Risks in the implementation and use of smart pumps in a pediatric intensive care unit: application of the failure mode and effects analysis.
OBJECTIVE
The aim of this study was to identify risk points in the different stages of the smart infusion pump implementation process to prioritize improvement measures.


METHODS
Failure modes and effects analysis (FMEA) in the pediatric intensive care unit (PICU) of a General and Teaching Hospital. A multidisciplinary team was comprised of two intensive care pediatricians, two clinical pharmacists and the PICU nurse manager. FMEA was carried out before implementing CareFusion infusion smart pumps and eighteen months after to identify risk points during three different stages of the implementation process: creating a drug library; using the technology during clinical practice and analyzing the data stored using Guardrails® CQI v4.1 Event Reporter software.


RESULTS
Several actions for improvement were taken. These included carrying out periodical reviews of the drug library, developing support documents, and including a training profile in the system so that alarms set off by real programming errors could be distinguished from those caused by incorrect use of the system. Eighteen months after the implementation, these measures had helped to reduce the likelihood of each risk point occurring and increase the likelihood of their detection.


CONCLUSIONS
Carrying out an FMEA made it possible to detect risk points in the use of smart pumps, take action to improve the tool, and adapt it to the PICU. Providing user training and support tools and continuously monitoring results helped to improve the usefulness of the drug library, increased users' compliance with the drug library, and decreased the number of unnecessary alarms.
Pharmacy Service,Gregorio Marañón University Hospital.
Silvia
S
Manrique-Rodríguez
Pediatric Intensive Care Unit,Gregorio Marañón University Hospital.
Amelia C
AC
Sánchez-Galindo
Pediatric Intensive Care Unit,Gregorio Marañón University Hospital.
Jesús
J
López-Herce
Pharmacy Service,Virgen de las Nieves University Hospital.
Miguel Ángel
MÁ
Calleja-Hernández
Faculty of Pharmacy,Complutense University of Madrid,Ciudad Universitaria.
Irene
I
Iglesias-Peinado
Pediatric Intensive Care Unit,Gregorio Marañón University Hospital.
Angel
A
Carrillo-Álvarez
Pharmacy Service,Gregorio Marañón University Hospital.
María Sanjurjo
MS
Sáez
Pharmacy Service,Gregorio Marañón University Hospital.
Cecilia M
CM
Fernández-Llamazares
D019544:Equipment Failure Analysis; D007260:Infusion Pumps / Q000592:standards*; D015278:Intensive Care Units, Pediatric; D033183:Interdisciplinary Communication; D061214:Patient Safety; D018570:Risk Assessment / Q000379:methods