Increasing the use of 'smart' pump drug libraries by nurses: a continuous quality improvement project

The use of infusion pumps that incorporate "smart" technology (smart pumps) can reduce the risks associated with receiving IV therapies. Smart pump technology incorporates safeguards such as a list of high-alert medications, soft and hard dosage limits, and a drug library that can be tailored to specific patient care areas. Its use can help to improve patient safety and to avoid potentially catastrophic harm associated with medication errors. But when one independent community hospital in Massachusetts switched from older mechanical pumps to smart pumps, it neglected to assign an "owner" to oversee the implementation process. One result was that nurses were using the smart pump library for only 37% of all infusions.To increase pump library usage percentage-thereby reducing the risks associated with infusion and improving patient safety-the hospital undertook a continuous quality improvement project over a four-month period in 2009. With the involvement of direct care nurses, and using quantitative data available from the smart pump software, the nursing quality and pharmacy quality teams identified ways to improve pump and pump library use. A secondary goal was to calculate the hospital's return on investment for the purchase of the smart pumps. Several interventions were developed and, on the first of each month, implemented. By the end of the project, pump library usage had nearly doubled; and the hospital had completely recouped its initial investment.     

Smart pumps: implications for nurse leaders

Nurse leaders are challenged to stay abreast of the unintended consequences of safety technology. Many hospitals have adopted smart pumps to improve medication safety. Unfortunately, this technology has limitations. Despite their success in averting some errors, lethal outcomes are still reported in organizations using smart pumps. Documented workarounds, such as bypassing safety features, threaten patient safety. This concerning information has prompted leaders to evaluate current implementation strategies. This article provides an overview of smart pumps, highlights the Institute for Safe Medication Practices' implementation guidelines, and presents a case report of the use of smart pump data to improve clinical practice.     

Using Smart Pumps to Reduce Medication Errors in the NICU

Infants in the neonatal intensive care unit (NICU) are considered one of the most vulnerable patient populations, and medication errors in this population can result in devastating, life-threatening consequences. The use of "smart pump" technology has the potential to minimize risk of error by providing safety measures before medication administration. Successful integration of smart pumps requires a clear communication plan to facilitate staff education and acceptance of advanced technology systems. Unit adoption of smart pumps can enhance patient safety while supporting the implementation of evidenced-based practices in nursing care. DOI: 10.1111/j.1751-486X.2012.01721.x.     

Nurses' risk without using smart pumps

Intravenous smart pump devices hold specific medications in electronic libraries. These libraries contain predetermined volumes with corresponding administration rate limits. Smart pumps prevent nurses from engaging in calculations under high-pressure situations and ensure that only therapies available to the nurse are administered to patients. When this technology is available and not utilized, litigation could be successful in finding fault on the nurse. Therefore, nurses should use the available smart pump technology every time when administering intravenous therapy.     

Harnessing Innovation and Collaboration to Improve Unit-Based Huddle Communication

This article details the effectiveness of utilizing smart board technology and multidisciplinary collaboration to ensure huddle presentation is visually appealing, consistent, timely, and relevant, and encourages staff engagement. To improve huddles in the emergency department of a busy level 1 trauma center, the leadership team implemented smart board technology and multidisciplinary participation to promote effective formal transmission of information. Staff surveys showed significant improvement in the areas of satisfaction, timeliness, and feeling that they received a formal huddle report. Implications for health care organizations include leveraging technology and standardized processes to improve communication, staff satisfaction, patient safety, and operational efficiency.     

Smart infusion technology: a minimum safety standard for intensive care?

There is overwhelming evidence that medication errors present a risk to patients. This risk is highest in the intensive care unit (ICU) setting and even greater when medications are administered via an infusion pump. Standard pumps will not alert for, or prevent, drug calculation, drug unit, button push, or multiple of ten errors when medication delivery data is inputted. However, the literature suggests that smart pumps programmed with hard (unchangeable) limits can significantly reduce drug errors at the point of administration. Staff at St George's Hospital paediatric ICU wanted to implement an infusion pump system that would be immediately effective in reducing medication errors at the point of administration. This article presents an overview of the relevant literature together with clinical examples from the authors' ICU, which demonstrates their experiences with smart pumps. It is the authors' firm belief that smart infusion technology sets a new minimum safety standard for intensive care.     

How Older Adults Make Decisions Regarding Smart Technology: An Ethnographic Approach

ABSTRACT

Comparatively little research has been conducted regarding the smart technology needs of the older adult population despite the proliferation of smart technology prototypes. The purpose of this study was to explore the perceived smart technology needs of older adults with mobility impairments while using an ethnographic research approach to construct a preliminary decision tree model of how these smart technology decisions are made. In-depth individual interviews with 11 older adults aged 65 and older with mobility impairments provided insight into how older adults perceived smart technology. Audio-taped interviews were transcribed verbatim, then analyzed for key phrases that represented participant decision criteria. Decision criteria concepts were combined to construct an older adult smart technology decision tree model. The model consisted of a preliminary decision stage that participants engaged in to make the decision of whether a change was needed in their current pattern of behavior; followed by an evaluation stage that included five potential barriers (i.e., not easy to use/learn) and seven potential facilitators (i.e., decreasing imposition on family/friends) to the smart technology need decision process. Future designers could use this decision model to create appropriately matched technological devices to promote independence of aging baby boomers with mobility impairments.     

