IV Safety Systems
IV Safety Systems - New Standard for Medication Safety Technology Averts Medical Errors
Few people have a better understanding of the extraordinary professional pressures facing nurses than Cathi Whelchel, RN, Chief Nursing Officer at Spartanburg Regional Healthcare System in Spartanburg, South Carolina. That's one of the reasons Whelchel is so enthusiastic about a new technology that can dramatically reduce high-risk errors in the administration of intravenous (IV) medication.
As Whelchel points out, almost all of today's hospitalized patients are acutely ill. More than 10,000 drugs are available for treatment, with more approved each year.1 A steady stream of new technologies and treatments requires nurses to adapt constantly. At the bedside, a nurse is bombarded with family questions and patient concerns as well as multiple drugs and IV therapies-at the same moment.
"Even for a highly experienced nurse, the demands often exceed an individual's capacity to function without error," Whelchel says.
Regrettably, critical medical errors happen-and relatively frequently. A series of reports issued by the Institute of Medicine beginning in 1999 highlights the seriousness of medical errors as a major cause of increased injury and death, including the loss of 45,000 to 94,000 lives each year in the United States.2
Preventable adverse drug events-those caused by human error, not an allergic reaction of the patient-were estimated to cost $2 billion per year.3Medication errors account for one out of 854 inpatient deaths.4 The risk of patient harm from IV medication errors is of particular concern, since infusion therapy involves powerful drugs flowing directly into a patient's bloodstream. IV delivery for medications often results in the most serious medication error outcomes.5
Today hospital patients often receive high-risk drugs such as heparin, insulin, or opioid sedatives that are delivered intravenously and can cause serious problems if administered incorrectly. Accurate dosing of these agents is essential; a relatively simple mistake in programming a general-purpose IV pump can have tragic results. As Whelchel remembers from her days as a floor nurse, "You walk away thinking, 'I hope I did that right.'"
Such second-guessing no longer happens at Spartanburg Regional. One of the top 100 "most wired" hospitals in the nation, Spartanburg Regional was one of the first hospitals to implement a new IV medication safety system in November 2002. Sometimes referred to as "smart pumps," this major technological advance allows hospitals to play a key role in preventing adverse IV medication events, saving lives and money in the process.
Smart Pump Technology
To help reduce the risk of harm, IV safety systems integrate infusion, patient monitoring, clinical best practice guidelines and information management tools. Acting as a bedside computer, a smart pump performs a "final check" after a clinician has entered the dosing information. If a programmed dose exceeds a hospital's pre-established limits, the software alerts the clinician. Infusion cannot begin until the alert has been addressed.
"The max-min dosing limits in the new software are extremely important," says George Reid, PharmD, Director of Pharmacy at Spartanburg Regional. "In the past, you depended on pharmacist-nurse communication or on nurses looking up information in texts to make sure that dosing was correct. This technology provides a safeguard that dramatically improves patient safety."
IV safety systems also have continuous quality improvement (CQI) logs that allow a hospital to track "near misses" that could have resulted in patient harm. The new CQI data allow researchers to analyze programming "events"-instances in which a smart pump alerted a nurse that a programmed dose exceeded the limits and the nurse changed the programming. Pharmacists and nurses now can identify patient care areas with the most alerts, the drugs most often associated with alerts, the magnitude of dosing errors, the times of day when errors are most likely to occur, and other causes for concern.
CQI findings can be correlated with patient information to prompt policy and practice changes that can improve treatment and reduce costs. The recently developed IV Medication Harm Index,6 sponsored by ALARIS Medical Systems, will allow hospitals to objectively measure the harm prevented by infusion medication safety technology.
