title: JCAHO's National Patient Safety Goal for infusion pump free-flow protection: ECRI's assessment of the protection offered by general-purpose, PCA, and ambulatory pumps.
abstract: One of the U.S. National Patient Safety Goals promulgated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is to "improve the safety of using infusion pumps" by ensuring that pumps are protected against free-flow. In this Guidance Article, we provide ECRI's updated guidance for achieving this goal. Free-flow refers to the uncontrolled delivery of an infusion to a patient when a controlled or metered delivery was intended. For more than 20 years--in numerous articles presented in Health Devices and its sister publication Health Devices Alerts--ECRI has offered guidance to help hospitals avoid the dangers of free-flow. The current article is the latest in a series of reports addressing JCAHO's goal; it describes the dangers, provides updated guidance for interpreting JCAHO's goal, and categorizes the available pump models according to the level of free-flow protection offered. This report supersedes Health Devices Alerts Special Reports S0008 (August 23, 2002), S0018 (March 21, 2003), and S0029 (November 14, 2003).
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000295:instrumentation / Q000592:standards; D004868:Equipment Failure; D004869:Equipment Safety / Q000592:standards; D007260:Infusion Pumps / Q000592:standards*; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008508:Medication Errors / Q000517:prevention & control* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000592:standards; D014481:United States