Hepatic arterial infusion pump chemotherapy combined with systemic chemotherapy for borderline resectable and unresectable colorectal liver metastases: phase II feasibility study.

BACKGROUND: Hepatic arterial infusion pump chemotherapy combined with systemic chemotherapy (HAIP-SYS) for liver-only colorectal liver metastases (CRLMs) has shown promising results but has not been adopted worldwide. This study evaluated the feasibility of HAIP-SYS in the Netherlands. METHODS: This was a single-arm phase II study of patients with CRLMs who received HAIP-SYS consisting of floxuridine with concomitant systemic FOLFOX or FOLFIRI. Main inclusion and exclusion criteria were borderline resectable or unresectable liver-only metastases, suitable arterial anatomy and no previous local treatment. Patients underwent laparotomy for pump implantation and primary tumour resection if in situ. Primary end point was feasibility, defined as ≥70% of patients completing two cycles of HAIP-SYS. Sample size calculations led to 31 patients. Secondary outcomes included safety and tumour response. RESULTS: Thirty-one patients with median 13 CRLMs (i.q.r. 6-23) were included. Twenty-eight patients (90%) received two HAIP-SYS cycles. Three patients did not get two cycles due to extrahepatic disease at pump placement, definitive pathology of a recto-sigmoidal squamous cell carcinoma, and progressive disease. Five patients experienced grade 3 surgical or pump device-related complications (16%) and 11 patients experienced grade ≥3 chemotherapy toxicity (38%). At first radiological evaluation, disease control rate was 83% (24/29 patients) and hepatic disease control rate 93% (27/29 patients). At 6 months, 19 patients (66%) had experienced grade ≥3 chemotherapy toxicity and the disease control rate was 79%. CONCLUSION: HAIP-SYS for borderline resectable and unresectable CRLMs was feasible and safe in the Netherlands. This has led to a successive multicentre phase III randomized trial investigating oncological benefit (EUDRA-CT 2023-506194-35-00). Current trial registration number: clinicaltrials.gov (NCT04552093).

Implementación de un programa de terapia intravenosa en pacientes nefrológicos: análisis de los resultados / Implementation of an Intravenous Therapy Program in Nephrological Patients: Analysis of Results

Introducción:Evaluar la prevalencia y el impacto del uso de líneas medias canalizadas por el Equipo de Infusión y Accesos Vasculares mediante punción eco-guiada comparada con la es-trategia endovenosa convencional (punción de catéter venoso periférico por enfermeras de hospitalización) en una unidad de nefrología y trasplante renal.Material y Método: Estudio observacional retrospectivo. Se compararon 3 periodos: pre-implantación, implantación y consolidación del Equipo de Infusión y Accesos Vasculares. Se incluyeron todos los pacientes ingresados en las unidades de hospitalización de Nefrología y Trasplante Renal que requirie-ron de la colocación de catéteres vasculares periféricos y línea media. Se analizó la prevalencia de acceso venoso, el tiempo de permanencia y los motivos de retirada (complicaciones).Resultados: La incidencia de los catéteres vasculares perifé-ricos fue decreciente mientras que el de las líneas medias se incrementó progresivamente en los tres períodos. Así mismo, no se observaron diferencias en el tiempo medio de perma-nencia de los catéteres vasculares periféricos mientras que la permanencia de días de la línea media se incrementó.Se confirma en todos los periodos una tasa de complicaciones más elevada y variable en los catéteres vasculares periféricos; mientras que en la línea media la tasa de complicaciones fue menor y más estable.Conclusiones: La implementación de un programa de terapia intravenosa en pacientes nefrológicos ha permitido minimizar el número de dispositivos venosos por paciente, con la conse-cuente reducción de punciones durante el ingreso, así como la disminución de las complicaciones asociadas a la canaliza-ción venosa (menor morbilidad).Palabras clave: Equipo de Infusión y Accesos Vasculares (EIAV); Líneas Medias (LM); Catéteres Vasculares Periféricos (CVP); complicaciones; paciente nefrológico. (AU)

