Pharmacy Times

"Smart" Pump Technology

Author: Stephen F. Eckel, PharmD, BCPS, Assistant Director of Pharmacy, University of North Carolina Hospitals

Over the past decade, various technologies have been introduced to reduce the number of medication errors associated with the medication-use process. Computerized prescriber order entry has been adopted to aid the physician in appropriate prescribing. Robots and automated dispensing machines have been utilized to help pharmacists in the dispensing of medications. Finally, point-of-care technology has been introduced to ensure that the right patient gets the right medication at the right time.

All of these technologies are essential and very helpful in enhancing patient safety, but they are ineffective at reducing intravenous (IV)-administration medication errors, which are some of the most costly and dangerous. Point-of-care technology will ensure that the nurse selects the correct IV medication to give to the correct patient, but it will not assist in the programming of the IV pump. The nurse still has to perform this step, and errors can result.

Some of the errors that can occur are calculation errors. The nurse is responsible for taking a physician's order and converting it to a flow rate. For example, the physician may prescribe a drug to be given in mcg/kg/min, but the pump can deliver only in mL/hr. To be able to give this drug, the nurse has to know the concentration of the drug and the weight of the patient. The nurse will then need to calculate by hand how to program the pump.

Other errors that could be introduced are programming errors. For instance, the nurse may want to give an insulin infusion of 4.5 units per hour. If the concentration is 1 unit/1 mL, the rate would be 4.5 mL/hr. If the nurse hits the decimal point and it does not register, the patient could mistakenly receive 45 units per hour, as opposed to 4.5 units per hour.

In both of these situations, the nurse may never know that the pump was programmed incorrectly until the patient has an untoward response. Also, these scenarios still can occur even in an institution that has implemented many of the technologies mentioned above.

To prevent IV-administration medication errors, vendors are beginning to introduce pump technology utilizing decision-support software. A drug library will be completed by the institution and will be imbedded as a safety tool into these pumps. These drug libraries will have a listing of the drug name, the standardized concentration used at that institution, and an appropriate dosing range for that drug. This list also can be updated as new prescribing information is known or drugs are changed on the formulary. The pumps will store usage information that can be downloaded to provide quality assurance data to demonstrate the value of the technology.

If a physician prescribes dopamine to be infused at 15 mcg/kg/min, these "smart" pumps will greatly decrease the chance for IV-administration errors. To provide the infusion to the patient, the nurse would select dopamine from the drug library. The drug concentration and infusion parameters would automatically appear if the data had been preloaded into the software. The nurse would need only to enter the dose the physician prescribed and the patient weight. The pump would make the calculation from mcg/kg/min to mL/hr, reducing the chance of the nurse making a calculation error.

The drug software also would have an appropriate infusion range built into it. If the nurse entered an infusion rate that exceeded the predetermined limit, the pump would alert the nurse and either not allow the infusion to proceed (hard stop) or make the nurse confirm that this rate was what was wanted (soft stop). If the nurse typed in 155 mcg/kg/min, as opposed to 15 mcg/kg/min, for dopamine, the drug library would alert the nurse that this rate is inappropriate and stop the infusion from starting. Thus this technology is useful in preventing programming errors.

"Smart" pump technology recently has been added to the marketplace to provide another layer in minimizing medication errors. It assists in reducing IV-medication errors?some of the most dangerous and costly of errors? by providing the nurse with a tool to help in the calculation and programming of IV medications.