Achieving Outcomes With Innovative Smart Pump Technology: Partnership, Planning, and Quality Improvement.

BACKGROUND: A 5-time designated Magnet academic medical center partnered with its infusion systems supplier to successfully integrate 1327 smart pumps across 45 departments with an aggressive 3-month timeline. The team also achieved quality improvement (QI) outcomes through increased drug library compliance and decreased alerts with their new technology. PROBLEM: This large academic medical center needed to implement innovative wireless infusion pump technology in a short time frame. APPROACH: The approach involved a strong partnership from the medical center and the supplier, with extensive planning and collaboration among the clinical nurse specialists and consultants from both organizations to accomplish QI goals. Lean principles were also followed to enhance efficiency and accountability. OUTCOMES: Quality improvement outcomes included 100% drug library compliance across all 6 intensive care units, a decrease in pump alert rates from 4.18% to 0.79%, and a decrease in pump programming correction rate from 0.36% to 0.06%. CONCLUSIONS: A partnership led to a large implementation being completed efficiently across an academic medical center. Through these joint efforts, quality of care was improved within a short period of time.

Frequency and Duration of Infusion Pump Alarms: Establishing National Benchmarks.

Reduction of clinical alarms is a priority due to alarm fatigue and the high incidence of nonactionable alarms, especially those generated from physiological monitors. However, research on infusion pump alarm types and frequencies is limited. The purpose of this study was to establish a baseline for infusion pump alarm frequencies and duration in the hospital setting. Frequency and duration of alarms across 29 hospitals using 11,410 infusion pumps revealed 987,240 alarms associated with 568,164 infusions during a consecutive 60-day period. Pump alarms accounted for only 0.8% of infusion time, with an average of 1.74 alarms per delivery and 0.18 alarms per hour. Average alarm duration was 0:02:38 (h:min:s), with 60% of alarms being addressed within 0:01:08. The most frequent alarms were keep vein open (33.77%), hold expired (27.18%), and downstream occlusion (22.94%). The medical/surgical and intensive care unit (ICU) care areas had the highest number of alarms (41.66% and 39.70% of total alarms, respectively), but pediatrics/neonatal ICU had the highest frequency of alarms per delivery (4.91). Intravenous fluids accounted for 47.16% of total alarms, with an average of 3.03 alarms per delivery, whereas parenteral nutrition and propofol had 6.77 and 6.74 average alarms per delivery, respectively. A higher average number of alarms per delivery occurred on Saturdays (1.74) and Sundays (1.73) compared with weekdays. Infusion pump alarm data collected and analyzed were sufficient to establish a reasonable baseline of infusion pump alarm types and relative frequencies for the device.

Perceptions of Infusion Pump Alarms: Insights Gained From Critical Care Nurses.

Between 1983 and 2011, equipment-related alarms in critical care have increased from 6 to 40 different alarm types. As nurses become overwhelmed, distracted, or desensitized by alarm noise, they may miss critical alarms that could result in patient harm. The findings of an infusion pump alarm survey indicated that nurses overwhelmingly agree that infusion pump nuisance alarms occur frequently and disrupt patient care. But nurses' perceptions of pump alarms are different from those previously reported for clinical alarms in general. It may not be appropriate to broadly apply general alarm management recommendations to infusion pump alarms at this time.

Types and Frequency of Infusion Pump Alarms: Protocol for a Retrospective Data Analysis.

BACKGROUND: The variety of alarms from all types of medical devices has increased from 6 to 40 in the last three decades, with today's most critically ill patients experiencing as many as 45 alarms per hour. Alarm fatigue has been identified as a critical safety issue for clinical staff that can lead to potentially dangerous delays or nonresponse to actionable alarms, resulting in serious patient injury and death. To date, most research on medical device alarms has focused on the nonactionable alarms of physiological monitoring devices. While there have been some reports in the literature related to drug library alerts during the infusion pump programing sequence, research related to the types and frequencies of actionable infusion pump alarms remains largely unexplored. OBJECTIVE: The objectives of this study protocol are to establish baseline data related to the types and frequency of infusion pump alarms from the B. Braun Outlook 400ES Safety Infusion System with the accompanying DoseTrac Infusion Management Software. METHODS: The most recent consecutive 60-day period of backup hospital data received between April 2014 and February 2017 from 32 United States-based hospitals will be selected for analysis. Microsoft SQL Server (2012 - 11.0.5343.0 X64) will be used to manage the data with unique code written to sort data and perform descriptive analyses. A validated data management methodology will be utilized to clean and analyze the data. Data management procedures will include blinding, cleaning, and review of existing infusion data within the DoseTrac Infusion Management Software databases at each hospital. Patient-identifying data will be removed prior to merging into a dedicated and secure data repository. This pooled data will then be analyzed. RESULTS: This exploratory study will analyze the aggregate alarm data for each hospital by care area, drug infused, time of day, and day of week, including: overall infusion pump alarm frequency (number of alarms per active infusion), duration of alarms (average, range, median), and type and frequency of alarms distributed by care area. CONCLUSIONS: Infusion pump alarm data collected and analyzed in this study will be used to help establish a baseline of infusion pump alarm types and relative frequencies. Understanding the incidences and characteristics of infusion pump alarms will result in more informed quality improvement recommendations to decrease and/or modify infusion pump alarms, and potentially reduce clinical staff alarm fatigue and improve patient safety. . REGISTERED REPORT IDENTIFIER: RR1-10.2196/10446.