Developing a drug library for smart pumps in a pediatric intensive care unit

Standardisation of intravenous infusion therapy for paediatrics: big challenges for the little patients

BACKGROUND

Worldwide organisations advocate standardising the management of intravenous drugs as an essential strategy to increase safety in paediatric healthcare settings. Intravenous administration is a route associated with some potential complications. Many adverse events are related to the use of intravenous medications, and the great variability in their handling and preparation represents an added risk that jeopardises the safety of children.

PURPOSE

To standardise the dilutions of intravenous drugs most commonly administered to Spanish hospitalised paediatric and neonatal patients.

METHODS

The process leading to the standardisation of concentrations was undertaken following a two-round modified Delphi procedure. The consensus included the most common drugs administered by continuous or intermittent intravenous infusion to hospitalised and/or critically ill paediatric patients.

RESULTS

For paediatric patients, the proposal included a total of 102 drugs (45 continuous infusion and 59 intermittent infusion), with 192 concentrations to be standardised. The final consensus included 101 drugs (99%), of which 44 were continuous infusion and 59 intermittent infusion; 160 concentrations were standardised (72.7%). For neonates, the initial proposal included 80 drugs (38 continuous infusion and 43 intermittent infusion), with 189 concentrations to be standardised. The final consensus included 80 drugs (100%), of which 38 were continuous infusion and 43 were intermittent infusion; 120 concentrations were standardised (49.2%).

CONCLUSIONS

This proposal showed that standardisation is a feasible approach that can be reached by other healthcare institutions. It can be used in other centres and contribute in the future to unifying paediatric clinical practice.

Protocolization of Analgesia and Sedation Through Smart Technology in Intensive Care: Improving Patient Safety

BACKGROUND

The risk of medication errors in intensive care units is high, primarily in the drug administration phase.

LOCAL PROBLEM

Management of high-alert medications within intensive care units in the study institution varied widely. The aim of this quality improvement project was to protocolize and centralize the management of high-alert medications in acute care settings and to implement smart intravenous infusion pump technology in intensive care units.

METHODS

The project was conducted in 4 phases: (1) protocolization and standardization of intravenous mixtures, (2) centralization of intravenous mixture preparation in the Pharmacy Department, (3) programming of the smart pumps, and (4) dissemination and staged implementation of intravenous mixture protocols. Smart pumps (Alaris, CareFusion) were used to deliver the medicines, and the manufacturer's software (Alaris Guardrails, CareFusion) was used to analyze data regarding adherence to the drug library and the number of programming errors detected.

RESULTS

Morphine, remifentanil, fentanyl, midazolam, dexmedetomidine, and propofol were included. After implementation of the smart pumps, 3283 infusions were started; of these, 2198 were programmed through the drug library, indicating 67% compliance with the safety software. The pumps intercepted 398 infusion-related programming errors that led to cancellation or reprogramming of drug infusions.

CONCLUSIONS

Protocolization and centralization of the preparation of high-alert sedative and analgesic medications for critically ill patients and the administration of these drugs using smart pump technology decrease variability of clinical practice and intercept potentially serious medication errors.

Dose error reduction software in medication safety risk management - optimising the smart infusion pump dosing limits in neonatal intensive care unit prior to implementation

Background

Smart infusion pumps with dose error reduction software can be used to prevent harmful medication errors. The aim of this study was to develop a method for defining and assessing optimal dosing limits in a neonatal intensive care unit’s smart infusion pump drug library by using simulation-type test cases developed based on medication error reports.

Methods

This mixed-methods study applied both qualitative and quantitative methods. First, wrong infusion rate-related medication errors reported in the neonatal intensive care unit during 2018–2019 were explored by quantitative descriptive analysis and qualitative content analysis to identify the error mechanisms. The researchers developed simulation-type test cases with potential errors, and a literature-based calculation formula was used to set upper soft limits to the drug library. The limits were evaluated by conducting programming of pumps without errors and with potential errors for two imaginary test patients (1 kg and 3.5 kg).

Results

Of all medication errors reported in the neonatal intensive care unit, 3.5% (n = 21/601) involved an error or near-miss related to wrong infusion rate. Based on the identified error mechanisms, 2-, 5-, and 10-fold infusion rates, as well as mix-ups between infusion rates of different drugs, were established as test cases. When conducting the pump programming for the test cases (n = 226), no alerts were triggered with infusion rates responding to the usual dosages (n = 32). 73% (n = 70/96) of the erroneous 2-, 5-, and 10-fold infusion rates caused an alert. Mix-ups between infusion rates triggered an alert only in 24% (n = 24/98) of the test cases.

Conclusions

Simulation-type test cases can be applied to assess the appropriateness of dosing limits within the neonatal intensive care unit’s drug library. In developing the test cases, combining hospital’s medication error data to other prospective data collection methods is recommended to gain a comprehensive understanding on mechanisms of wrong infusion rate errors. After drug library implementation, the alert log data and drug library compliance should be studied to verify suitability of dosing limits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03183-8.

Analysis of standard concentrations of continuous infusions in nine Spanish neonatal intensive care units

OBJECTIVES

The aim of this study was to describe the use of standard concentrations for continuous infusion drugs in Spanish neonatal intensive care units (NICUs).

METHODS

We conducted an observational multicentre study based on a survey sent by email to 9 Spanish NICUs during January and February 2018. We collected data on intravenous drugs frequently used in neonates, and their preparation. Continuous infusion drugs with a standard concentration implemented in ≥2 NICUs were selected. An analysis of the concentrations reported was performed, and the rate of adherence to international recommendations of the Institute of Safe Medication Practice (ISMP) and Vermont Oxford Network (VON) was calculated.

RESULTS

From 69 drugs mentioned in the survey, 14 were included in the study, with all but one (furosemide) being considered high-alert medications by the ISMP. From the 9 participating NICUs, 3 had no established standard concentrations for any of the 14 drugs selected. In the other participating NICUs, dexmedetomidine was used with a standard concentration in the 3 NICUs which used the drug, whereas furosemide showed the lowest implementation rate (a standard concentration was implemented in 2 of the 7 NICUs which used the drug). In regard to concentrations adopted in the different NICUs, 80 variations were identified for the 14 drugs. The mean number of different standard concentrations for each drug per NICU was 2 (range 1-5). Adherence to ISMP/VON recommendations varied considerably depending on the drugs, from high adherence for heparin (2/3) and fentanyl (2/3) to low adherence for norepinephrine (0/4).

CONCLUSIONS

The establishment of standard concentrations is highly recommended for continuous infusion medications as an effective error-prevention strategy. Nevertheless, we detected a low implementation rate in our NICUs and a lack of consistency in the concentrations selected.

Interdisciplinary collaboration between nursing and engineering in health care: A scoping review

BACKGROUND

Due to the rapid advancements in precision medicine and artificial intelligence, interdisciplinary collaborations between nursing and engineering have emerged. Although engineering is vital in solving complex nursing problems and advancing healthcare, the collaboration between the two fields has not been fully elucidated.

OBJECTIVES

To identify the study areas of interdisciplinary collaboration between nursing and engineering in health care, particularly focusing on the role of nurses in the collaboration.

METHODS

In this study, a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was performed. A comprehensive search for published literature was conducted using the PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Web of Science, ScienceDirect, Institute of Electrical and Electronics Engineers Digital Library, and Association for Computing Machinery Digital Library from inception to November 22, 2020. Data screening and extraction were performed independently by two reviewers. Any discrepancies in results were resolved through discussions or in consultation with a third reviewer. Data were analyzed by descriptive statistics and content analysis. Results were visualized in an interdisciplinary collaboration model.

RESULTS

We identified 6,752 studies through the literature search, and 60 studies met the inclusion criteria. The study areas of interdisciplinary collaboration concentrated on patient safety (n = 18), symptom monitoring and health management (n = 18), information system and nursing human resource management (n = 16), health education (n = 5), and nurse-patient communication (n = 3). The roles of nurses in the interdisciplinary collaboration were divided into four themes: requirement analyst (n = 21), designer (n = 22), tester(n = 37) and evaluator (n = 49). Based on these results, an interdisciplinary collaboration model was constructed.

