Safety implications of the dose change alert function in smart infusion pumps on the administration of high-alert medications.

Background: Most intravenous medication errors occur during administration. Smart pumps can reduce the incidence of dose or rate errors using soft and hard limits. However, industry standard dose error reduction software misses errors that occur during titration. The dose change alert was developed...

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Published in:Canadian Journal of Critical Care Nursing Vol. 26; no. 4; pp. 23 - 28
Main Authors: Goulding, Catherine, Bedard, Mario
Format: research tables/charts Journal Article
Published: Canadian Association of Critical Care Nurses Winter2015
Online Access:View this record in EBSCOhost
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      dt: Winter2015
      vid: 26
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      pub: Canadian Association of Critical Care Nurses
      place: London, Ontario
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        atl: Safety implications of the dose change alert function in smart infusion pumps on the administration of high-alert medications.
      aug:
        au:
          Goulding, Catherine
          Bedard, Mario
        affil: Medical Affairs Pharmacy Consultant, Baxter Corporation, Mississauga, ON
      sug:
        subj:
          Patient Safety
          Infusion Pumps
          Medication Errors Prevention and Control
          Software
          Drug Administration
          Human
          Ontario
          Hospitals
          Retrospective Design
          Convenience Sample
          Record Review
          Quality Improvement
          Evaluation Research
          Professional Compliance Evaluation
          Descriptive Statistics
          Hospital Units
      ab: Background: Most intravenous medication errors occur during administration. Smart pumps can reduce the incidence of dose or rate errors using soft and hard limits. However, industry standard dose error reduction software misses errors that occur during titration. The dose change alert was developed to detect errors during titration. Purpose: To evaluate the safety implications of the dose change alert in the SIGMA Spectrum Infusion System on the administration of high-alert medications at The Ottawa Hospital. Method: This retrospective analysis included all titratable highalert medication infusions administered between May 1 and October 31, 2014 (inclusive). Analysis of continuous quality improvement reports included drug library compliance, dose change alerts, soft limit confirmations and cancellations, and hard limit pull-back reports for each high-alert medication and care area. Findings: Compliance with using the drug library was 96.8%. The percentage of dose change alert confirmations and cancellations within the soft limits were 48.1% and 1.9%, respectively. The titration of vasopressors resulted in the highest percentage (75%) of dose change alert confirmations. The titration of anticoagulants resulted in the highest percentage (12%) of dose change alert cancellations. Titration within the soft limits accounted for 65% of the alerts. Conclusions: This study provided insight into the safety implications of the dose change alert on the titration of high-alert medications. Key-press errors during titration of high-alert medications can cause patient harm, even within the soft limits. Nurses can be involved in customizing the percentage dose change limit for individual drugs within each care area to provide an additional safety check during titration.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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