title: Benefits and risks of using smart pumps to reduce medication error rates: a systematic review.
abstract: BACKGROUND
  Smart infusion pumps have been introduced to prevent medication errors and have been widely adopted nationally in the USA, though they are not always used in Europe or other regions. Despite widespread usage of smart pumps, intravenous medication errors have not been fully eliminated.
  
  
  OBJECTIVE
  Through a systematic review of recent studies and reports regarding smart pump implementation and use, we aimed to identify the impact of smart pumps on error reduction and on the complex process of medication administration, and strategies to maximize the benefits of smart pumps.
  
  
  METHODS
  The medical literature related to the effects of smart pumps for improving patient safety was searched in PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (2000-2014) and relevant papers were selected by two researchers.
  
  
  RESULTS
  After the literature search, 231 papers were identified and the full texts of 138 articles were assessed for eligibility. Of these, 22 were included after removal of papers that did not meet the inclusion criteria. We assessed both the benefits and negative effects of smart pumps from these studies. One of the benefits of using smart pumps was intercepting errors such as the wrong rate, wrong dose, and pump setting errors. Other benefits include reduction of adverse drug event rates, practice improvements, and cost effectiveness. Meanwhile, the current issues or negative effects related to using smart pumps were lower compliance rates of using smart pumps, the overriding of soft alerts, non-intercepted errors, or the possibility of using the wrong drug library.
  
  
  CONCLUSIONS
  The literature suggests that smart pumps reduce but do not eliminate programming errors. Although the hard limits of a drug library play a main role in intercepting medication errors, soft limits were still not as effective as hard limits because of high override rates. Compliance in using smart pumps is key towards effectively preventing errors. Opportunities for improvement include upgrading drug libraries, developing standardized drug libraries, decreasing the number of unnecessary warnings, and developing stronger approaches to minimize workarounds. Also, as with other clinical information systems, smart pumps should be implemented with the idea of using continuous quality improvement processes to iteratively improve their use.
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, OBC-3, Boston, MA, 02120-1613, USA, kohashi@partners.org.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Ohashi
authors.forename: Olivia
authors.initials: O
authors.lastname: Dalleur
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Dykes
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000295:instrumentation*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D004869:Equipment Safety; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D008508:Medication Errors / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid