Keywords
Medication errors
intravenous administration
safety management
adverse effects
infusion pumps
intravenous administration
safety management
adverse effects
infusion pumps
How to Cite
López-Romero, L. A., Cáceres-Rivera, D. I., Dueñas Badillo, R. E., Acosta-Barón, J. V., Robles Méndez, I. Y., Rincón Castillo, D., & Parra de Rey, G. I. (2019). Adherence and potential adverse events prevented during the administration of intravenous medications using smart infusion pump in four intensive care units in Colombia. Salud UIS, 51(4), 293–304. https://doi.org/10.18273/revsal.v51n4-2019002
Abstract
Introduction: Smart infusion pumps have become a useful tool for the safe administration of intravenous medications, since they allow the prevention of potential adverse events. Objetive: To assess adherence and potential adverse events prevented during intravenous medication administration using smart infusion pumps. Methods: Observational study, conducted in four intensive care units using data from Hospira MedNetTM software. A descriptive analysis was carried out together with a bivariate analysis using a Mann-Whitney U test, a Kruskal- Wallis test and a Bonferroni test to assess adherence and potential adverse events prevented by year and service. Results: Adherence was 74.0%, 78,299 safety alerts were presented and 4.54% (n = 16,288) potential adverse events were prevented. Differences were found between the first and second year in adherence [Median: 69.15 (Q1: 64.2-Q3:75.5) versus Median: 84.2 (Q1: 72.15-Q3: 89.05), p<0.001]. Likewise safety adherence [Median: 87.1% (Q1: 83.05-Q3: 91.2) versus Median: 94.05 (Q1: 89.95-Q3: 96.2), p<0.001] and the relative limit alert editions [Median: 17.0 (Q1: 8.5-Q3: 24.5) versus Median: 12.0 (Q1: 7.0-Q3: 17.5), p=0.013]. The saline solution, norepinephrine, ringer’s lactate, piperacillin-tazobactam, nitroglycerin and heparin presented the highest number of safety alerts. Conclusions: Adequate adherence (use of the drug library) and safety adherence (indicator of pump use) were found, with a reduction in potential adverse events; thus, the use of smart pumps could contribute to the prevention of potential errors during the administration of intravenous medications in the intensive care unit.
References
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2. Kliger J. Giving medication administration the respect it is due. Arch Intern Med. 2010; 170(8): 690-692. doi: http://dx.doi.org/10.1001/ archinternmed.2010.58.
3. Gómez-Baraza C, Agustín-Fernández MJ, Palomo- Jiménez PI, Real-Campaña JM, Abad-Sazatornil R. Seguridad en la administración intravenosa de medicamentos mediante bombas de infusión inteligentes. Farm Hosp. 2014; 38(4): 276-282. doi: http://dx.doi.org/10.7399/FH.2014.38.4.1116.
4. Kliger J, Blegen MA, Gootee D, O’Neil E. Empowering frontline nurses: a structured intervention enables nurses to improve medication administration accuracy. Jt Comm J Qual Patient Saf. 2009; 35(12): 604-612. doi: https://doi. org/10.1016/S1553-7250(09)35085-0.
5. Pepper GA. Errors in drug administration by nurses. Am J Health Syst Pharm. 1995; 52: 390-395. doi: https://doi.org/10.1093/ajhp/52.4.390.
6. Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. ADE prevention study group. Systems analysis of adverse drug events. JAMA. 1995; 274: 35-43. doi: http://dx.doi. org/10.1001/jama.1995.03530010049034.
7. Keers RN, Williams SD, Cooke J, Ashcroft DM. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf. 2013; 36(11): 1045-1067. doi: http://dx.doi.org/10.1007/ s40264-013-0090-2.
8. Hug BL, Keohane C, Seger DL, Yoon C, Bates DW. The costs of adverse drug events in community hospitals. Jt Comm J Qual Patient Saf. 2012; 38(3): 120-126. doi: https://doi.org/10.1016/S1553- 7250(12)38016-1.
9. Otero MJ, Codina C, Robles D. Programa multidisciplinario de prevención de errores de medicación en un hospital. Rev Calidad Asistencial. 2005; 20(2): 79-89. doi: http://dx.doi.org/10.1016/ S1134-282X(08)74727-4.
10. Rothschild JM, Keohane CA, Cook EF, Orav EJ, Burdick E, Thompson S. A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Crit Care Med. 2005; 33(3): 533-540. doi: http://dx.doi.org/10.1097/01. ccm.0000155912.73313.cd.
11. Manrique-Rodríguez S, Fernández-Llamazares CM, Herranz-Alonso A, Sanjurjo-Sáez M. Bombas de infusión inteligentes: luces y sombras de una tecnología en desarrollo. Med Clin (Barc). 2011; 137(8): 361-365. doi: http://dx.doi.org/10.1016/j. medcli.2010.01.016.
12. Manrique-Rodríguez S, Sánchez-Galindo A, Fernández-Llamazares CM, López-Herce J, García- López I, Carrillo-Álvarez A, et al. Developing a drug library for smart pumps in a pediatric intensive care unit. Artif Intell Med. 2012; 54(3): 155-161. doi: http://dx.doi.org/10.1016/j.artmed.2011.12.001.
13. Trbovich PL, Pinkney S, Cafazzo JA, Easty AC. The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit. Qual Saf Health Care. 2010; 19(5): 430-434. doi: http:// dx.doi.org/10.1136/qshc.2009.032839.
14. Trbovich PL, Jeon J, Easty A. Smart medication delivery systems: Infusion Pumps. In: group Hhf, ed. Toronto: University Health Network, 2009.
15. Ohashi K, Dalleur O, Dykes PC, Bates DW. Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug Saf. 2014; 37(12): 1011-1020. doi: http://dx.doi.org/10.1007/ s40264-014-0232-1.
16. Ibarra-Pérez R, Puértolas-Balint F, Lozano-Cruz E, Zamora-Gómez SE, Castro-Pastrana LI. Intravenous Administration Errors intercepted by smart infusion technology in an adult intensive care unit. J Patient Saf. 2017. doi: http://dx.doi.org/10.1097/ PTS.0000000000000374.
17. Manrique-Rodríguez S, Sánchez-Galindo AC, Fernández-Llamazares CM, Calvo-Calvo MM, Carrillo-Álvarez Á, Sanjurjo-Sáez M. Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps. Med Intens. 2016; 40(7): 411-421. doi: http://dx.doi.org/10.1016/j. medin.2016.01.011.
18. Torres IA. Implementación de una tecnología de bombas de infusión inteligentes. Una estrategia
para mejorar la seguridad en el manejo de la terapia intravenosa del paciente en estado crítico. Rev
Enferm. 2011; 14(3):1-10.
19. Pang RKY, Kong DCM, de Clifford JM, Lam SS, Leung BK. Smart infusion pumps reduce intravenous medication administration errors at an Australian teaching hospital. J Pharm Pract Res. 2011; 41: 192-195. doi: https://doi.org/10.1002/j.2055-2335.2011.tb00860.
20. Bergon-Sendin E, Perez-Grande C, Lora-Pablos D, Moral-Pumarega MT, Melgar-Bonis A, Peña-Peloche C, et al. Smart pumps and random safety audits in a Neonatal Intensive Care Unit: a new challenge for patient safety. BMC Pediatr. 2015; 15(206): 1-10. doi: http://dx.doi.org/10.1186/s12887-015-0521-6.
21. Manrique-Rodriguez S, Sanchez-Galindo AC,Lopez-Herce J,Calleja-Hernandez MA, Martinez-Martinez F, Iglesias-Peinado I, et al. Implementing smart pump technology in a pediatric intensive care unit: a cost-effective approach. Int J Med Inform.2014; 83: 99-105. doi: http://dx.doi.org/10.1016/j.ijmedinf.2013.10.011.
22. Manrique-Rodríguez S, Sánchez-Galindo AC, López-Herce J, Calleja-Hernández MÁ,
Martínez-Martínez F, Iglesias-Peinado I, et al. Impact of implementing smart infusion pumps in a pediatric intensive care unit. Am J Health Syst Pharm. 2013; 70(21):1897-906. doi: http://dx.doi.org/10.2146/ajhp120767.
23. Kennerly J, Jenkins A, Lewis AN, Eckel SF. Implementing smart pumps for epidural infusions in an academic medical center. Am J Health Syst Pharm. 2012; 69(7): 607-611. doi: http://dx.doi.org/10.2146/ajhp110477.
