Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events.
BACKGROUND
Patients in intensive care units (ICUs) frequently experience adverse drug events involving intravenous medications (IV-ADEs), which are often preventable.


OBJECTIVE
To determine how frequently preventable IV-ADEs in ICUs match the safety features of a programmable infusion pump with safety software ("smart pump") and to suggest potential improvements in smart-pump design.


METHODS
Using retrospective medical-record review, we examined preventable IV-ADEs in ICUs before and after 2 hospitals replaced conventional pumps with smart pumps. The smart pumps alerted users when programmed to deliver duplicate infusions or continuous-infusion doses outside hospital-defined ranges.


METHODS
4,604 critically ill adults at 1 academic and 1 nonacademic hospital.


METHODS
Preventable IV-ADEs matching smart-pump features and errors involved in preventable IV-ADEs.


RESULTS
Of 100 preventable IV-ADEs identified, 4 involved errors matching smart-pump features. Two occurred before and 2 after smart-pump implementation. Overall, 29% of preventable IV-ADEs involved overdoses; 37%, failures to monitor for potential problems; and 45%, failures to intervene when problems appeared. Error descriptions suggested that expanding smart pumps' capabilities might enable them to prevent more IV-ADEs.


CONCLUSIONS
The smart pumps we evaluated are unlikely to reduce preventable IV-ADEs in ICUs because they address only 4% of them. Expanding smart-pump capabilities might prevent more IV-ADEs.
Nuckols
Teryl K
TK
The RAND Corporation, Santa Monica, CA, USA. teryl@rand.org
Bower
Anthony G
AG
Paddock
Susan M
SM
Hilborne
Lee H
LH
Wallace
Peggy
P
Rothschild
Jeffrey M
JM
Griffin
Anne
A
Fairbanks
Rollin J
RJ
Carlson
Beverly
B
Panzer
Robert J
RJ
Brook
Robert H
RH
D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000295:instrumentation*; D000368:Aged; D016638:Critical Illness; D004360:Drug Therapy, Computer-Assisted; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007260:Infusion Pumps / Q000592:standards* / Q000639:trends; D015918:Infusion Pumps, Implantable / Q000592:standards / Q000639:trends; D007362:Intensive Care Units; D008297:Male; D008499:Medical Records; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D012308:Risk Management; D012680:Sensitivity and Specificity