Objective:To evaluate the prevalence and impact of midline catheters inserted by the Infusion and Vascular Access Team using echo-guided puncture compared to conventional intra-venous strategies (peripheral venous catheter insertion by hospitalization nurses) in a nephrology and kidney transplant unit.Material and Method: This is a retrospective observational study. Three periods were compared: pre-implementation, implementation, and consolidation of the Infusion and Vas-cular Access Team. All patients admitted to the Nephrology and Kidney Transplantation hospitalization units requiring the placement of peripheral vascular catheters and midline were included. The prevalence of venous access, dwell time, and reasons for removal (complications) were analyzed. Resultados: The incidence of peripheral vascular catheters decreased while that of midlines progressively increased in all three periods. Moreover, there were no differences in the mean dwell time of peripheral vascular catheters, whereas the dwell time of midlines increased. A higher and variable rate of complications was confirmed in peripheral vascular catheters in all periods, while in midlines, the complication rate was lower and more stable.Conclusions: Implementing an intravenous therapy program in nephrology patients has allowed for minimizing the num-ber of venous devices per patient, resulting in a reduction in punctures during hospitalization and a decrease in com-plications associated with venous cannulation (lower mor-bidity). (AU)

Implementation of Infusion Pumps and Filtered Administration Sets for Stem Cell Transplantation.

Stem cell infusion practices vary widely among institutions. A nurse-driven quality improvement project sought to determine whether peristaltic pumps and filtered tubing compromised the safety of stem cell infusion. A preclin.

Analgesia con bloqueo TAP y bomba elastomérica en la reparación de hernias ventrales (primarias e incisionales) abdominales por laparoscopia en régimen de cirugía mayor ambulatoria / Analgesia with TAP block and elastomeric pump in the repair of ventral (primary and incisional) abdominal hernias by laparoscopy in major outpatient surgery

Antecedentes: El dolor moderado severo es una limitación para la incorporación de procedimientos en cirugía mayor ambulatoria (CMA), siendo uno de los principales motivos de reingreso o consulta a urgencias en las primeras horas del postoperatorio. Representa un indicador de calidad para las unidades de CMA. Algún estudio ya mide la eficacia de las bombas elastoméricas en el domicilio en CMA, pero no para la reparación de eventración de línea media por laparoscopia. Objetivo: Se diseñó un estudio para medir el dolor postoperatorio en la reparación de hernias ventrales, primarias o incisionales, de línea media por vía laparoscópica (malla fijada con tackers y cola de cianocrialato) con un diámetro transverso inferior a los 8 centímetros, en pacientes ASA I-II. Se valoró la viabilidad de la utilización de las bombas elastoméricas, con infusión continua de antinfl amatorio, opiáceos débiles y antieméticos en el domicilio del paciente. Pacientes y métodos: Estudio prospectivo observacional en pacientes ASA I-II, intervenidos de reparación de hernia ventral por laparoscopia, bajo una estrategia de control de dolor multimodal. Se realizó anestesia general endovenosa, con propofol y remifentanilo, junto a perfusión de lidocaína, y bloqueo TAP ecoguiado con levobupivacaína y mepivacaína con punción bilateral. Se inició la analgesia endovenosa intraoperatoriamente y para domicilio se pautó bomba elastomérica con dexketoprofeno, tramadol y ondansetrón, que se inció en la zona de recuperación postanestésica, junto a paracetamol fi jo y metamizol de rescate. La enfermería integrante de la unidad de hospitalización a domicilio se encargó del control postoperatorio en el domicilio del paciente. Se midió a las 24 h y 48 h el dolor postoperatorio a través de las escalas EVA y Andersen, además de las complicaciones que hubieran surgido (disfunción del dispositivo, náuseas/vómitos, complicaciones quirúrgicas)...(AU)

Background: Severe moderate pain is a limitation for the incorporation of procedures in major ambulatory surgery (MOS), being one of the main reasons for readmission or consultation to the emergency department in the first postoperative hours. It represents a quality indicator for AMC units. Some studies have already measured the efficacy of elastomeric pumps in the home in the AMC, but not for laparoscopic repair of midline eventration. Objective: A study was designed to measure postoperative pain in the repair of ventral, primary or incisional, midline hernias by laparoscopy (mesh fixed withtackers and cyanocryalate glue) with a transverse diameter of less than 8 centimeters, in ASA I-II patients. The feasibility of using elastomeric pumps withcontinuous infusion of anti-inflammatory drugs, weak opioids and antiemetics at the patient’s home was assessed. Patients and methods: Prospective observational study in ASA I-II patients who underwent laparoscopic ventral hernia repair under a multimodal pain control strategy. Intravenous general anesthesia was performed with propofol and remifentanil, together with lidocaine perfusion, and ultrasound-guided TAP block with levobupivacaine and mepivacaine with bilateral puncture. Intravenous analgesia was started intraoperatively and an elastomeric pump with dexketoprofen, tramadoland ondansetron was prescribed for home use, which was started in the postanesthetic recovery area, together with fixed paracetamol and rescue metamizole. The nursing staff of the home hospitalization unit was in charge of postoperative monitoring at the patient’s home. Postoperative pain was measured at 24 h and 48 h using the VAS and Andersen scales, as well as any complications that might have arisen (device dysfunction, nausea/vomiting, surgical complications). Patient satisfaction was measured by means of a survey at 30 days, during the postoperative follow-up with the surgeon.(AU)

Infusion pump innovation: Embracing change for patients and bottom lines.

