Infusion Pump Integration: Why Is It Needed, and What Are the Challenges?
July 1, 2013 | Evaluations & Guidance
Medication administration errors related to infusion pumps are a perennial problem. In fact, they came in at number 2 on ECRI Institute’s latest Top 10 Health Technology Hazards list. For years, we have recommended the use of “smart” pumps to address this issue. These pumps have drug libraries and are thus able to alert clinicians to gross misprogrammings that trigger alert limits (e.g., 10- or 100-fold overdoses). Most facilities using smart pumps today have connected them to a central pump server via the facility’s wireless network for the purpose of downloading new drug libraries to the pumps and uploading pump logs to the server.
However, there are many types of pump-related medication errors that can’t be addressed by using drug libraries alone—for example, wrong-drug selections or misprogrammed doses that do not trip an alert limit (but that are still potentially harmful). One way to address many of these errors is through infusion pump integration—that is, connecting pump servers with other information systems to ensure that pump programming matches provider orders. (For information on device integration using standards-based messaging, see our June 2013 Guidance Article “Secure Connections: IHE Showcases Interoperability Certification at the 2013 Connectathon.”)
Reports to ECRI Institute’s patient safety organization program, ECRI Institute PSO, demonstrate the diversity of infusion-related errors and make a safety case for integrating infusion pumps. For example, a query of our PSO database revealed 468 infusion-related events reported between May 2010 and March 2012. We analyzed a random sample of 100 of these events, and the distribution of problems is shown in the "Potential Role of Pump Integration" table. Overall, the data shows that 75% of the reported problems could have been averted with successful pump integration. Smart pump drug libraries alone could potentially have averted 28% of the reported problems, though only if the entered values triggered alert limits.
To date, three different approaches have been established to integrate infusion pumps with other clinical information systems: autoprogramming, autoverification, and autodocumentation. The first two approaches increase the safety of infusions by engaging the pump’s drug library and ensuring that initial programming matches medication orders.1 The third, which occurs during infusion, reduces the documentation burden on caregivers. These approaches are described in detail below. (Also see the “Characteristics of Integration Types” table, and the figure below, which depicts each approach. )