV pump vendor was held in January 2024, where we requested a trial of the vendor's latest FDA-approved IV pump. From January 1, 2023, to March 4, 2024, a total of 114 IV pump-related events were logged, underscoring the critical need for updated equipment.

On March 5, 2024, the vendor conducted a clinical unit tour, approving a trial of the new IV pumps. Our hospital received the updated pumps on April 30, 2024, and immediately initiated configuration, testing, and simulation protocols. The trial officially began on May 14, 2024, focusing on critical patients in the cardiac intensive care unit (CICU). The trial pumps were used on patients transferred from the cardiovascular operating room (CVOR) or admitted to CICU until the trial concluded on June 27, 2024.

Why conduct a trial? The high number of errors and safety events associated with the current IV pumps. Nurses and physicians had lost confidence in the pumps' reliability, directly affecting patient care. The potential for these issues to impact patient safety, especially among critically ill patients, required an immediate solution.

How was the trial conducted? The trial was carefully designed to ensure accurate monitoring and results. The CICU was selected due to its critical patient population and willingness to participate. The trial was confined to a closed unit to prevent pump movement, with daily inventory tracking and server connection monitoring. Systematic pump changes were made from old to new equipment, with staff education provided beforehand. Nursing staff completed surveys to assess their experience and perceptions of the new pumps.

Trial outcomes: The 45-day trial proved successful, with 34 patients receiving care using the new pumps, administering a total of 6,000 infusions. These included some of the most critical patients, such as those on ECMO and VAD support. The trial revealed only four events, with one being directly attributed to the pump’s network card, while the others were related to connectivity and ID mismatches. The new IV pump was recommended to our hospital executives for selection.

Key learnings: Results from the nurse shift surveys were overwhelmingly positive, with 270 responses, 99% of which supported the adoption of the new pump. Additionally, 100% of respondents indicated the pumps adequately supported the complexity of their patients' infusion needs. The pumps met critical care demands without altering nursing workflows, while errors and system failures decreased significantly compared to previous equipment.

Conclusion: This trial demonstrated the value of involving front-line nursing staff and ensuring rigorous control in product/equipment evaluations. The collaborative effort between nursing, leadership, biomedical, informatics, and supply chain teams contributed to the trial’s effectiveness, resulting in greater confidence in the IV pump’s safety and performance.

Cynthia Quackenbush MBA, BSN, RN, NI-BC, FACHE

Appearances