Within the infusion delivery landscape, significant room exists for an improved experience with more intuitive and interoperable solutions. The majority of smart infusion pumps still rely on technology developed more than a decade ago. Many Canadian healthcare institutions regularly undergo a comprehensive re-evaluation of infusion fleets, to modernize infusion delivery for patients across the country. Amid the availability of new technologies with evidence demonstrating their ability to elevate the current standards of care, this article argues for the need for healthcare systems to prepare for, and embrace, change when it comes to new technologies. Clinical informatics consultant, Helen Edwards, delves into why new technologies are needed now more than ever. She shares her experience with the Ivenix Infusion System, capturing how it can help redefine clinical workflows, reduce costs across the entire healthcare continuum, and better support patient care. She also offers insights on how to effectively introduce new technologies and cultivate an environment that is likely to be open and adaptive to the change. As the Canadian healthcare landscape continues to evolve, the proactive adoption of new technologies will be a step towards advancing the outcomes for patients and the sustainability of Canadian healthcare infrastructures.

Flow Rate Deviation in Infusion Pump: Infusion Set Defect Enables Pump Malfunction and Considerable Accuracy Deviation.

Volumetric infusion pumps are used together with infusion sets to deliver medication to patients. Flow rate errors leading to overinfusion or underinfusion are known problems with these devices. Recently, numerous underinfusion flow rate errors were reported at a Swedish hospital. This experimental study reports on the investigation of these errors and specifically investigates the effect of operating the pump with a defective infusion set that has a visible elongation of the silicone segment of the set. Pump flow rate accuracy testing was performed using a gravimetric method. Experiments included a manipulated infusion set and a defective infusion set used in clinic. The use of a defective infusion set resulted in considerable accuracy deviations. The pump reported an infused amount greater than what was infused and did not provide any alarm or information indicating a reduced output. Using an elongated infusion set, the pump can be brought into an erroneous operating state where the infused amount delivered by the pump is considerably less than what has been programmed and what is shown on the pump display. This could put the patient at risk of not receiving the intended medication within the appropriate time.

Mapping Injection Order Messages to Health Level 7 Fast Healthcare Interoperability Resources to Collate Infusion Pump Data.

BACKGROUND: When administering an infusion to a patient, it is necessary to verify that the infusion pump settings are in accordance with the injection orders provided by the physician. However, the infusion rate entered into the infusion pump by the health care provider cannot be automatically reconciled with the injection order information entered into the electronic medical records (EMRs). This is because of the difficulty in linking the infusion rate entered into the infusion pump by the health care provider with the injection order information entered into the EMRs. OBJECTIVES: This study investigated a data linkage method for reconciling infusion pump settings with injection orders in the EMRs. METHODS: We devised and implemented a mechanism to convert injection order information into the Health Level 7 Fast Healthcare Interoperability Resources (FHIR), a new health information exchange standard, and match it with an infusion pump management system in a standard and simple manner using a REpresentational State Transfer (REST) application programming interface (API). The injection order information was extracted from Standardized Structured Medical Record Information Exchange version 2 International Organization for Standardization/technical specification 24289:2021 and was converted to the FHIR format using a commercially supplied FHIR conversion module and our own mapping definition. Data were also sent to the infusion pump management system using the REST Web API. RESULTS: Information necessary for injection implementation in hospital wards can be transferred to FHIR and linked. The infusion pump management system application screen allowed the confirmation that the two pieces of information matched, and it displayed an error message if they did not. CONCLUSION: Using FHIR, the data linkage between EMRs and infusion pump management systems can be smoothly implemented. We plan to develop a new mechanism that contributes to medical safety through the actual implementation and verification of this matching system.

Stability of meropenem in portable elastomeric infusion devices: which protocol should be implemented in clinical practice?