CONCLUSIONS

Interdisciplinary collaborations between nursing and engineering promote nursing innovation and practice. However, these collaborations are still emerging and in the early stages. In the future, nurses should be more involved in the early stages of solving healthcare problems, particularly in the requirement analysis and designing phases. Furthermore, there is an urgent need to develop interprofessional education, strengthen nursing connections with the healthcare engineering industry, and provide more platforms and resources to bring nursing and engineering disciplines together.

Implementation of Smart Infusion Pumps: A Scoping Review and Case Study Discussion of the Evidence of the Role of the Pharmacist

"Smart" infusion pumps include built in drug error reduction software which uses a drug library. Studies have reported the drug library build should be undertaken by a multidisciplinary team, including a pharmacist; however, the extent or nature of the input required by the pharmacist for greatest benefit is unknown. This review aimed to identify key factors for the implementation of the smart infusion pumps, with a focus on the role of pharmacists and compare this to the experience from a case study. A literature review was conducted using Embase and Ovid Medline, and 13 eligible papers were found. Predominant themes relating to the pharmacist's role and successful implementation of the smart infusion pumps were determined. Key factors for success included team involvement across the entire process from procurement, set-up through to implementation including risk assessment and device distribution, and training, which were comparable to the case study experience. Few studies described the extent or details of the pharmacist's responsibilities.

Smart pumps improve medication safety but increase alert burden in neonatal care

Background

Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source of alert burden and alert fatigue in an intensive care environment.

Methods

Using smart pump records, over 370,000 infusion starts for continuously infused medications used in neonates and infants hospitalized in a level IV NICU from 2014 to 2016 were evaluated. Attempts to exceed preset soft and hard maximum limits, percent variance from those limits, and pump alert frequency, patterns and salience were evaluated.

Results

Smart pumps prevented 160 attempts to exceed the hard maximum limit for doses that were as high as 7–29 times the maximum dose and resulted in the reprogramming or cancellation of 2093 infusions after soft maximum alerts. While the overall alert burden from smart pumps for continuous infusions was not high, alerts clustered around specific patients and medications, and a small portion (17%) of infusions generated the majority of alerts. Soft maximum alerts were often overridden (79%), consistent with low alert salience.

Conclusions

Smart pumps have the ability to improve neonatal medication safety when compliance with dose error reducing software is high. Numerous attempts to administer high doses were intercepted by dosing alerts. Clustered alerts may generate a high alert burden and limit safety benefit by desensitizing providers to alerts. Future efforts should address ways to improve alert salience.

Automated, Web-Based Solution for Bidirectional EHR-Infusion Pump Communication

Smart Agent is a web-based solution for establishing bidirectional communication between an infusion pump and an electronic health record (EHR). It eliminates the need for clinician double check of medication administration using an infusion pump. Because the clinician already is using the EHR to review patient health information and update status, the addition of the web service would help eliminate the potential for human error when using a manual system. The Smart Agent process encompasses the reading of pertinent patient data from the EHR, determination of a new medication dosage based on an internal protocol, input of the dosage into an infusion pump, confirmation of the medication dosage acceptance at the infusion pump, and recording the medication change back into the EHR. The widespread use of Smart Agent-type algorithms with bidirectional communication capabilities would result in safer, more efficient provision of care, as well as better value.

Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care

Pediatricians render care in an increasingly complex environment, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown since the National Academy of Medicine (formerly the Institute of Medicine) published its report "To Err Is Human: Building a Safer Health System" in 1999. Patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to reveal a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification and diagnostic error. Pediatric health care providers in all practice environments benefit from having a working knowledge of patient safety language. Pediatric providers should serve as advocates for best practices and policies with the goal of attending to risks that are unique to children, identifying and supporting a culture of safety, and leading efforts to eliminate avoidable harm in any setting in which medical care is rendered to children. In this Policy Statement, we provide an update to the 2011 Policy Statement "Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care."

A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom

OBJECTIVES

This study aimed to explore the use of standard concentration infusions for intravenous infusions (SCI) in paediatric and neonatal units in the United Kingdom (UK). This included how many units use SCI, variation and overlap in concentrations, devices in use for administration and how the infusions were provided.

METHODS

Paediatric and neonatal units in the UK were surveyed using a self-administered web-based survey tool. Respondents were accessed through professional networks over a one-month period in summer 2016.

