• J Gen Intern Med · Jan 2008

    Comparative Study

    Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events.

    • Teryl K Nuckols, Anthony G Bower, Susan M Paddock, Lee H Hilborne, Peggy Wallace, Jeffrey M Rothschild, Anne Griffin, Rollin J Fairbanks, Beverly Carlson, Robert J Panzer, and Robert H Brook.
    • The RAND Corporation, Santa Monica, CA, USA. teryl@rand.org
    • J Gen Intern Med. 2008 Jan 1;23 Suppl 1:41-5.

    BackgroundPatients in intensive care units (ICUs) frequently experience adverse drug events involving intravenous medications (IV-ADEs), which are often preventable.ObjectivesTo determine how frequently preventable IV-ADEs in ICUs match the safety features of a programmable infusion pump with safety software ("smart pump") and to suggest potential improvements in smart-pump design.DesignUsing retrospective medical-record review, we examined preventable IV-ADEs in ICUs before and after 2 hospitals replaced conventional pumps with smart pumps. The smart pumps alerted users when programmed to deliver duplicate infusions or continuous-infusion doses outside hospital-defined ranges.Participants4,604 critically ill adults at 1 academic and 1 nonacademic hospital.MeasurementsPreventable IV-ADEs matching smart-pump features and errors involved in preventable IV-ADEs.ResultsOf 100 preventable IV-ADEs identified, 4 involved errors matching smart-pump features. Two occurred before and 2 after smart-pump implementation. Overall, 29% of preventable IV-ADEs involved overdoses; 37%, failures to monitor for potential problems; and 45%, failures to intervene when problems appeared. Error descriptions suggested that expanding smart pumps' capabilities might enable them to prevent more IV-ADEs.ConclusionThe smart pumps we evaluated are unlikely to reduce preventable IV-ADEs in ICUs because they address only 4% of them. Expanding smart-pump capabilities might prevent more IV-ADEs.

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