The use of pre -programmed intravenous (IV) infusion devices with safety warnings can save hundreds of lives every year, but they are often not available or the software is overwritten, researchers conclude in a new study.
In the first study in its kind in English hospitals, pharmacy researchers from the University of Manchester assessed data from two large NHS-Trusts with smart IV pumps and discovered that the devices were able to prevent 110 deaths over the course of a year by warning staff For potentially dangerous errors in medicine dosing.
Published in BMJ Open Quality On July 12, 2022, the study showed that less than half of the infusions (338,263 of 745.170 infusions; 45%) that were carried out at the trusts for a year were administered using a Dose Error Reduction Software (Ders) system . With the other infusions, the system was not used or overwritten.
About 20-30 NHS hospitals currently use ‘smart pumps’ on which Ders is installed. Ders devices are pre-programmed with medicine libraries, medicine concentrations and dosing speeds and limits to reduce programming and administration errors, and are recommended as an intervention to reduce administration errors.
The authors of the study concluded: “Where Ders is used, the prevalence of potentially harmful medication side effects is roughly the same as those estimates of systematic reviews in which one in ten IV medication errors can be associated with a potential for damage.”
Adam Sutherland, lead researcher of the research and children’s pharmacist in the Royal Manchester Children’s Hospital, said that previous research had shown that “programming devices was not configured for the way people work in practice”.
“If it doesn’t do what you want, you will bypass the device. That explains somewhat why they are not used. “
He added that another problem was the lack of staff training in its use, and inconsistency in the way in which smart pumps are configured, so that users found them confusing.
The devices must be configured by the hospital when they arrive – a task that is often delegated to the pharmacy department, as was the case for the Sutherland team. “Our organization bought a series of smart pumps last year and turned to the pharmacy department and said:” You can arrange the programming, right? “
However, setting up the systems is time -consuming and challenging, partly due to the lack of standardized parameters. The situation will probably be more acute, Sutherland said, because IV infusion systems in most hospitals will be replaced by smart pumps in the coming years.
“We now have some time to get our house like NHS in order, to think about how those pumps will be introduced,” he said.
He added that there was “no reason” why devices could not be pre -programmed with standardized configurations to be used “out of the box”, for which only small local changes were needed, but this would require the manufacturers who work with pharmacists and Other experts agree to standardization (see box).
The BMJ Open Quality Research showed that, where Ders was used, the 18 warnings caused every 1,000 infusions (17.9/1,000, 95% confidence interval 17.5 to 18.4). However, most of these warnings were small deviations and could be due to rounding errors (4,652 of the 6,067 warnings; 77%). Of the remaining 1,415 warnings taken by experts, 747 were supposed to cause little or no damage. This resulted in 668 warnings for errors that could cause moderate or serious damage. The researchers estimate that 110 of these could have caused disabledness or death if they were not picked up – a percentage of 0.2% of the ders infusions administered.
Although the number of dangerous infusion errors is low, “my position as a researcher and pharmacist is that you cannot justify you have smart pumps and not use them,” said Sutherland.
“Busy hospitals serve a million infusions per year. If you use smart pumps, you will prevent many possible errors. “
The drugs that are most likely associated with potentially dangerous mistakes were anticoagulants (24.16 warnings per 1,000 administrations), antiarrhythmics (21.8 per 1,000 administrations) and anti-epileptics (20.86 per 1,000 administrations). Pediatric and medical departments were most likely to activate potentially harmful warnings.