Meropenem has an excellent activity against gram-positive and gram-negative bacteria, including multi-resistant microorganisms. Even though meropenem is a great candidate for outpatient parenteral antimicrobial therapy (OPAT), its physicochemical stability is a major challenge. This work aimed to demonstrate the suitability of including meropenem in OPAT by elucidating its physicochemical stability in a range of commonly prescribed concentrations within portable elastomeric infusion devices. Physical and chemical stability were evaluated at two concentrations commonly used in clinical practice (2 and 25 mg/mL), and three temperatures (2°C-8°C, 25°C, and 32°C) using Accufuser portable elastomeric infusion devices. Drug adsorption onto portable elastomeric infusion devices was also determined at the end of the experiment. Meropenem stability significantly decreased at higher temperatures and when higher drug solution concentrations were used. Meropenem solutions at 2 mg/mL kept the drug content above 95% over 24 h at 2°C-8°C but just for 8 h at 25°C. Nevertheless, solutions containing 25 mg/mL of meropenem showed a dramatic decrease in chemical stability after 8 h 2°C-8°C and just after 4 h at 25°C or 32°C. However, physical stability was kept favorable during this period. The drug adsorption on the material of the elastomeric infusion device was below 1%, indicating the suitability of the chosen device. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the results obtained in our study. The results obtained in this study open up the possibility of administering meropenem in an OPAT setting despite its short stability.IMPORTANCEAlthough outpatient parenteral antibiotic therapy can be a good approach to treating infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe and effective use. Actually, meropenem is used for prolonged periods above 24 h, and it is not physicochemically stable, which can compromise efficacy and toxicity. This work is of high importance to show the clinicians the real shelf life of meropenem when administered in portable elastomeric infusion devices. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the stability drug results obtained in our study.

Does circle priming improve smart infusion pump and electronic health record interoperability for chemotherapy in a pediatric hematology/oncology setting?

INTRODUCTION: The objective of this project was to assess the percentage of interoperability compliance within our pediatric hematology/oncology patient care areas for intravenous chemotherapy medications before and after the implementation of circle priming. METHODS: We conducted a retrospective quality improvement project at an inpatient pediatric hematology/oncology floor and outpatient pediatric infusion center before and after implementation of circle priming. RESULTS: There was a statistically significant increase in percent interoperability compliance for the inpatient pediatric hematology/oncology floor from 4.1% prior to implementation of circle priming to 35.6% after (odds ratio 13.1 (95% CI, 3.96-43.1), p < 0.001), as well as for the outpatient pediatric infusion center from 18.5% to 47.3%, respectively (odds ratio 3.9 (95% CI, 2.7-5.9), p < 0.001). CONCLUSION: Implementation of circle priming has significantly increased the percentage of interoperability compliance for intravenous chemotherapy medications in our pediatric hematology/oncology patient care areas.

Stability of meropenem in portable elastomeric infusion devices: which protocol should be implemented in clinical practice?

IMPORTANCE: Although outpatient parenteral antibiotic therapy can be a good approach to treating infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe and effective use. Actually, meropenem is used for prolonged periods above 24 h, and it is not physicochemically stable, which can compromise efficacy and toxicity. This work is of high importance to show the clinicians the real shelf life of meropenem when administered in portable elastomeric infusion devices. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the stability drug results obtained in our study.

Pressure-adjusted venting eliminates start-up delays and compensates for vertical position of syringe infusion pumps used for microinfusion.

Microinfusions are commonly used for the administration of catecholamines, but start-up delays pose a problem for reliable and timely drug delivery. Recent findings show that venting of the syringe infusion pump with draining of fluid to ambient pressure before directing the flow towards the central venous catheter does not counteract start-up delays. With the aim to reduce start-up delays, this study compared fluid delivery during start-up of syringe infusion pumps without venting, with ambient pressure venting, and with central venous pressure (CVP)-adjusted venting. Start-up fluid delivery from syringe pumps using a microinfusion of 1 mL/h was assessed by means of liquid flow measurement at 10, 60, 180 and 360 s after opening the stopcock and starting the pump. Assessments were performed using no venting, ambient pressure venting or CVP-adjusted venting, with the pump placed either at zero, - 43 cm or + 43 cm level and exposed to a simulated CVP of 10 mmHg. Measured fluid delivery was closest to the calculated fluid delivery for CVP-adjusted venting (87% to 100% at the different timepoints). The largest deviations were found for ambient pressure venting (- 1151% to + 82%). At 360 s after start-up 72% to 92% of expected fluid volumes were delivered without venting, 46% to 82% with ambient pressure venting and 96% to 99% with CVP-adjusted venting. CVP-adjusted venting demonstrated consistent results across vertical pump placements (p = 0.485), whereas the other methods had significant variances (p < 0.001 for both). In conclusion, CVP-adjusted venting effectively eliminates imprecise drug delivery and start-up delays when using microinfusions.