KEY FINDINGS

Thirty-one units (40%) used SCI. Twenty-one units provided information on presentation and administration of SCI. Forty-six medicines were used as SCI with 143 different concentrations. 'Smart' pump technology was most commonly used in the administration of SCI, and SCI were predominantly prepared by nurses in the near-patient setting.

CONCLUSIONS

The majority of paediatric and neonatal units in the UK used traditional weight-based methods for IV infusions and only 40% of responding units had established SCI. This local implementation of SCI resulted in a wide variation of presentations and concentrations and thus there is no true 'standardisation'. Further research should be conducted on harmonising these SCI across neonatal and paediatric care to facilitate adoption across all units.

Practice Change From Intermittent Medication Boluses to Bolusing From a Continuous Infusion in Pediatric Critical Care: A Quality Improvement Project

OBJECTIVES

To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost.

DESIGN

This is a pre- and postimplementation quality improvement study.

SETTING

An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital.

PATIENTS

Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion.

INTERVENTIONS

Change in practice from administering bolus doses from an automated dispensing machine to administering bolus medications from continuous infusion in PICUs.

MEASUREMENTS AND MAIN RESULTS

Timing studies were conducted pre- and post implementation in 29 and 26 occurrences, respectively. The median time from the decision to give a bolus until it began infusing decreased by 169 seconds (p < 0.01). Nursing satisfaction increased from 19.3% pre- to 100% post implementation. Safety was assessed via barcode scanning compliance, which decreased by 1.4% for patients and 1% for medications, and smart pump limit overrides. The percentage of infusion pump bolus overrides increased as expected, with the majority (99%) of these exceeding soft maximum limits by less than two-fold. Central line entries were unaffected post implementation. To assess medication utilization, a total of 50 patients in each intervention group were selected for retrospective chart review. Daily fentanyl boluses increased from one to three (p = 0.021). However, midazolam infusion dose and fentanyl infusion duration decreased (p = 0.026 and p = 0.005, respectively). Medication utilization was otherwise unchanged post implementation (p > 0.05). Annualized cost avoidance was $124,160.

CONCLUSIONS

Implementation of bolus medications from continuous infusion in PICUs significantly decreased time to begin a bolus dose and increased nursing satisfaction. The practice change also improved medication utilization without negatively impacting patient safety.

Interventions to reduce medication errors in neonatal care: a systematic review

Background

Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates. The objective of this systematic review was to determine the effectiveness of interventions to reduce neonatal medication errors.

Methods

A systematic review was undertaken of all comparative and noncomparative studies published in any language, identified from searches of PubMed and EMBASE and reference-list checking. Eligible studies were those investigating the impact of any medication safety interventions aimed at reducing medication errors in neonates in the hospital setting.

Results

A total of 102 studies were identified that met the inclusion criteria, including 86 comparative and 16 noncomparative studies. Medication safety interventions were classified into six themes: technology (n = 38; e.g. electronic prescribing), organizational (n = 16; e.g. guidelines, policies, and procedures), personnel (n = 13; e.g. staff education), pharmacy (n = 9; e.g. clinical pharmacy service), hazard and risk analysis (n = 8; e.g. error detection tools), and multifactorial (n = 18; e.g. any combination of previous interventions). Significant variability was evident across all included studies, with differences in intervention strategies, trial methods, types of medication errors evaluated, and how medication errors were identified and evaluated. Most studies demonstrated an appreciable risk of bias. The vast majority of studies (>90%) demonstrated a reduction in medication errors. A similar median reduction of 50-70% in medication errors was evident across studies included within each of the identified themes, but findings varied considerably from a 16% increase in medication errors to a 100% reduction in medication errors.

Conclusion

While neonatal medication errors can be reduced through multiple interventions aimed at improving the medication use process, no single intervention appeared clearly superior. Further research is required to evaluate the relative cost-effectiveness of the various medication safety interventions to facilitate decisions regarding uptake and implementation into clinical practice.

Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps

OBJECTIVES

To estimate the impact of smart pump implementation in a pediatric intensive care unit in terms of number and type of administration errors intercepted.

DESIGN

Observational, prospective study carried out from January 2010 to March 2015 with syringe and great volumen infusion pumps available in the hospital.

SETTING

A tertiary level hospital pediatric intensive care unit.

