Smart Pumps and Drug Libraries The Way Forward
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1 Smart Pumps and Drug Libraries The Way Forward Kathryn Phillips North West Regional MI Centre The first stop for professional medicines advice
2 Outline The drivers behind the development/use of Smart Pumps What are Smart Pumps & Drug Libraries Where does MI fit in?
3 Where Medication Errors Occur Start of infusion (NPSA 05/06 59%) 138,117 Medication errors were reported to NHS NRLS in one year (April 12-March 13) Medication errors at administration stage account for: 34% of adverse events (Bates et al 1995) 38% of adverse events (Kohn 1999, Rodriguez, 2011) 42% of adverse events (NPSA 2010) * NHS NRLS used to be NPSA
4 MHRA Patient Safety Alert 20 March 2014 Patient Safety Alert Stage Three: Directive Improving medication error incident reporting and learning Sign up to Safety Campaign Launched by Health Secretary 20 March 2014 Aim to half avoidable harm in the next 3 years and save 6000 lives. Trusts which take action to reduce harm and claims => One off reduction in clinical negligence insurance premiums
5 What are SMART Pumps? Smart Infusion pumps can help prevent medication errors by alerting you to a pump setting that doesn't match your drug administration guidelines Drug Libraries convert a conventional IV pump into a Smart Pump Smart Pumps can log data e.g. time, date, drug, concentration, rate, volume infused, near misses allows audit, education and improvement
6 Braun Infusomat Space for infusion bags Braun Perfusor Space for syringes
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8 Drug Libraries Let nurses and clinicians select medication and fluids from pre-set lists Each drug library can be tailored to specific care units Southport General Wards ICU Obs & Gynae Leeds General Wards ICU Obs & Gynae Can set hard and soft limits Hard will not let infusion proceed Soft will notify clinician/nurse and ask if they want to override and proceed A & E
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11 Barriers to DERS / Smart Pumps? Smart pumps have been widely available in the UK since 2005 Most UK hospitals already have Smart Pumps but don t utilise the technology Historical Barriers Creation of Drug Library Creating the initial drug library is a significant amount of work for the hospital usually pharmacy Logistics Before WiFi, uploading of the drug library and any changes to it would have to be carried out manually. All pumps in a hospital had to be physically located and returned to the Medical Equipment Library
12 Learning Points Need to be involved in the decision making process, tender and implementation Dedicated Project Team link to Trust Board Level More time consuming than we thought! Need IT involved at the start More discussion with Medical Equipment Library How many pumps available? Which drugs to target initially? Segregation between wards? WiFi
13 Real Data Data courtesy Graham Cox Leeds Teaching Hospitals NHS Trust
14 Ward Data Data courtesy Graham Cox Leeds Teaching Hospitals NHS Trust
15 Ward Data Data courtesy Graham Cox Leeds Teaching Hospitals NHS Trust
16 Where does MI fit in? The Tendering Process Needs a dedicated pharmacist to be involved from the start Risk Minimisation The Drug Library An MI pharmacist has the skills to ensure there is a clear safe strategy for introduction of the pumps Writing The MI pharmacist has all the reference sources at their fingertips for writing the drug library but will need to liaise with clinical specialists QA MI pharmacists are excellent at QA
17 The Process and MI Education & Training Ongoing updates Project Board Lead A pharmacist needs to be involved both with pump training, explaining the benefits of the drug library, and with the clinical information that has been programmed Information from drug alerts, company information, discussion groups etc comes to the MI Pharmacists Reports on drug library progress: usage, changes required, incidents prevented, resulting education Communication at the start and throughout the process Succession planning Collaboration (Carter)
18 What can go wrong Staff not using the drug Library Overriding soft limits Infusion related errors may still occur Incorrect drug chosen from the drug library Right drug given to the wrong patient Drug already given and given again Infusion is within maximum limits but is incorrect for the patient
19 Future Possibilities A Bar-Code Medication Administration System is needed (BCMA) Would ensure right patient gets the correct drug, dose, route at the right time All infusions given via SMART Pumps
20
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