Effectiveness and safety of a disposable elastomeric continuous infusion pump for outpatient parenteral antimicrobial therapy (OPAT) in a UK setting.

We evaluated the effectiveness and safety of continuous antimicrobial infusion using a disposable elastomeric device in an outpatient parenteral antimicrobial therapy (OPAT) setting. We conducted a retrospective analysis of all patients who received either flucloxacillin (n = 131 episodes) or piperacillin/tazobactam (n = 301 episodes) as continuous infusion via elastomeric devices over 5 years (January 2018-December 2022) at a tertiary referral hospital in Derbyshire, UK. Overall, 81 adverse events were recorded in 77 (18%; 77/432) patient-episodes. Most adverse events were vascular access-related (59%; 4.6 events per 1000 OPAT-days), including one line-related infection (0.2%; 0.1 events per 1000 OPAT-days). 165 (38%) patient-episodes experienced at least one incident of incomplete infusion. Successful outcome (cure or improvement) occurred in 364 (84%) episodes. Our findings suggest that elastomeric infusion pumps are safe and effective for administering selected antimicrobial agents in OPAT. However, close monitoring of patients and the device are essential to ensure optimal delivery of prescribed therapy.

A novel, small-volume subcutaneous furosemide formulation delivered by an abdominal patch infusor device in patients with heart failure: results of two phase I studies.

AIMS: Subcutaneous (SC) furosemide has potential advantages over intravenous (IV) furosemide by enabling self-administration or administration by a lay caregiver, such as facilitating early discharge, preventing hospitalizations, and in palliative care. A high-concentration, pH-neutral furosemide formulation has been developed for SC administration via a small patch infusor pump. We aimed to compare the bioavailability, pharmacokinetic (PK), and pharmacodynamic (PD) profiles of a new SC furosemide formulation with conventional IV furosemide and describe the first use of a bespoke mini-pump to administer this formulation. METHODS AND RESULTS: A novel pH-neutral formulation of SC furosemide containing 80 mg furosemide in ∼2.7 mL (infused over 5 h) was investigated. The first study was a PK/PD study of SC furosemide compared with 80 mg IV furosemide administered as a bolus in ambulatory patients with heart failure (HF). The primary outcome was absolute bioavailability of SC compared with IV furosemide. The second study investigated the same SC furosemide preparation delivered by a patch infusor in patients hospitalized with HF. Primary outcome measures were treatment-emergent adverse events, infusion site pain, device performance, and PK measurements.The absolute bioavailability of SC furosemide in comparison to IV furosemide was 112%, resulting in equivalent diuresis and natriuresis. When SC furosemide was administered via the patch pump, there were no treatment-emergent adverse events and 95% of participants reported no/minor discomfort at the infusion site. CONCLUSION: The novel preparation of SC furosemide had similar bioavailability to IV furosemide. Administration via a patch pump was feasible and well tolerated.

Data-based program management of system-wide IV smart pump integration.

PURPOSE: Smart pump bidirectional interoperability offers automated infusion programming and documentation that can improve patient safety and workflow efficiency. This technology has been poorly implemented across US hospitals, and there is little guidance on the tracking or monitoring of interoperability systems. The purpose of this report is to describe the successful implementation of intravenous (IV) smart pump interoperability in a large health system. SUMMARY: Bidirectional IV smart pump interoperability and compliance monitoring were implemented across a large Midwestern health system using ICU Medical's Plum 360 and LifeCare PCA devices and Smith Medical's MedFusion 4000 Syringe Pump devices. The hospital system's experience in implementing and monitoring IV smart pump compliance using automated reports and a dedicated medication safety integration nurse is described. Compliance trends suggest that the implementation of IV smart pump interoperability has achieved a reduction in programming outside of the dose error reduction system, manual overrides, and IV medication administration error rates. CONCLUSION: The monitoring of smart pump compliance has had demonstrated benefits in investigating usability concerns, recognizing system errors, and identifying increased needs for nurse training. This program can serve as an example for other healthcare systems adopting IV smart pump interoperability.

Evaluation of oncology infusion pharmacy practices: A nationwide survey.

