IV Smart Pumps: The Impact of a Simplified User Interface on Clinical Use.

More than a decade ago, the introduction of intravenous (IV) smart pumps with drug libraries and dose error reduction systems (DERSs) provided a means for decreasing IV medication administration errors. Before IV smart pumps were available, all pump programming required the user to manually calculate the rate of infusion, then input the desired infusion rate into the pump. Because many different units of measure are used in the administration of IV medications, required calculations often are complex and therefore increase the likelihood of user error.1 In contrast, IV smart pumps have built-in drug libraries and a DERS, which allows the user to choose the desired medication from an approved list and input the required patient information, after which the IV smart pump calculates the infusion rate. Drug libraries contain the most commonly used IV medications, and the DERS alerts the user if the calculated infusion rate exceeds normally acceptable dosing limits. These limits can be expressed as either hard dose limits (i.e., cannot be bypassed by users at the pump, thereby preventing users from starting the programmed infusion) or soft dose limits (which provide a warning that the dose may be too high but will still allow users to start the infusion as programmed after the limits are acknowledged). IV smart pumps have become indispensable in the administration of medication, fluids, and nutrients. Although the use of IV smart pumps can reduce the incidence of IV adverse drug events and medication administration errors,2 IV infusion continues to be associated with 54% of all adverse drug events,3 56% of medication errors, and 61% of serious and life-threatening errors.4 A study from 2005 found a staggering 67% error rate with the administration of IV infusions in an intensive care unit (ICU).5 Of important note, many of the errors involved labeling and other administrative omissions, while only a portion of the errors resulted in serious harm to patients. Common sources of error include overriding dose error alerts and, even more concerning, manually bypassing drug libraries and the DERSs completely.6,7 The complexity of the device-user interface, the time required to complete IV smart pump programming, and libraries that lack drug entries that are properly harmonized with how medications are ordered or dispensed in that location are among the most frequently cited reasons for nurses bypassing drug libraries and DERSs.8 Research suggests that the majority of adverse drug events are related to incorrect or incomplete programming.9 Clinicians report that pump programming is frequently rushed and that they often feel forced to make hasty decisions about overriding alerts because of time constraints and competing work demands.6,9 Research has identified three specific IV medication infusion tasks as particularly susceptible to errors.10 The first is administration of multiple IV infusions, including secondary (also referred to as “piggyback”) IV Smart Pumps: The Impact of a Simplified User Interface on Clinical Use