PARTICIPANTS

Infusions delivered with infusion pumps in all pediatric intensive care unit patients.

INTERVENTIONS

Design of a drug library with safety limits for all intravenous drugs prescribed.

MAIN VARIABLES

Users' compliance with drug library as well as number and type of errors prevented were analyzed.

RESULTS

Two hundred and eighty-three errors were intercepted during 62 months of study. A high risk drug was involved in 58% of prevented errors, such as adrenergic agonists and antagonists, sedatives, analgesics, neuromuscular blockers, opioids, potassium and insulin. Users' average compliance with the safety software was 84%.

CONCLUSIONS

Smart pumps implementation has proven effective in intercepting high risk drugs programming errors. These results might be exportable to other critical care units, involving pediatric or adult patients. Interdisciplinary colaboration is key to succeed in this process.

Benefits and risks of using smart pumps to reduce medication error rates: a systematic review

BACKGROUND

Smart infusion pumps have been introduced to prevent medication errors and have been widely adopted nationally in the USA, though they are not always used in Europe or other regions. Despite widespread usage of smart pumps, intravenous medication errors have not been fully eliminated.

OBJECTIVE

Through a systematic review of recent studies and reports regarding smart pump implementation and use, we aimed to identify the impact of smart pumps on error reduction and on the complex process of medication administration, and strategies to maximize the benefits of smart pumps.

METHODS

The medical literature related to the effects of smart pumps for improving patient safety was searched in PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (2000-2014) and relevant papers were selected by two researchers.

RESULTS

After the literature search, 231 papers were identified and the full texts of 138 articles were assessed for eligibility. Of these, 22 were included after removal of papers that did not meet the inclusion criteria. We assessed both the benefits and negative effects of smart pumps from these studies. One of the benefits of using smart pumps was intercepting errors such as the wrong rate, wrong dose, and pump setting errors. Other benefits include reduction of adverse drug event rates, practice improvements, and cost effectiveness. Meanwhile, the current issues or negative effects related to using smart pumps were lower compliance rates of using smart pumps, the overriding of soft alerts, non-intercepted errors, or the possibility of using the wrong drug library.

CONCLUSION

The literature suggests that smart pumps reduce but do not eliminate programming errors. Although the hard limits of a drug library play a main role in intercepting medication errors, soft limits were still not as effective as hard limits because of high override rates. Compliance in using smart pumps is key towards effectively preventing errors. Opportunities for improvement include upgrading drug libraries, developing standardized drug libraries, decreasing the number of unnecessary warnings, and developing stronger approaches to minimize workarounds. Also, as with other clinical information systems, smart pumps should be implemented with the idea of using continuous quality improvement processes to iteratively improve their use.

Impact of implementing smart infusion pumps in a pediatric intensive care unit

PURPOSE

The impact of smart infusion pumps on the interception of errors in the programming of i.v. drug administrations on a pediatric intensive care unit (PICU) is investigated.

METHODS

A prospective observational intervention study was conducted in the PICU of a hospital in Madrid, Spain, to estimate the patient safety benefits resulting from the implementation of smart pump technology (Alaris System, CareFusion, San Diego, CA). A systematic analysis of data stored by the devices during the designated study period (January 2010-June 2011) was conducted using the system software (Guardrails CQI Event Reporter, CareFusion). The severity of intercepted errors was independently classified by a group of four clinical pharmacists and a group of four intensive care pediatricians; analyses of intragroup and intergroup agreement in perceptions of severity were performed.

RESULTS

During the 17-month study period, the overall rate of user compliance with the safety software was 78%. The use of smart pump technology resulted in the interception of 92 programming errors, 84% of which involved analgesics, antiinfectives, inotropes, and sedatives. About 97% of the errors resulted from user programming of doses or infusion rates above the hard limits defined in the smart pump drug library. The potential consequences of the intercepted errors were considered to be of moderate, serious, or catastrophic severity in 49% of cases.

CONCLUSION

The use of smart pumps in a PICU improved patient safety by enabling the interception of infusion programming errors that posed the potential for severe injury to pediatric patients.