Insulin pumps: from inception to the present and toward the future

As an alternative to the usual insulin injections, insulin pumps have been introduced as an advanced method of insulin delivery for managing type 1 diabetes mellitus patients. This review documents the history of insulin pump development and the production of ‘smart pumps’ that offer patients greater dosing accuracy, flexibility, and ease of use. This has resulted in an increase in the number of insulin pump users around the world. This paper also provides a comprehensive survey of the pumps currently available on the market and their specifications. Unique features of each product and the drawbacks are addressed in the review. The future direction of insulin pump development is targeted toward closing the loop, to allow feedback control between an insulin pump and a glucose sensor, and hence finer adjustment of insulin delivery rates as required.     

肝移植手术中输注血管活性药物的护理管理

目的探讨肝脏移植手术中应用微量注射泵输注血管活性药物的护理管理。方法对2009年1-12月52例行肝移植术患者的临床资料进行回顾性分析。结果在整个手术期间,通过使用微量注射泵及时调整血管活性药物的剂量,及时、快速、准确地进行血管活性药物的配置,除在无肝期及新肝早期血流动力学有波动外,基本保证了患者血液动力学的稳定。结论准确合理地使用血管活性药物是肝移植手术成功的关键。准确配制血管活性药的浓度,规范化使用微量注射泵是手术成功的重要保证。     

Comparing the methods of measuring compartment pressures in acute compartment syndrome

The objectives of this study were to compare the reliability and accuracy of published methods of measuring intramuscular compartment pressures. A muscle compartment model was constructed. Pressure was standardized using a water column exerting pressure on a muscle slab. The following three methods of intracompartmental pressure were used to measure the pressure within the muscle slab of the model: (1) Stryker, (2) manometric IV pump, and (3) Whitesides method. The Stryker and IV pump methods were similarly accurate compared with the "standard pressure." The Whitesides method was not reliable in measuring a reproducible pressure. The IV pump method is comparable to the Stryker instrument in terms of accuracy and ease of use. If a Stryker instrument is unavailable, the IV pump method can serve as a suitable and satisfactory alternative.     

Intravenous medication safety and smart infusion systems: lessons learned and future opportunities.

The Institute of Medicine report To Err Is Human: Building a Safe Health System greatly increased national awareness of the need to improve patient safety in general and medication safety in particular. Infusion-related errors are associated with the greatest risk of harm, and "smart" (computerized) infusion systems are currently available that can avert high-risk errors and provide previously unavailable data for continuous quality improvement (CQI) efforts. As healthcare organizations consider how to invest scarce dollars, infusion nurses have a key role to play in assessing need, evaluating technology, and selecting and implementing specific products. This article reviews the need to improve intravenous medication safety. It describes smart infusion systems and the results they have achieved. Finally, it details the lessons learned and the opportunities identified through the use of smart infusion technology at Brigham and Women's Hospital in Boston, Massachusetts.     

护理质量标准化管理的实践体会

从建立标准、贯彻标准、评价修订标准三方面介绍护理质量标准化管理的实践,提出质量控制应贯穿于标准化管理的全过程,制订标准应具有可行性,建立一个灵敏、准确、有力的反馈系统.     

预防硬膜外留置镇痛泵滑脱护理方法的探讨

目的预防硬膜外留置镇痛泵滑脱，提高镇痛效果。方法将240例腹部手术病人分为两组，每组120例。试验组采用规范护理行为；对照组未规范护理行为，每组病人均为120例。结果实验组硬膜外留置镇痛泵滑脱5例（4.2％），对照组滑脱21例（17.5％），差异有显著意义（P〈0．01）。结论规范护理方法有利于病人及家属更好配合，加强工作人员的责任心，可有效预防硬膜外留置镇痛泵的滑脱。     

Aging well with smart technology

As baby-boomers age, the need for long-term nursing care services increases. In the future, there will simply not be enough long-term care facilities to accommodate all of these patients. In addition, many people prefer to grow old at home, a concept known as aging-in-place. Smart home technology facilities aging-in-place by assisting patients with emergency assistance, fall prevention/detection, reminder systems, medication administration and assistance for those with hearing, visual or cognitive impairments. Benefits include making aging-in-place a reality, continuous monitoring, and improved psychosocial effects. Concerns of this technology include cost, availability of technology, retrofitting complications, and potential inappropriate use of the technology. Overall, the concept of smart homes is gaining in popularity and will expand the role of the nurse in the future. It is important for all nurses to understand how their practices will be transformed as smart homes become a reality for the aging population.     

