Making “Smart Pumps” smarter: Utilizing electronic medical administration record information to optimize dose error reduction software on large volume infusion devices

Purpose: Large volume infusion devices with dose error reduction systems (“smart pumps”) and associated drug libraries can offer increased safety and continuous quality improvement opportunities related to the administration of intravenous medications.  The work of an innovative multidisciplinary Pharmacy and Therapeutics (P&T) Drug Library Subcommittee involving pharmacists, nurses, and value measurement analysts is described and includes: drug library software initiation and deployment, dose error reduction systems (DERS) data review, and DERS optimization through incorporation of electronic medication administration record (eMAR) information.

Methods: In October of 2008, smart pumps were introduced in an academic medical center with house-wide implementation by July of 2009. Continuous quality improvement review of the pumps’ DERS data began in August of 2009.  In April of 2011, the institution transitioned to a comprehensive electronic health record.  The P&T Drug Library Subcommittee incorporated the newly-available eMAR data into its regular DERS review for further drug library optimization.

Results: While initial drug library parameters were based upon medication administration recommendations from resources such as the institution’s standard concentration chart and tertiary drug information references, DERS limits within the drug library were able to be added and/or optimized based on medication use throughout the institution.

Conclusion: Utilizing eMAR information allowed further evaluation of drug library limits through comparison to actual clinical practice, thereby maximizing potential patient safety gained through DERS within a smart pump.  A multidisciplinary committee was expanded to include value measurement analysts within the institution’s department of Value Performance, Measurement, and Patient Safety.   Pharmacist and nurse representatives worked with analysts to guide the collection and interpretation of eMAR and DERS data.  Such involvement of data review experts as part of a P&T Drug Library Subcommittee and integration of information obtained from two systems (electronic health records and smart pumps) is an advantageous approach to ongoing drug library management.