Institute for Healthcare Improvement: Implement Smart Infusion Pumps

Tips

Prior to deploying these pumps, standardize concentrations within the hospital. Asking the nurse to choose among several concentrations increases the risk of selection error.
Prior to deploying these pumps, standardize dosing units for a given drug (for example, agreeing to always dose nitroglycerin in terms of mcg/min or mcg/kg/min but not both). Asking the nurse to choose among several dosing units increases the risk of selection error.
Prior to deploying these pumps, standardize drug nomenclature (for example, agreeing to always use the term KCl, but not Potassium chloride, K, Pot Chloride, or others). Asking the nurse to remember and choose among several possible drug names increases the risk of selection error.
Perform a Failure Modes and Effects Analysis (FMEA) on the deployment of these devices.
Ensure that the concentrations, dose units, and nomenclature used in the pump are consistent with that used on the Medication Administration Record (MAR), the pharmacy computer system, and the electronic medical record.
Meet with all relevant clinicians to come to agreement on the proper upper and lower hard and soft dose limits.
Monitor overrides of alerts to assess if the alerts have been properly configured or if additional quality intervention is required.
Be sure the “smart” feature is utilized in all parts of the hospital. If the pump is set up volumetrically in the operating room but the “smart” feature is used in the ICU, an error may occur if the pump is not properly reprogrammed.
Be sure there are upper and lower dose limits for bolus doses, when applicable.
Engage the services of a human factors engineer to identify new opportunities for failure when the pumps are deployed.
Identify a procedure for the staff to follow in the event a drug must be given which is either not in the library or when its concentration is not standard.
Deploy the pump in all areas of the hospital. If a different pump is used on one floor and the patient is later transferred, this will create new opportunities for failure. Also, there may be incorrect assumptions about the technology available to a given floor or patient.
Consider using “smart” technology for syringe pumps as well as large volume infusion devices.

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