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Purpose: The innovation of clinical technologies such as smart infusion pumps enables healthcare systems to further improve safety and efficiency of patient care. The defined smart pump parameters that include high-alert medications, soft and hard dosage limits, and a customized library for specific patient care areas provide safeguards when administering medications and fluids. This project was implemented to foster the improvement of safe and efficient patient care surrounding infusion administration in two mid-size acute care hospitals for a period of 10 months. Project goals were to identify library infusions triggering the highest alerts, reduce override alerts to < 5%, increase nursing adoption of the use of the infusion pump drug library to > 95%, and avoid workarounds.
Methods/interventions: Infusion pump drug library data set reports were used for two acute care hospitals from September 2019 to July 2020. Analysis of both concurrent and retrospective pump drug library data was performed to identify trends with drug library use and override alerts. Observation of end user practice with use of the pump drug library was completed for educational opportunities. Collaboration was achieved with the pharmacy team to identify issues and implement changes to the pump drug library. Additionally, a crosswalk of the drug library alongside providers’ order sets for consistency was performed.
Findings/opportunities: The most common overridden alerts and inconsistent practice trends for maintenance infusion fluids and blood transfusions were identified. No specific KVO rate was defined in the admission order set. A single pump setting was noted for all blood product types at 75ml/hr, which does not allow infusion within 4 hours. Some variance was noted for the titratable drips dexmedetomidine and dobutamine in comparison to the order sets along with inconsistent policies throughout the organization. Moreover, educational opportunities were realized for nursing to reduce errors when using the pump drug library, avoid overriding alerts, and dissuade deviation from standard nursing practice.
Actions implemented and outcomes: In December 2020, changes were made in the pump drug library to blood products labels, removal of generic antibiotic labels, and upper limit modification to dexmedetomidine. A lower soft limit of 20 ml/hr was added for the KVO option and policies changed for blood products transfusion and KVO fluid rate. Modification to system order set builds were requested for dexmedetomidine and dobutamine in accordance with the pump drug library. Face-to-face education was also provided to staff and no adverse drug event was recorded during the project. Overrides for blood products decreased from 85.0% to 35.0%. Overall override alerts decreased from 5.8% to 3.4%. Use of the infusion pump drug library increased from 94.0% to 99.8 %.
Implications for practice: Adjustments to the infusion pump drug library alongside system order sets and policies improved alignment with clinical practice. Enhanced nursing education increased the adoption of the pump drug library use, decreased override alerts, and endorsed standard practice. Overall, these transformations reduced dosing errors and promoted patient safety and benefits for the organization.
Learning Objective:
After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.