To identify the key issues around use of computerized patient infusion devices (called "smart pumps"). To develop strategies that will improve the prevention of intravenous errors that will be broadly applicable. The investigators will conduct a national study using the general methodology developed by Husch et al. to allow a rapid assessment of the frequency and types of medication errors at an institution. The key questions the investigators will address are: 1. What are the frequency and types of intravenous medication errors? 2. How much variability is there by frequency and type among settings? 3. After review of the initial data, what strategies appear to have the greatest potential for reducing intravenous medication error frequency? 4. How effective is an intervention including a bundle of these strategies at multiple sites?
Overall Study Design: This is a multi-hospital study to investigate medication errors using smart pumps. The proposed study will be conducted over three phases for a total of 36 months phases. In Year 1, an observational study will be conducted by investigators at ten multiple hospital sites. The investigators will prospectively compare the medication, dose, and infusion rate on the IV pump with the prescribed medication, doses, and rate in the medical record. Preventability with smart pump technology will be retrospectively determined based on a rigorous definition of currently available technology. The investigators will also make comparisons across sites by overall rate and degree of variability among sites. Then, in Year 2, these results will be evaluated, and a consensus process including a face-to-face meeting will take place to evaluate the types of events and to develop an intervention which will be implemented at multiple sites. After a run-in period, the intervention will be tested in Year 3 at the sites, and the data will be analyzed, and the investigators will produce a report and a set of recommendations.
Study Type
OBSERVATIONAL
Enrollment
900
Smart pump safety intervention bundle includes three components--1) eliminating unauthorized medications; implement standardized discontinuation policy of medications, implement standardized keep vein open rates and keep vein open rate order sets, and implement standardized verbal order practice. 2) Implement standardized intravenous(IV) labeling and IV tubing labels. 3) Implement standardized drug library lists and drug library use policies
Brigham and Women's Hospital
Boston, Massachusetts, United States
Incident rates of wrong dose
The same medication but the dose is different from the prescribed order.
Time frame: Two years
Incident rates of wrong rate
A different rate is displayed on the pump from that prescribed in the medical record. Also refers to weight based doses calculated incorrectly including using a wrong weight.
Time frame: Two years
Incident rates of wrong concentration
An amount of a medication in a unit of solution that is different from the prescribed order.
Time frame: Two years
Incident rates of wrong IV fluids/medications
A different fluid/medication as documented on the IV bag label is being infused compared with the order in the medical record.
Time frame: Two years
Incident rates of delay of medication administration
An order to start or change medication or rate not carried out within 4 hours of the written order or intended start time per institution policy.
Time frame: Two years
Incident rates of omission of IV fluids/medications
The medication ordered was not administered to a patient or administered anytime after 4 hours of the intended start time.
Time frame: Two years
Incident rates of unauthorized medication
Fluids/medications are administered to the patient but no order is present in medical record. This includes failure to document a verbal order.
Time frame: Two years
Incident rates of patient identification (ID) error (wrong patient)
Patient either has no ID band on or information on the ID band or label is incorrect.
Time frame: Two years
Incident rates of smart pump or drug library not used
Smart pump is not used (bypassing smart pump) or smart pump was used but the drug library was not selected, rather manual entry mode was used (bypassing drug library)
Time frame: Two years
Incident rates of oversight allergy
Medication is administered to a patient with a known allergy to the drug or class.
Time frame: Two years
Incident rates of pump setting error
Setting programmed into the pump is different from the prescribed order.
Time frame: Two years
Compliance rate of label not complete according to policy
Documented information on the medication label is different from required information per institution policy.
Time frame: Two years
Compliance rate of IV tubing not tagged according to policy
IV tubing change label is not tagged per institution policy.
Time frame: Two years
Incident rates of expired drug
The expiration date or time of the fluids/medications has passed.
Time frame: Two years
Overall medication errors
Total number of all observed medication errors(including outcome 1-14)
Time frame: Two years
Higher-severity medication errors
All medication errors with an NCC MERP severity rating of C or greater (excluding violation of hospital policy errors;outcome 12 and 13).
Time frame: Two years
Compliance rate of using smart pump use
Compliance rate of using smart pump
Time frame: Two years
Compliance rate of using drug library use
Compliance rate of using drug library
Time frame: Two years
Potential adverse drug events
Medication errors with potential for harm categorized as D (errors that would have required increased monitoring to preclude harm) or higher by NCC MERP Index
Time frame: Two years
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