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Education and training
The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit
  1. P L Trbovich1,2,
  2. S Pinkney1,
  3. J A Cafazzo1,2,3,
  4. A C Easty1,2
  1. 1Healthcare Human Factors, Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
  2. 2Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Patricia L. Trbovich, Ph.D, Human Factors Specialist, Healthcare Human Factors Group, University Health Network, 4th Floor, R. Fraser Elliott Building, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4; patricia.trbovich{at}uhn.on.ca

Abstract

Objective Assess the impact of infusion pump technologies (traditional pump vs smart pump vs smart pump with barcode) on nurses' ability to safely administer intravenous medications.

Design Experimental study with a repeated measures design.

Setting High-fidelity simulated inpatient unit.

Results The nurses remedied 60% of “wrong drug” errors. This rate did not vary as a function of pump type. The nurses remedied “wrong patient” errors more often when using the barcode pump (88%) than when using the traditional pump (46%) or the smart pump (58%) (Cochran Q=14.36; p<0.05). The number of nurses who remedied “wrong dose hard limit” errors was higher when using the smart pump (75%) and the barcode pump (79%) than when using the traditional pump (38%) (Cochran Q=12.13; p<0.003). Conversely, there was no difference in remediation of “wrong dose soft limit” errors across pump types. The nurses' pump programming was less accurate when mathematical conversions were required. Success rates on secondary infusions were low (55.6%) and did not vary as a function of pump type.

Conclusions These findings indicate that soft (changeable) limits in smart infusion pumps had no significant effect in preventing dosing errors. Provided that smart pumps are programmed with hard (unchangeable) limits, they can prevent dosing errors, thereby increasing patient safety. Until barcode pumps are integrated with other systems within the medication administration process, their role in enhancing patient safety will be limited. Further improvements to pump technologies are needed to mitigate risks associated with intravenous infusions, particularly secondary infusions.

  • Patient safety
  • medical error
  • infusion pumps
  • medication safety

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/qshc.2009.032839

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    Footnotes

    • Funding This research was funded by the Ministry of Health and Long-Term Care (MoHLTC grant no. 06431, Toronto, Ontario, Canada) and conducted at the request of the Ontario Health Technology Assessment Committee (OHTAC, Toronto, Ontario, Canada). The opinions in the present paper are those of the authors and do not necessarily reflect the sponsor's official position.

    • Competing interests None.

    • Ethics approval Research Ethics Board (REB) approval was obtained. REB reference number: 08-0161-AE.

    • Provenance and peer review Not commissioned; externally peer reviewed.