The IV safety systems in place now offer insight into their effectiveness since the pumps provide previously unavailable information on "near misses." Analysis of data from community and regional hospitals, as well as major medical centers, reveals that in an average 350-bed hospital, 'smart pump' technology helps avert a potentially life-threatening IV error every 2.6 days, and an additional potentially significant IV error every 3.6 days.7
Need for safety
Of all medication errors, 38 percent occur at the bedside as the drug is being administered, and only 2 percent of these errors are intercepted before reaching the patient.8 But the longer an error goes undetected, the greater the likelihood of increased patient harm, length of stay and hospital costs. Research has shown that 61percent of the most serious and life-threatening potential adverse drug events are related to IV therapy.9
That's why Ray Shingler, Sr., Vice President/Chief Information Officer at Spartanburg Regional, believes that "the single most important thing a hospital can do to improve medication safety is to correct the risk of harm from IV medication errors."
The general-purpose pumps still being used in most United States hospitals today made modern therapy possible. Designed to deliver any dose-from a few drops to 999 mL/hr-they could be used in any patient care area, but their flexibility also increased the potential for error. Nothing in a conventional pump safeguards against programming an IV dosing error. And if an error is made, there is no systematic way to detect it.
"A nurse would never give a patient 100 pills," Denise Taylor, RN, IV Team Coordinator at Spartanburg Regional points out, "but with a conventional pump, even checking and double-checking, a nurse can inadvertently deliver a massive overdose."
An average hospitalized patient may have one or two IV "lines"; an ICU patient, seven or eight; and cancer patients may have 12 or more lines infusing simultaneously. If a conventional pump delivers an overdose, clinicians might not even know. The effect on the patient could be misinterpreted as being due to general deterioration. With IV safety systems, clinicians are alerted to possible overdose and dosing can be checked at any time.
"Nobody wants to make a mistake. We always double-check. But the smart pump dosing limits give you tremendous peace of mind," Taylor says. "The software provides you with a back-up, that extra assurance that the device is programmed correctly. I wish it had been there when I was doing bedside nursing."
"Speed to Impact"
Charles Denham, MD, founder of the Texas Medical Institute on Technology and the CEO of Health Care Concepts, Inc. helps health care executives invest in safety technology. Considering the various efforts to improve medication safety, he says, "There are errors, harm, and errors that cause harm. Errors that cause great harm are in the IV area-they are really dramatic and there is a great return on investment in reducing them. The speed to impact is better with smart pumps than anything we have seen."10
Spartanburg Regional's experience bears this out. "With smart pumps we saw a dramatic improvement in patient care in a relatively short period of time, about six weeks," Reid reports.
From a senior management perspective, especially for hospitals just beginning to select technology, "The important thing is to find a 'win,' a technology that will allow you to measure results and show tangible benefits," Shingler emphasizes. "Our early CQI data confirmed that we had made the right decision."
1 Food and Drug Administration. Approved Drug Products with Therapeutic Equivalence Evaluations Orange Book. www.fda.gov/cder/orange/supplement/cspreface.htm#1.6 (accessed 2004 Jan 28).
2 American Hospital Association. Hospital Statistics. Chicago, Il. 1999. Cited in Kohn, LT, JM Corrigan and MS Donaldson, ed. Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.
3 Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA. 1997;277:307-311.
4 Kohn, LT, JM Corrigan and MS Donaldson, ed. Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.
5 Hicks, RW, DD Cousins, RL Williams. Summary of Information Submitted to MEDMARX in the Year 2002. The Quest for Quality. Rockville, MD: USP Center for the Advancement of Patient Safety, 2003.
6 Sullivan J, Rich VL, and IV Medication Harm Index Study Group. IV Medication Harm Index. © 2003 Alaris Medical Systems, Inc.
7 Data on file, ALARIS Medical Systems, Inc.
8 Leape LL, Bates DW, Cullen DJ et al. Systems analysis of adverse drug events. JAMA. 1995; 274:35-43.
9 Communication with David W. Bates, MD, MSc. in October 2001.
10 Schneider PJ, ed. Proceedings: bar code medication administration conference. Hosp Pharm. 2003;38:S32.
April 2004
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