title: Impact of smart infusion technology on administration of anticoagulants (unfractionated Heparin, Argatroban, Lepirudin, and Bivalirudin).
abstract: This study reviewed 863 alerts generated from the infusion of anticoagulants in 355 patients from October 2003 to January 2005. Alerts were generated by smart infusion technology pumps and recorded in the devices' memory. The most common alerts were underdose alerts (59.8%), followed by overdose alerts (31.3%) and duplicate drug therapy alerts (8.9%). In response to the alerts, users' most frequent action was to cancel (46.5%) or reprogram (43.1%) the infusions. The highest percentage of alerts occurred from 2 to 4 p.m. During the study, there were 4 infusion rate errors, compared with 15 in the immediately preceding 16-month period. In conclusion, smart infusion technology intercepted keypad entry errors, thereby reducing the likelihood of intravenous anticoagulant overdose or underdose. Dose or infusion rate programming during intravenous anticoagulation is an important targets for medication safety interventions.
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: John
authors.initials: J
authors.lastname: Fanikos
authors.forename: Karen
authors.initials: K
authors.lastname: Fiumara
authors.forename: Steve
authors.initials: S
authors.lastname: Baroletti
authors.forename: Carol
authors.initials: C
authors.lastname: Luppi
authors.forename: Catherine
authors.initials: C
authors.lastname: Saniuk
authors.forename: Amar
authors.initials: A
authors.lastname: Mehta
authors.forename: Jon
authors.initials: J
authors.lastname: Silverman
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001120:Arginine / Q000031:analogs & derivatives; D001900:Boston; D062787:Drug Overdose; D004360:Drug Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D008508:Medication Errors; D008510:Medication Systems, Hospital; D010446:Peptide Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D010875:Pipecolic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012107:Research Design; D013449:Sulfonamides
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban; C074619:bivalirudin; C083544:lepirudin