Maximizing a transport platform through computer technology

One of the most recent innovations coalescing computer technology and medical care is the further development of integrated medical component technology coupled with a computer subsystem. One such example is the self-contained patient transport system known as the Life Support for Trauma and Transport (LSTAT(tm)). The LSTAT creates a new transport platform that integrates the most current medical monitoring and therapeutic capabilities with computer processing capacity, creating the first "smart litter". The LSTAT is built around a computer system that is network capable and acts as the data hub for multiple medical devices and utilities, including data, power, and oxygen systems. The system logs patient and device data in a simultaneous, time-synchronized, continuous format, allowing electronic transmission, storage, and electronic documentation. The third-generation LSTAT includes an oxygen system, ventilator, clinical point-of-care blood analyzer, suction, defibrillator, infusion pump, and physiologic monitor, as well as on-board power and oxygen systems. The developers of LSTAT and other developers have the ability to further expand integrative component technology by developing and integrating clinical decision support systems.     

The development and piloting of electronic standardized measures on nursing work: combining engineering and nursing knowledge

bragadóttir h., gunnarsdóttir s. & ingason h.t. (2013) Journal of Nursing Management  21 , 679–689 The development and piloting of electronic standardized measures on nursing work: combining engineering and nursing knowledge Aims  This paper describes the development and piloting of electronic standardized measures on nursing work (e-SMNW) for rich data gathering on the work and work environment of registered nurses (RNs) and practical nurses (PNs). Background  Efficient and valid methods are needed to measure nursing work to enhance the optimal use of the nursing workforce for safe patient care. Methods  The study combined human factors engineering (HFE) and nursing knowledge to develop electronic standardized measures for observational studies on nursing work in acute care. Results  The work and work environment of RNs and PNs in acute care medical and surgical inpatient units was successfully measured using e-SMNW. With predetermined items of work activities and influencing factors in the work of nurses, and full use of computer technology, multi-layered rich standardized data were gathered, analysed and displayed. Conclusions  The combination of nursing knowledge, HFE and computer technology enables observational data collection for a rich picture of the complex work of nursing. Implications for nursing management  Information collected by standardized and multi-layered measures makes it easier to identify potential improvements, with regard to influencing factors and management of the work and work environment of nurses. Further use of computer technology in health services research is encouraged.     

基于信息系统成功模型研究智能护理信息系统的应用效果

目的：基于信息系统成功模型,探索护士对智能护理信息系统使用意愿的调查研究,并提出相关建议,以提高护士对智能护理信息系统使用的接受度。方法：经过文献查询阅读,小样本问卷调查分析,确定本问卷调查以Delone and Mclean 信息技术成功模型为基础,以该模型的六个组成部分：信息质量,服务质量,系统质量,满意度,个人影响,净收益为基本理论框架,自行设计问卷调查表,采用横断面研究方法进行问卷调查和收集数据,通过分析问卷调查的数据来确定智能护理信息系统的应用效果,提高护士对智能护理信息系统的使用意愿。本问卷向南京大学医学院附属鼓楼医院935名使用智能护理信息系统的在职护士发放,获取有效问卷份935份,有效回收率为100%,采用SPSS21.0统计软件对问卷调查进行人口统计学分析和Amos24.0结构方程对模型进行分析。结果：基于Delone and Mclean 信息技术成功模型,提高用户满意度,增加净收益可提高智能护理信息系统使用意愿。系统质量,信息质量和服务质量都是影响用户满意度的关键因素,信息质量对使用意愿有直接影响。结论：智能护理信息系统优化了护士的工作流程,护士使用依赖性和满意度越高,净收益越高,同时需要进一步改进智能护理信息系统,优化系统流程,以更好地提高护理工作效率,提高临床护士对智能护理信息系统的使用意愿和接受度。     

The insulin pump: why not use it for every type I diabetic patient?

Critical care nurses are likely to care for patients with insulin pumps, and it is essential that they understand the rationale for using them selectively for individuals with diabetes mellitus. The assets and limitations of the technology associated with insulin pump use must be appreciated in regard to glycemic control during hospitalization. Although most patients and family members are well indoctrinated on insulin protocols, pump use, and self-monitoring, it is vital that nurses are aware of the unique issues that surface during critical illness.     

Smart pump technology: what we have learned

Intravenous infusion may present the greatest preventable medication administration error risk to hospitalized patients. Smart pumps can provide clinical decision support at the bedside for nurses who are administering intravenously administered medications with the potential to significantly reduce medication errors and subsequent patient harm. However, implementations of smart pumps have yielded mixed results and mixed perceptions of their ability to actually decrease error. To realize the potential of smart pumps, there must exist a clear understanding of how these devices are being integrated into healthcare organizations, specifically nursing practice. The purpose of this article was to describe current smart pump evaluation studies and to suggest areas of future evaluation focus.