PURPOSE: Oncology care continues to evolve at a rapid pace including provision of infusion-based care. There is currently a lack of robust metrics around oncology infusion centers and pharmacy practice. The workgroup completed a nationwide survey to learn about oncology-based infusion pharmacy services offered. The objective was to highlight consistent, measureable oncology-based infusion pharmacy metrics that will provide a foundation to describe overall productivity including emphasis on high patient-safety standards. METHODS: A nationwide survey was developed via a workgroup within the Vizient Pharmacy Cancer Care Group beginning in April 2019 and conducted electronically via the Vizient Pharmacy Network from September to November 2020. The survey was designed to capture a number of key metrics related to oncology-based infusion pharmacy services. RESULTS: Forty-one sites responded to the survey. Responses highlighted hours of operation (median = 11.5), number of infusion chairs (median = 45). Staffing metrics included 7.1 pharmacist full-time equivalent (FTE) and 7.6 technician FTE per week. 80.5% of sites had cleanrooms and 95.1% reported both hazardous and nonhazardous compounding hoods. 68.3% of sites reported using intravenous (IV) technology, 50.0% measured turnaround time, and 31.4% prepared treatment medications in advance. CONCLUSION: There was variability among oncology infusion pharmacy practices in regard to survey responses among sites. The survey results highlight the need for standardization of established productivity metrics across oncology infusion pharmacies in order to improve efficiency and contain costs in the changing oncology landscape. The survey provides insight into oncology infusion pharmacy practices nationwide and provides information for pharmacy leaders to help guide their practices.

Evaluation of the venting principle to reduce start-up delays in syringe infusion pumps used for microinfusions.

Start-up delays of syringe pump assemblies can impede the timely commencement of an effective drug therapy when using microinfusions in hemodynamically unstable patients. The application of the venting principle has been proposed to eliminate start-up delays in syringe pump assemblies. However, effectively delivered infusion volumes using this strategy have so far not been measured. This invitro study used two experimental setups to measure the effect of the venting principle compared to a standard non-venting approach on delivered start-up infusion volumes at various timepoints, backflow volumes, flow inversion and zero drug delivery times by means of liquid flow measurements at flow rates of 0.5, 1.0 and 2.0 mL/h. Measured delivered initial start-up volumes were negative with all flow rates in the vented and non-vented setup. Maximum backflow volumes were 1.8 [95% CI 1.6 to 2.3] times larger in the vented setup compared to the non-vented setup (p < 0.0001). Conversely, times until flow inversion were 1.5 [95% CI 1.1 to 2.9] times shorter in the vented setup (p < 0.002). This led to comparable zero drug delivery times between the two setups (p = 0.294). Start-up times as defined by the achievement of at least 90% of steady state flow rate were achieved faster with the vented setup (p < 0.0001), but this was counteracted by the increased backflow volumes. The application of the venting principle to the start-up of microinfusions does not improve the timely delivery of drugs to the patient since the faster start-up times are counteracted by higher backflow volumes when opening the three-way stopcock.

Intravenous Medication Administration Safety with Smart Infusion Pumps in the Neonatal Intensive Care Unit: An Observational Study.

INTRODUCTION: Infants in the neonatal intensive care unit (NICU) are among the most vulnerable patient populations and medication errors are a significant source of risk and harm to neonates. Smart infusion pumps have been implemented to support the safe medication administration process; however, the effect of using smart infusion pumps on medication safety in the NICU is still unclear. METHODS: We conducted an observational study with a prospective point-prevalence approach to investigate intravenous (IV) medication administration errors in the NICU at one academic medical center in the USA. Observations were conducted in 48 days in a 3-month data collection period in 2019. RESULTS: We observed a total of 441 patients with 905 IV medication administrations during the data collection period. The total number of errors was 130 (14.4 per 100 administrations). Of these, the most frequent errors were selecting the wrong drug library entry (5.3 per 100 administrations), unauthorized medication (0.7 per 100 administrations), and wrong dose (0.6 per 100 administrations). Sixty-eight errors (7.5 per 100 administrations) were unlikely to cause harm despite reaching the patient (category C errors), while the rest did not reach the patient. CONCLUSION: We identified the medication errors, which was unique to NICU populations, but no harm to the patients were identified. Most errors occurred due to a lack of compliance of using smart pump technology; therefore, potential exists to maximize safety related to medication administration practices in the NICU through hospital policy change and increasing adherence to appropriate use of smart pump technology.