24. McCartney P. Evidence for practice with smart infusion pumps. Am J Matern Child Nurs. 2014; 39(4): 270. doi: http://dx.doi.org/10.1097/NMC.0000000000000053.
25. Skledar SJ, Niccolai CS, Schilling D, Costello S, Mininni N, Ervin K, et al. Quality-improvement analytics for intravenous infusion pumps. Am J Health Syst Pharm. 2013; 70(8): 680-686. doi: http://dx.doi.org/10.2146/ajhp120104.
26. Murdoch LJ, Cameron VL. Smart infusion technology: a minimum safety standard for intensive care? Br J Nurs. 2008; 17(10): 630-636. doi: http://dx.doi.org/10.12968/bjon.2008.17.10.29476.
27. Cour M, Hernu R, Bénet T, Robert JM, Regad D, Chabert B, et al. Benefits of smart pumps for automated changeovers of vasoactive drug infusion pumps: a quasi-experimental study. Br J Anaesth. 2013; 111(5): 818-824. doi: http://dx.doi.org/10.1093/bja/aet199.
28. Rothschild JM, Keohane CA, Cook EF, Orav EJ, Burdick E, Thompson S, et al. A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Crit Care Med. 2005; 33(3): 533-540. doi: http://dx.doi.org/10.1097/01.ccm.0000155912.73313.cd.
29. Fanikos J, Fiumara K, Baroletti S, Luppi C, Saniuk C, Mehta A, et al. Impact of smart infusion technology on administration of anticoagulants (unfractionated Heparin, Argatroban, Lepirudin, and Bivalirudin). Am J Cardiol. 2007; 99(7): 1002-1005. doi: http://dx.doi.org/10.1016/j.amjcard.2006.10.069.
30. Husch M, Sullivan C, Rooney D, Barnard C, Fotis M, Clarke J, et al. Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Qual Saf Health Care. 2005; 14(2): 80-86. doi: http://dx.doi.org/10.1136/qshc.2004.011957.
31. Nuckols TK1, Bower AG, Paddock SM, Hilborne LH, Wallace P, Rothschild JM, et al. Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events. J Gen Intern Med. 2008; 23(Suppl 1): 41-45. doi: http://dx.doi.org/10.1007/s11606-007-0414-y.
32. Palacios-Rosas E, Soria-Cedillo IF, Puértolas-Balint F, Ibarra-Pérez R, Zamora-Gómez SE, Lozano-Cruz E, et al. Impact of implementing smart infusion pumps in an Intensive Care Unit in Mexico: A prepost cost analysis based on intravenous solutions consumption. Hosp Pharmacy. 2018; 1-6. doi: https://doi.org/10.1177/0018578718786943.
33. Puértolas-Balint F, Ibarra-Pérez R, Soria-Cedillo IF, Zamora-Gómez SE, Lozano-Cruz E, Amezcua-Gutiérrez MA, et al. Costos evitados por bombas de infusión inteligentes al interceptar errores por sobredosificación de insulina en una unidad de cuidados intensivos. Rev Mex C Farm. 2016; 47(4): 40-56.
2. Kliger J. Giving medication administration the respect it is due. Arch Intern Med. 2010; 170(8): 690-692. doi: http://dx.doi.org/10.1001/ archinternmed.2010.58.
3. Gómez-Baraza C, Agustín-Fernández MJ, Palomo- Jiménez PI, Real-Campaña JM, Abad-Sazatornil R. Seguridad en la administración intravenosa de medicamentos mediante bombas de infusión inteligentes. Farm Hosp. 2014; 38(4): 276-282. doi: http://dx.doi.org/10.7399/FH.2014.38.4.1116.
4. Kliger J, Blegen MA, Gootee D, O’Neil E. Empowering frontline nurses: a structured intervention enables nurses to improve medication administration accuracy. Jt Comm J Qual Patient Saf. 2009; 35(12): 604-612. doi: https://doi. org/10.1016/S1553-7250(09)35085-0.
5. Pepper GA. Errors in drug administration by nurses. Am J Health Syst Pharm. 1995; 52: 390-395. doi: https://doi.org/10.1093/ajhp/52.4.390.
6. Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. ADE prevention study group. Systems analysis of adverse drug events. JAMA. 1995; 274: 35-43. doi: http://dx.doi. org/10.1001/jama.1995.03530010049034.
7. Keers RN, Williams SD, Cooke J, Ashcroft DM. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf. 2013; 36(11): 1045-1067. doi: http://dx.doi.org/10.1007/ s40264-013-0090-2.
8. Hug BL, Keohane C, Seger DL, Yoon C, Bates DW. The costs of adverse drug events in community hospitals. Jt Comm J Qual Patient Saf. 2012; 38(3): 120-126. doi: https://doi.org/10.1016/S1553- 7250(12)38016-1.
9. Otero MJ, Codina C, Robles D. Programa multidisciplinario de prevención de errores de medicación en un hospital. Rev Calidad Asistencial. 2005; 20(2): 79-89. doi: http://dx.doi.org/10.1016/ S1134-282X(08)74727-4.
10. Rothschild JM, Keohane CA, Cook EF, Orav EJ, Burdick E, Thompson S. A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Crit Care Med. 2005; 33(3): 533-540. doi: http://dx.doi.org/10.1097/01. ccm.0000155912.73313.cd.
11. Manrique-Rodríguez S, Fernández-Llamazares CM, Herranz-Alonso A, Sanjurjo-Sáez M. Bombas de infusión inteligentes: luces y sombras de una tecnología en desarrollo. Med Clin (Barc). 2011; 137(8): 361-365. doi: http://dx.doi.org/10.1016/j. medcli.2010.01.016.
12. Manrique-Rodríguez S, Sánchez-Galindo A, Fernández-Llamazares CM, López-Herce J, García- López I, Carrillo-Álvarez A, et al. Developing a drug library for smart pumps in a pediatric intensive care unit. Artif Intell Med. 2012; 54(3): 155-161. doi: http://dx.doi.org/10.1016/j.artmed.2011.12.001.
13. Trbovich PL, Pinkney S, Cafazzo JA, Easty AC. The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit. Qual Saf Health Care. 2010; 19(5): 430-434. doi: http:// dx.doi.org/10.1136/qshc.2009.032839.
14. Trbovich PL, Jeon J, Easty A. Smart medication delivery systems: Infusion Pumps. In: group Hhf, ed. Toronto: University Health Network, 2009.
15. Ohashi K, Dalleur O, Dykes PC, Bates DW. Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug Saf. 2014; 37(12): 1011-1020. doi: http://dx.doi.org/10.1007/ s40264-014-0232-1.
16. Ibarra-Pérez R, Puértolas-Balint F, Lozano-Cruz E, Zamora-Gómez SE, Castro-Pastrana LI. Intravenous Administration Errors intercepted by smart infusion technology in an adult intensive care unit. J Patient Saf. 2017. doi: http://dx.doi.org/10.1097/ PTS.0000000000000374.
17. Manrique-Rodríguez S, Sánchez-Galindo AC, Fernández-Llamazares CM, Calvo-Calvo MM, Carrillo-Álvarez Á, Sanjurjo-Sáez M. Safe intravenous administration in pediatrics: A 5-year Pediatric Intensive Care Unit experience with smart pumps. Med Intens. 2016; 40(7): 411-421. doi: http://dx.doi.org/10.1016/j. medin.2016.01.011.
18. Torres IA. Implementación de una tecnología de bombas de infusión inteligentes. Una estrategia
para mejorar la seguridad en el manejo de la terapia intravenosa del paciente en estado crítico. Rev
Enferm. 2011; 14(3):1-10.
19. Pang RKY, Kong DCM, de Clifford JM, Lam SS, Leung BK. Smart infusion pumps reduce intravenous medication administration errors at an Australian teaching hospital. J Pharm Pract Res. 2011; 41: 192-195. doi: https://doi.org/10.1002/j.2055-2335.2011.tb00860.
20. Bergon-Sendin E, Perez-Grande C, Lora-Pablos D, Moral-Pumarega MT, Melgar-Bonis A, Peña-Peloche C, et al. Smart pumps and random safety audits in a Neonatal Intensive Care Unit: a new challenge for patient safety. BMC Pediatr. 2015; 15(206): 1-10. doi: http://dx.doi.org/10.1186/s12887-015-0521-6.
