By Sylvia Foley, AJN senior editor
In January 2009 an independent community hospital in Massachusetts switched from using older, outmoded IV pumps to using “smart” pumps—pumps that have built-in computers with libraries of information on selected drugs and fluids, including predetermined concentrations and volumes with relevant administration limits. Library subsets (called profiles) contain information specific to certain patient populations or care areas. When properly implemented, these devices can be invaluable tools in reducing the risk of medication errors and improving patient safety.
But when the hospital conducted a review, it found that smart pump libraries had been used in only 37% of all smart pump infusions done between January and June. One reason was that no “owner” had been assigned to oversee the implementation process. So the hospital’s nursing quality team (NQT) and pharmacy quality team began collaborating to find ways to increase nurses’ use of the pump libraries.
From July through October 2009 the NQT implemented several interventions. Author Andrew D. Harding describes the project as it evolved and reports on the results in this January CE feature, “Increasing the Use of ‘Smart’ Pump Libraries by Nurses: A Continuous Quality Improvement Project.”
The interventions included, among others:
- communicating with direct care nurses to find out why pump libraries weren’t being used.
- running weekly usage and monthly limit override reports from the pump database.
- e-mailing nursing staff weekly with current usage reports and requests for feedback.
- contacting the pump manufacturer’s clinical representative regarding best practices.
- adding and amending therapies in the pump libraries.
- tweaking the pump “screens” so that the most-used therapies were more readily accessible.
Over the four-month period of the project, for all infusions given via the smart pumps, the pump library usage rate nearly doubled. Asking for nurses’ feedback and incorporating it as the project evolved appears to have been an essential factor. Harding concludes with a plug for nurses’ active participation (and this is probably the case for any new technology): “Those who provide direct patient care must be involved with the planning of the smart pump libraries, especially