The use of smart pump technology has improved quality and safety during the administration of IV medications; however, problems with medication errors still exist. In an attempt to further reduce their occurrence, smart pump technology has been integrated with the electronic health record. However, information is limited on whether smart pump interoperability (SPI) has decreased harm.
Researchers conducted an industry-sponsored, observational study at a community healthcare system to assess the frequency, type, and severity of errors associated with IV medication administration pre- and post-SPI.
This study was performed in three community hospitals in San Diego, California. Data were collected on active continuous infusions, intermittent infusions, and IV fluids for patients not on contact precautions from June 2017 and August 2017, which was immediately prior to SPI, and again between August to September 2018, which was following SPI. Data from operating rooms, labor and delivery suites, and outpatient infusion centers, as well as epidural injections, were excluded.
Information on the frequency of IV medication errors was broken down by error type and the National Coordinating Council for Medical Error Reporting and Prevention (NCC MERP) Index for Categorizing Medication Errors rating. NCC MERP rates medication errors and their risk of harm on an alphabetical scale of "A," indicating no error occurred to "I," meaning that the error resulted in a patient's death. Using the point prevalence method, the error rate per 100 infusions was calculated as the number of identified errors per number of observed infusions.
The primary outcome was the administration error rate for those errors with a NCC MERP score of "C" or greater. A secondary outcome was medication errors or harm involving high-risk medications, which included antiarrhythmics, anticoagulants, electrolytes, insulin, neuromuscular-blocking agents, opioids, vasopressors, and parenteral nutrition or those drugs deemed high risk by the Institute for Safe Medication Practice.
A total of 350 infusions involving 178 patients in the pre-SPI phase and 367 infusions involving 200 patients in the post-SPI phase were observed. There was a statistically significant difference in the number of total errors observed pre- and post-SPI with 401 (114.6 per 100 infusions) errors prior to SPI and 354 (96.5 per 100 infusions) errors following SPI (P = .02). There was also a statistically significant decrease in errors involving high-risk medications from 45 to 25 (12.8 -6.8 per 100 infusions, P = .01). Expired medication errors also significantly declined from 11 to 2 (3.1 -0.5 per 100 infusions, P = .02).
Labeling errors, which were the most common type of medication error in both phases, decreased but not significantly. Decreases were also seen in administration errors and user documentation errors, which also did not achieve statistical significance.
While there was a significant difference in the number of IV continuous medications administered without error pre- and post-SPI from 44 to 22 (12.6-6 per 100 infusions, P = .005), there was actually a nonsignificant increase in medication errors associated with IV fluids from 89 to 94 (25.4-25.6 per 100 infusions) and for IV intermittent medications from 5 to 6 (1.4-1.6 per 100 infusions), making the overall error rate decline not statistically significant.
Autoprogramming also had a profound effect on administration and user documentation errors, reducing them from 77.2% to 22.8%. Errors involving high-risk medications also dropped from 84.0% to 16.0% with the use of autoprogramming.
This study provides useful information on the role of SIP in improving patient safety.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
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