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Infusion device management and use

Key points

  • We have built a picture of how, in various contexts, UK hospitals are using and managing infusion devices: pumps that deliver medication to patients.
  • Smart pumps, which can alert nurses when unusual infusion values are set, are only occasionally used in UK hospitals, despite their potential benefits for safety.
  • There are important barriers preventing smart pumps being used including existing contracts, and those making the decisions needing to be convinced that the benefit is worth the effort needed to adopt them.
  • The Singleton Hospital is using the research as a driver to introduce smart pump software.

Infusion devices are used to deliver medication and other fluids directly into the veins of patients (i.e., intravenously). There are a great many brands and models available and each can be configured in different ways. Over ten years ago, the National Patient Safety Agency argued that in order to reduce the chances of errors occurring, hospitals should make sure they are using as few different kinds of devices as possible, and should store these devices in centralised equipment libraries so that wards can share them more efficiently. In addition, advances in the technology continue to be made. In particular, "smart pumps" can now warn when a potentially harmful dose have been set. This is done by Drug Error Reduction Software (DERS). It takes longer to set up as it needs to be given extra information about the patient and medication, such as the patient's weight, the drug name, dose, concentration and so on. WIth this information it can detect when the drug administration is outside recommended limits (which might be caused by a prescription containing errors or by a nurse setting up the machine incorrectly). Some studies suggest that smart pumps are able to prevent certain kinds of errors but little is known about how they are actually used in practice, particularly in the UK.

Obstacles preventing safer technology being used
We found that both across and within hospitals, infusion devices are managed and configured in a variety of different ways for important reasons due to the different contexts. For example the needs of planned care differ to those of emergency care. While hospitals reported that they are standardising around a small number of devices, use of centralised equipment libraries remains low, as does DERS usage. Also, smart pumps are only being used by a small proportion of institutions. This is due to both practical and organisational challenges. Obstacles include hospitals being tied to existing device contracts, the significant time and resources required to switch to smart pumps, and decision makers not being convinced that the technology is worth the benefits.

The research has raised awareness of the need to determine and actively overcome the obstacles if new safer technology is to be used. Paul Lee, a medical device manager and trainer at the Singleton Hospital in Wales, stated: "we're going to use this article as a driver for our organisation to sort out DERS... A real impact on us from [CHI+MED]'' referring to the research as published in the British Journal of Nursing. The British Journal of Health Care Management republished it to ensure the work gets "exposure to a wider audience". A major infusion device manufacturer have also shown interest in the results, giving the company a deeper understanding of the challenges that need to be overcome to get new, safer technology adopted. Further investigation of these findings are a focus of a new project (called ECLIPSE), which has recently been funded by the the National Institute for Health Research.

See also
Diverse use: many uses of infusion devices: one size does not fit all

Iacovides, I., Blandford, A., Cox, A., Dean-Franklin, B., Lee, P., & Vincent, C.J. (2014). Infusion device standardisation and the use of dose error reduction software: a UK survey. British Journal of Nursing, 23(14): IV Therapy supplement, S20–S25.

Lee, P. (2013). Foreword: Safer systems for IV therapy: what role does drug error reduction software play? In P. Lee (Ed.), "Help eliminate medication errors using smart pump technology". British Journal of Nursing, 22(14): CareFusion supplement, 3.

Iacovides, I., Cox, A.L., & Blandford A. (2013). Supporting learning within the workplace: Device training in healthcare. In Proceedings of the European Conference on Cognitive Ergonomics (ECCE 2013), 30.