21. Manrique-Rodriguez S, Sanchez-Galindo AC,Lopez-Herce J,Calleja-Hernandez MA, Martinez-Martinez F, Iglesias-Peinado I, et al. Implementing smart pump technology in a pediatric intensive care unit: a cost-effective approach. Int J Med Inform.2014; 83: 99-105. doi: http://dx.doi.org/10.1016/j.ijmedinf.2013.10.011.
22. Manrique-Rodríguez S, Sánchez-Galindo AC, López-Herce J, Calleja-Hernández MÁ,
Martínez-Martínez F, Iglesias-Peinado I, et al. Impact of implementing smart infusion pumps in a pediatric intensive care unit. Am J Health Syst Pharm. 2013; 70(21):1897-906. doi: http://dx.doi.org/10.2146/ajhp120767.
23. Kennerly J, Jenkins A, Lewis AN, Eckel SF. Implementing smart pumps for epidural infusions in an academic medical center. Am J Health Syst Pharm. 2012; 69(7): 607-611. doi: http://dx.doi.org/10.2146/ajhp110477.
24. McCartney P. Evidence for practice with smart infusion pumps. Am J Matern Child Nurs. 2014; 39(4): 270. doi: http://dx.doi.org/10.1097/NMC.0000000000000053.
25. Skledar SJ, Niccolai CS, Schilling D, Costello S, Mininni N, Ervin K, et al. Quality-improvement analytics for intravenous infusion pumps. Am J Health Syst Pharm. 2013; 70(8): 680-686. doi: http://dx.doi.org/10.2146/ajhp120104.
26. Murdoch LJ, Cameron VL. Smart infusion technology: a minimum safety standard for intensive care? Br J Nurs. 2008; 17(10): 630-636. doi: http://dx.doi.org/10.12968/bjon.2008.17.10.29476.
27. Cour M, Hernu R, Bénet T, Robert JM, Regad D, Chabert B, et al. Benefits of smart pumps for automated changeovers of vasoactive drug infusion pumps: a quasi-experimental study. Br J Anaesth. 2013; 111(5): 818-824. doi: http://dx.doi.org/10.1093/bja/aet199.
28. Rothschild JM, Keohane CA, Cook EF, Orav EJ, Burdick E, Thompson S, et al. A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Crit Care Med. 2005; 33(3): 533-540. doi: http://dx.doi.org/10.1097/01.ccm.0000155912.73313.cd.
29. Fanikos J, Fiumara K, Baroletti S, Luppi C, Saniuk C, Mehta A, et al. Impact of smart infusion technology on administration of anticoagulants (unfractionated Heparin, Argatroban, Lepirudin, and Bivalirudin). Am J Cardiol. 2007; 99(7): 1002-1005. doi: http://dx.doi.org/10.1016/j.amjcard.2006.10.069.
30. Husch M, Sullivan C, Rooney D, Barnard C, Fotis M, Clarke J, et al. Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Qual Saf Health Care. 2005; 14(2): 80-86. doi: http://dx.doi.org/10.1136/qshc.2004.011957.
31. Nuckols TK1, Bower AG, Paddock SM, Hilborne LH, Wallace P, Rothschild JM, et al. Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events. J Gen Intern Med. 2008; 23(Suppl 1): 41-45. doi: http://dx.doi.org/10.1007/s11606-007-0414-y.
32. Palacios-Rosas E, Soria-Cedillo IF, Puértolas-Balint F, Ibarra-Pérez R, Zamora-Gómez SE, Lozano-Cruz E, et al. Impact of implementing smart infusion pumps in an Intensive Care Unit in Mexico: A prepost cost analysis based on intravenous solutions consumption. Hosp Pharmacy. 2018; 1-6. doi: https://doi.org/10.1177/0018578718786943.
33. Puértolas-Balint F, Ibarra-Pérez R, Soria-Cedillo IF, Zamora-Gómez SE, Lozano-Cruz E, Amezcua-Gutiérrez MA, et al. Costos evitados por bombas de infusión inteligentes al interceptar errores por sobredosificación de insulina en una unidad de cuidados intensivos. Rev Mex C Farm. 2016; 47(4): 40-56.
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