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Smart pumps improve medication safety but increase alert burden in neonatal care

BACKGROUND: Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source...

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Autores principales: Melton, Kristin R., Timmons, Kristen, Walsh, Kathleen E., Meinzen-Derr, Jareen K., Kirkendall, Eric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836424/
https://www.ncbi.nlm.nih.gov/pubmed/31699078
http://dx.doi.org/10.1186/s12911-019-0945-2
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author Melton, Kristin R.
Timmons, Kristen
Walsh, Kathleen E.
Meinzen-Derr, Jareen K.
Kirkendall, Eric
author_facet Melton, Kristin R.
Timmons, Kristen
Walsh, Kathleen E.
Meinzen-Derr, Jareen K.
Kirkendall, Eric
author_sort Melton, Kristin R.
collection PubMed
description BACKGROUND: Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source of alert burden and alert fatigue in an intensive care environment. METHODS: Using smart pump records, over 370,000 infusion starts for continuously infused medications used in neonates and infants hospitalized in a level IV NICU from 2014 to 2016 were evaluated. Attempts to exceed preset soft and hard maximum limits, percent variance from those limits, and pump alert frequency, patterns and salience were evaluated. RESULTS: Smart pumps prevented 160 attempts to exceed the hard maximum limit for doses that were as high as 7–29 times the maximum dose and resulted in the reprogramming or cancellation of 2093 infusions after soft maximum alerts. While the overall alert burden from smart pumps for continuous infusions was not high, alerts clustered around specific patients and medications, and a small portion (17%) of infusions generated the majority of alerts. Soft maximum alerts were often overridden (79%), consistent with low alert salience. CONCLUSIONS: Smart pumps have the ability to improve neonatal medication safety when compliance with dose error reducing software is high. Numerous attempts to administer high doses were intercepted by dosing alerts. Clustered alerts may generate a high alert burden and limit safety benefit by desensitizing providers to alerts. Future efforts should address ways to improve alert salience.
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spelling pubmed-68364242019-11-08 Smart pumps improve medication safety but increase alert burden in neonatal care Melton, Kristin R. Timmons, Kristen Walsh, Kathleen E. Meinzen-Derr, Jareen K. Kirkendall, Eric BMC Med Inform Decis Mak Research Article BACKGROUND: Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source of alert burden and alert fatigue in an intensive care environment. METHODS: Using smart pump records, over 370,000 infusion starts for continuously infused medications used in neonates and infants hospitalized in a level IV NICU from 2014 to 2016 were evaluated. Attempts to exceed preset soft and hard maximum limits, percent variance from those limits, and pump alert frequency, patterns and salience were evaluated. RESULTS: Smart pumps prevented 160 attempts to exceed the hard maximum limit for doses that were as high as 7–29 times the maximum dose and resulted in the reprogramming or cancellation of 2093 infusions after soft maximum alerts. While the overall alert burden from smart pumps for continuous infusions was not high, alerts clustered around specific patients and medications, and a small portion (17%) of infusions generated the majority of alerts. Soft maximum alerts were often overridden (79%), consistent with low alert salience. CONCLUSIONS: Smart pumps have the ability to improve neonatal medication safety when compliance with dose error reducing software is high. Numerous attempts to administer high doses were intercepted by dosing alerts. Clustered alerts may generate a high alert burden and limit safety benefit by desensitizing providers to alerts. Future efforts should address ways to improve alert salience. BioMed Central 2019-11-07 /pmc/articles/PMC6836424/ /pubmed/31699078 http://dx.doi.org/10.1186/s12911-019-0945-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Melton, Kristin R.
Timmons, Kristen
Walsh, Kathleen E.
Meinzen-Derr, Jareen K.
Kirkendall, Eric
Smart pumps improve medication safety but increase alert burden in neonatal care
title Smart pumps improve medication safety but increase alert burden in neonatal care
title_full Smart pumps improve medication safety but increase alert burden in neonatal care
title_fullStr Smart pumps improve medication safety but increase alert burden in neonatal care
title_full_unstemmed Smart pumps improve medication safety but increase alert burden in neonatal care
title_short Smart pumps improve medication safety but increase alert burden in neonatal care
title_sort smart pumps improve medication safety but increase alert burden in neonatal care
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836424/
https://www.ncbi.nlm.nih.gov/pubmed/31699078
http://dx.doi.org/10.1186/s12911-019-0945-2
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