Medication Safety

Smart Pumps

Intravenous medications represent an important source of risk of harm to the patient. As the IHI states: “When intravenous medications are involved in ADEs, the harmful effects to the patient may occur more rapidly and be more severe than errors with oral medications, due the direct administration into the bloodstream.” However, the degree of risk reduction with smart pumps is highly dependent upon integration into the hospital’s information systems, and the degree of improvement may be limited if the hospital does not yet have all of its patient information in integrated electronic systems.

The following resources assist in successful smart pump implementation.

Smart Infusion Pump Technology: Don’t Bypass the Safety Catches, Pennsylvania Patient Safety Advisory 2007 Dec;4(4):139–43. (free full access).

Smart Medication Delivery Systems: Infusion Pumps, Healthcare Human Factors Group, April, 2009. (free full access).

Ontario Health Technology Advisory Committee (OHTAC) Recommendation: Implementation and Use of Smart Medication Delivery Systems, July 2009. (free full access).

Proceedings from the ISMP Summit on the Use of Smart Infusion Pumps: Guidelines for Safe Implementation and Use, September 2009. (free full access).

The following reference describes the opportunities for improved safety that are not addressed by a particular smart pump implementation.

Nuckols TK, Bower AG, Paddock SM, et al. Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events. Journal of general internal medicine. 2008;23 Suppl 1:41-5. (free full access).

Specific Error Reduction Initiatives

Intravenous Medication Concentrations Standardization

Standardization of intravenous (IV) infusion medication concentrations and dosage units with and across hospitals in San Diego County was identified as a significant opportunity to reduce morbidity and mortality due to preventable, high-risk IV-related adverse drug events. This toolkit provides the results of the work by the SDPSC IV Safety Task Force, along with tools and information to assist other acute care organizations in implementing this standard approach.

Patient-Controlled Analgesia (PCA)

The use of PCA is a complex, high-risk treatment that is associated with harmful events and death. Extensive variability exists within and between hospital environments. Variability in patient response, clinical staffing, equipment, physician orders, medication dosages, and concentrations all contribute to risk for error. The San Diego Patient Safety Taskforce has provided San Diego County Acute Care settings with recommendations for the standardization of intravenous Patient Controlled Analgesia (PCA) medication administration in the care of the opioid naïve patient. These recommendations exclude the use of epidural PCA (PCEA), subcutaneous PCA use, the palliative care environment, and patients experiencing chronic pain. (free full access).

Implementation Examples

Contra Costa Regional Medical Center

1. Improving Medication Reconciliation (posted on the American Hospital Association Hospitals in Pursuit of Excellence site). (free full access).

Health Services Advisory Group (HSAG) Resources

HASG, the QIO for California, has assembled a set of resources for medication safety efforts. Those can be found at http://www.hsag.com/caproviders/drugsafety.aspx.