RISKS IN THE IMPLEMENTATION AND USE OF SMART PUMPS IN A PEDIATRIC INTENSIVE CARE UNIT: APPLICATION OF THE FAILURE MODE AND EFFECTS ANALYSIS

Objectives: The aim of this study was to identify risk points in the different stages of the smart infusion pump implementation process to prioritize improvement measures.

Methods: Failure modes and effects analysis (FMEA) in the pediatric intensive care unit (PICU) of a General and Teaching Hospital. A multidisciplinary team was comprised of two intensive care pediatricians, two clinical pharmacists and the PICU nurse manager. FMEA was carried out before implementing CareFusion infusion smart pumps and eighteen months after to identify risk points during three different stages of the implementation process: creating a drug library; using the technology during clinical practice and analyzing the data stored using Guardrails® CQI v4.1 Event Reporter software.

Results: Several actions for improvement were taken. These included carrying out periodical reviews of the drug library, developing support documents, and including a training profile in the system so that alarms set off by real programming errors could be distinguished from those caused by incorrect use of the system. Eighteen months after the implementation, these measures had helped to reduce the likelihood of each risk point occurring and increase the likelihood of their detection.

Conclusions: Carrying out an FMEA made it possible to detect risk points in the use of smart pumps, take action to improve the tool, and adapt it to the PICU. Providing user training and support tools and continuously monitoring results helped to improve the usefulness of the drug library, increased users’ compliance with the drug library, and decreased the number of unnecessary alarms.

Implementation of smart pump technology in a paediatric intensive care unit

Patient safety is a matter of major concern that involves every health professional. Nowadays, emerging technologies such as smart pumps can diminish medication errors as well as standardise and improve clinical practice with the subsequent benefits for patients. The aim of this paper was to describe the smart pump implementation process in a paediatric intensive care unit (PICU) and to present the most relevant infusion-related programming errors that were prevented. This was a comparative study between CareFusion Alaris Guardrails(®) and Hospira MedNet(®) systems, as well as a prospective and intervention study with analytical components carried out in the PICU of Gregorio Marañón General and Teaching Hospital. All intravenous infusions programmed with a pump in the eleven beds of the unit were analyzed. A drug library was developed and subsequently loaded into CareFusion and Hospira pumps that were used during a three month period each. The most suitable system for implementation was selected according to their differences in features and users' acceptance. Data stored in the pumps were analyzed to assess user compliance with the technology, health care setting and type of errors intercepted. The implementation process was carried out with CareFusion systems. Compliance with the technology was 92% and user acceptance was high. Vacation substitution and drug administration periods were significantly associated with a greater number of infusion-related programming errors. High risk drugs were involved in 48% of intercepted errors. Based on these results we can conclude that implementation of smart pumps proved effective in intercepting infusion-related programming errors from reaching patients. User awareness of the importance of programming infusions with the drug library is the key to succeed in the implementation process.

Implementing smart pump technology in a pediatric intensive care unit: a cost-effective approach

OBJECTIVE

To analyze the cost effectiveness of implementing smart infusion pump technology in a pediatric intensive care unit (PICU).

MATERIAL AND METHODS

An observational, prospective, intervention study with analytical components was carried out. A drug library was developed and integrated into the Carefusion Alaris Guardrails® infusion systems. A systematic analysis of all the data stored on the devices during use was performed by the data processing program Guardrails® CQI v4.1 Event Reporter. Intercepted errors were classified in terms of their potential severity and probability of causing an adverse effect (PAE) had they reached the patient. Knowing the estimated cost of a preventable adverse effect (AE), we analyzed costs saved and the profit/cost ratio resulting from the implementation process.

RESULTS

Compliance with the drug library was 92% and during the study period 92 infusion-related programming errors were intercepted, leading to a saving of 172,279 euros by preventing AEs. This means that 2.15 euros would be obtained for each euro invested in hiring a pharmacist to implement this technology.

DISCUSSION

The high percentage of use of safety software in our study compared to others allowed for the interception of 92 errors. The estimation of the potential impact of these errors is based on clinical judgment. The cost saved might be underestimated because the cost of an AE is usually higher in pediatrics, indirect and intangible costs were not considered and pharmacists involved do not spend the whole day on this task.

CONCLUSIONS

Smart pumps have shown to be profitable in a PICU because they have the ability to intercept potentially serious medication errors and reduce costs associated with such errors.