Are We Making Smart Pumps Smarter?

Indianapolis, IN

Smart pumps have been developed to improve patient safety by reducing medication errors. It is believed that routinely analyzing data on smart pump alerts, making corresponding adjustments in the drug libraries, and analyzing those adjustments can reduce alarm fatigue. For a given change made to the Indiana University Health smart pump drug library on April 1, 2016, actions taken in response to alerts corresponding to that change three months prior to, and three months after the change, were analyzed. The primary outcome was a surrogate of smart pump user behavior defined as the percent of total alerts that were overrides. The percentage of total alerts that were reprograms and the ratio of overrides to reprograms for each quarter were calculated. Analysis was conducted on carboplatin, fentanyl PCA, hydromorphone PCA, morphine PCA, morphine PCA 10-24kg, morphine PCA >40kg, naloxone, and octreotide. From the first quarter to the second quarter the percent of overrides increased for 3 drugs, but for all 3, the number of overrides and total alerts decreased. Of the 5 drugs that had a decrease in the percent of overrides, 3 had an increase in the number of overrides and total alerts. Only 2 drugs had a decrease in the percent of overrides and the number of overrides and total alerts. The difference between the first and second quarters in all the measured outcomes varied between the drugs. Forming any definitive conclusions was difficult due to the results containing a significant amount of variation.