title: Smart pumps and random safety audits in a Neonatal Intensive Care Unit: a new challenge for patient safety.
abstract: BACKGROUND
  Random safety audits (RSA) are a safety tool enabling prevention of adverse events, but they have not been widely used in hospitals. The aim of this study was to use RSAs to assess and compare the frequency of appropriate use of infusion pump safety systems in a Neonatal Intensive Care Unit (NICU) before and after quality improvement interventions and to analyse the intravenous medication programming data.
  
  
  METHODS
  Prospective, observational study comparing the frequency of appropriate use of Alaris® CC smart pumps through RSAs over two periods, from 1 January to 31 December 2012 and from 1 November 2014 to 31 January 2015. Appropriate use was defined as all evaluated variables being correctly programmed into the same device. Between the two periods they were established interventions to improve the use of pumps. The information recorded at the pumps with the new security system, also extracted for one year.
  
  
  RESULTS
  Fifty-two measurements were collected during the first period and 160 measurements during the second period. The frequency of appropriate use was 73.13 % (117/160) in the second period versus 0 % (0/52) in the first period (p < 0.0001). Information was recorded on 44,924 infusions; in 46.03 % (20,680/44,924) of cases the drug name was recorded. In 2.5 % (532/20,680) of cases there was an attempt to exceed the absolute limit.
  
  
  CONCLUSIONS
  Random Safety Audits were a very useful tool for detecting inappropriate use of pumps in the NICU. The improvement strategies were effective for improving appropriate use and programming of the intravenous medication infusion pumps in our NICU.
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. ebergon@hotmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Bergon-Sendin
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. menchuperezgrande@gmail.com.
authors.forename: Carmen
authors.initials: C
authors.lastname: Perez-Grande
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. david@h12o.es.
authors.forename: David
authors.initials: D
authors.lastname: Lora-Pablos
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. maitemoral@hotmail.com.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Moral-Pumarega
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. anitamelb77@yahoo.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Melgar-Bonis
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. cppeloche@hotmail.com.
authors.forename: Carmen
authors.initials: C
authors.lastname: Peña-Peloche
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. mediezma@hotmail.com.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Diezma-Rodino
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. sanjoselidia@hotmail.com.
authors.forename: Lidia
authors.initials: L
authors.lastname: García-San Jose
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. esther.cabanes@salud.madrid.org.
authors.forename: Esther
authors.initials: E
authors.lastname: Cabañes-Alonso
authors.affiliation: Department of Neonatology, Biomedical Research Institute i + 12, 12 de Octubre University Hospital, Avenida de Córdoba s/n, Madrid, 28041, Spain. kpallas.hdoc@gmail.com.
authors.forename: Carmen Rosa
authors.initials: CR
authors.lastname: Pallas-Alonso
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007260:Infusion Pumps; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D008485:Medical Audit; D008510:Medication Systems, Hospital / Q000592:standards; D061214:Patient Safety / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement; D017751:Safety Management