Australian registered nurse medical device education: a comparison of simple vs. complex devices

As the primary users of medical devices in direct patient care, registered nurses must be competent both with simple and complex devices because any device improperly used can have serious consequences Results of a cross-sectional survey of registered nurses ( n = 238) working at a large South Australian tertiary care centre on units with high usage both of indwelling urethral (Foley) catheters and intravenous infusion pumps revealed that participants were significantly more likely to have learned to use the indwelling urethral (Foley) catheter in nursing school than they were to have learned how to use an intravenous infusion pump Participants differed significantly on most (13 of 17) items about what they learned, with nurses being more likely to learn various factors about the indwelling urethral catheter than the infusion pump Registered nurses were more likely to feel stressed when using an intravenous infusion pump than when using an indwelling urethral catheter, but were more likely to have used an indwelling urethral catheter that caused a patient harm than an intravenous infusion pump that caused a patient harm The most frequently identified reasons for incidents of patient harm resulting from use of an intravenous infusion pump were user error and inadequate device education The most frequently identified reasons for incidents of patient harm resulting from use of an indwelling urethral catheter were the patient's condition, particularly confusion, user error, equipment malfunction, and inadequate device education     

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.     

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.     

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.     

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.     

Implementation of an intravenous medication infusion pump system: implications for nursing

AIM: To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction. BACKGROUND: Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety. METHODS: Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%. RESULTS: Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices. CONCLUSIONS: It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology. IMPLICATIONS FOR NURSING MANAGEMENT: Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses.     

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.     

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.     

Evaluation of an integrated intensive care unit monitoring display by critical care fellow physicians

In the past two far-view displays, which showed vital signs, trends, alarms, infusion pump status, and therapy support indicators, were developed and assessed by critical care nurses (G?rges et al. in Dimens Crit Care Nurs. 30(4):206–17, 2011). The aim of the current study is to assess the generalizability of these findings to physicians. The first aim is to test whether an integrated far-view display, designed to be readable from 3 to 5?m, enables critical care physicians to more rapidly and accurately (1) recognize a change in patient condition; (2) identify alarms; and (3) identify near-empty infusion pumps, than a traditional patient monitor and infusion pump. A second aim is to test if the new displays reduce the mental workload required for this decision making. Fifteen critical care fellow physicians (median age of 34?years, with 2–8?years of ICU experience) were asked to use the three displays to compare the data from two patients and decide which patient required their attention first. Each physician made 60 decisions: 20 with each of the two far-view displays and 20 decisions with a standard patient monitor next to an infusion pump. A 41 and 26?% improvement in decision accuracy was observed with the bar and clock far-view displays, respectively. Specifically, the identification of near empty infusion pumps, a task normally performed by nurses, and patients with a single alarm were better with the new displays. Using the bar display physicians made their decision 12?% faster than when using the control display, a median improvement of 2.1?s. No significant differences were observed in measured workload. Displays that present patient data in a redesigned format enables critical care clinicians to more rapidly identify changes in patient conditions and to more accurately decide which patient needs their attention. In a clinical setting, this could improve patient safety. In future work, an evaluation of the display using live patient data from an ICU should be performed.     

Patient-controlled analgesia infusion pumps for adults

Patient-controlled analgesia (PCA) via an infusion pump enables patients experiencing pain as a result of surgery, trauma or acute exacerbation of chronic conditions, to administer their own analgesia. Opioids are commonly used in the pumps because of their effectiveness and availability. This article, one of series on pain, describes the main features of opioid PCA, highlighting potential risks associated with this method of drug administration and common side effects of opioids. The article emphasises the importance of educating patients in PCA use to maintain safety. It is suggested that nurses must provide the same level of care to patients using PCA as patients receiving analgesia by other means.     

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.     

Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis

Background  Smart infusion pumps affect workflows as they add alerts and alarms in an information-rich clinical environment where alarm fatigue is already a major concern. An analytic approach is needed to quantify the impact of these alerts and alarms on nursing workflows and patient safety. Objectives  To analyze a detailed infusion dataset from a smart infusion pump system and identify contributing factors for infusion programming alerts, operational alarms, and alarm resolution times. Methods  We analyzed detailed infusion pump data across four hospitals in a health system for up to 1 year. The prevalence of alerts and alarms was grouped by infusion type and a selected list of 32 high-alert medications (HAMs). Logistic regression was used to explore the relationship between a set of risk factors and the occurrence of alerts and alarms. We used nonparametric tests to explore the relationship between alarm resolution times and a subset of predictor variables. Results  The study dataset included 745,641 unique infusions with a total of 3,231,300 infusion events. Overall, 28.7% of all unique infusions had at least one operational alarm, and 2.1% of all unique infusions had at least one programming alert. Alarms averaged two per infusion, whereas at least one alert happened in every 48 unique infusions. Eight percent of alarms took over 4 minutes to resolve. Intravenous fluid infusions had the highest rate of error-state occurrence. HAMs had 1.64 more odds for alerts than the rest of the infusions. On average, HAMs had a higher alert rate than maintenance fluids. Conclusion  Infusion pump alerts and alarms impact clinical care, as alerts and alarms by design interrupt clinical workflow. Our study showcases how hospital system leadership teams can leverage infusion pump informatics to prioritize quality improvement and patient safety initiatives pertaining to infusion practices.     

A performance improvement plan to increase nurse adherence to use of medication safety software

Nurses can protect patients receiving intravenous (IV) medication by using medication safety software to program "smart" pumps to administer IV medications. After a patient safety event identified inconsistent use of medication safety software by nurses, a performance improvement team implemented the Deming Cycle performance improvement methodology. The combined use of improved direct care nurse communication, programming strategies, staff education, medication safety champions, adherence monitoring, and technology acquisition resulted in a statistically significant (p < .001) increase in nurse adherence to using medication safety software from 28% to above 85%, exceeding national benchmark adherence rates (Cohen, Cooke, Husch & Woodley, 2007; Carefusion, 2011).     

Intrathecal baclofen therapy in adults and guideline for clinical nursing care.

Advancements in healthcare technology for patients with spasticity are promising. Nurses are expected to be well-versed in the use of technology to provide individualized and safe care. The focus of this article is on the current nursing care of patients who use technology such as intrathecal baclofen pumps to manage spasticity. Three phrases of intrathecal baclofen therapy and concurrent clinical nursing care are outlined. A fundamental understanding of the intrathecal baclofen pump allows nurses to provide cutting-edge technological and individualized care with compassion.     

Innovative solutions: Standardized concentrations facilitate the use of continuous infusions for pediatric intensive care unit nurses at a community hospital.

The pediatric intensive care unit at a community hospital successfully implemented the use of standardized concentrations. The process included deciding the standardized concentrations, use of titration charts, and integration of smart pump technology. Since the implementation of standardized concentrations, there has been no signal or sentinel events reported. It is safe and efficacious to use standardized concentrations combined with smart pump technology and abandon the use of the rule of 6 in the pediatric population.     

开展"优质护理服务示范工程"活动的实践与体会

目的 总结儿童支气管哮喘疾病的临床护理经验.方法 选择我院收治的66例儿童支气管哮喘患儿,进行对症、支持、抗感染等治疗,同时给予精心的临床观察和相应的护理措施.结果 66例哮喘患儿经过治疗和综合护理后,症状控制,未出现并发症,效果良好,全部治愈出院.结论 对临床确诊的支气管哮喘患儿及时治疗,密切临床观察,精心护理,可减少并发症,降低复发率,提高患儿生活质量.     

Analysis of infusion pump error logs and their significance for health care

Infusion therapy is one of the largest practised therapies in any healthcare organisation, and infusion pumps are used to deliver millions of infusions every year in the NHS. The aircraft industry downloads information from 'black boxes' to help design better systems and reduce risk; however, the same cannot be said about error logs and data logs from infusion pumps. This study downloaded and analysed approximately 360 000 hours of infusion pump error logs from 131 infusion pumps used for up to 2 years in one large acute hospital. Staff had to manage 260 129 alarms; this accounted for approximately 5% of total infusion time, costing about ￡1000 per pump per year. This paper describes many such insights, including numerous technical errors, propensity for certain alarms in clinical conditions, logistical issues and how infrastructure problems can lead to an increase in alarm conditions. Routine use of error log analysis, combined with appropriate management of pumps to help identify improved device design, use and application is recommended.     

The experiences of school nurses caring for students receiving continuous subcutaneous insulin infusion therapy.

Diabetes mellitus is the most common metabolic disorder in childhood. Today, children with diabetes are receiving new technologically advanced treatment options, such as continuous subcutaneous insulin infusion (CSII) therapy. School nurses are the primary health caregivers of children with diabetes during school hours. Therefore, it is important to determine their perceptions, resources, and resource needs when caring for students with continuous subcutaneous insulin infusion or insulin pump therapy. This study uses a phenomenological approach to examine the experiences of school nurses caring for students receiving insulin pump therapy. Eleven school nurses were interviewed using semistructured taped interviews. The nurses' responses indicated that they were "scared" when first caring for students with continuous subcutaneous insulin infusion therapy. However, they were able to work through their fear by using their resources and gaining more knowledge and hands-on experience with insulin pumps. The data also revealed that school nurses who were able to learn the language of continuous subcutaneous insulin infusion therapy and successfully deal with pump problems developed trusting and knowing relationships with students, teachers, and parents.     

合理使用糖尿病专科护士提升医院专项护理水平的做法与体会

目的探讨合理使用糖尿病专科护士提升医院专项护理水平的做法与体会。方法成立以糖尿病专科护士为核心的糖尿病护理小组并进行培训,定期组织糖尿病专项护理质量检查、开展护理会诊、开设专科护理门诊和组建全市糖尿病健康教育者网络。结果非内分泌专科糖尿病患者对健康教育总体满意度由56.00%上升到92.00%;非专科病区糖尿病专项护理质量检查均分由(71.25±3.64)分上升为(92.18±1.52)分;2010年糖尿病专科护士完成健康教育门诊328人次、院内疑难护理会诊59次、院外护理会诊3次;全市二级以上医院内分泌科病房常规开展集体小讲座由4所增加到8所;2010年底糖尿病专科护士申报的护理科研项目获得基金资助。结论糖尿病专科护士在提升医院专项护理水平中具有重要作用,应重视专科护士的正确使用,从而拓展护理服务内涵。