So what is an infusion pump?

In the inpatient setting, medications can be given through the intravenous route via infusion devices or infusion pumps. When a nurse receives a medication, it’s up to the nurse to set up the infusion pump to administer the medication correctly according to the order written by the provider and verified by the pharmacist. However, as we know, humans are error prone, and that’s where smart pumps come in.

So what is a smart pump?

Smart pumps are infusion pumps that have additional safety measures built in to lower the risk of medication administration errors. The typical workflow with a smart pump system in place would start with the nurse receiving the medication from pharmacy, then scanning the medication with a barcode scanner to ensure the order is correct, then the nurse will navigate on the smart pump to choose predefined medication entries that match the order in hand. Once chosen, the nurse then enters in the rate, then they administer the medication.

What are some of the features of a smart pump?

A smart pump has a library of medication entries that have drug names, concentrations, dosing units, and guardrails configured. A guardrail is basically a limitation on the rate of administration, and a soft guardrail asks the nurse “are you sure you want to give this rate because it’s above the normal rate for these drugs” while a hard guardrail doesn’t even allow the nurse to bypass the stop alert.

The other nice thing is that the smart pumps have profiles set so when the nurse signs into the pump, they have to choose which nursing unit that they are in or care status that the patient is experiencing before they choose the medications. For example, the IV drips may be given with different parameters in the ICU versus if they were given in a Med/Surg area, so the nurse would need to choose between the two locations depending on what level of care the patient is under.

Another thing to note is that smart pumps log everything. All the alerts fired, alerts bypassed, and near misses are logged into something called CQI data, which stands for continuous quality improvement. This is typically assessed to see where the near misses are and how we can improve the system to prevent future errors. What I’ve seen is that the medication safety pharmacist or officer would be reviewing this data as part of the Medication Error Reduction team.

What does a pharmacist have to do with smart pumps?

Remember, smart pumps need to have a library of medications built out before the smart pumps can be effectively used. Pharmacists are the medication experts. Typically, a pharmacist would need to review the configurations of the nursing unit profiles to make sure the appropriate medications are listed in each unit, then ensure that each medication entry is configured correctly with the medication concentration, the dosing units, the guardrails, and the display or order of the medications in the profile. Depending on the institution, this can be done by a staff pharmacist, an informatics pharmacist, a clinical coordinator, a medication safety pharmacist, or even the Director of Pharmacy.

Where can I learn more about smart pumps?

Several articles have been published on the impact of IV Smart Pumps. You can find out more at the following:

The Impact of a Simplified User Interface on Clinical Use: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850078/

Smart Intravenous Pumps: How Smart Are They?: https://qualitysafety.bmj.com/content/26/2/93

Smart Pump Technology Reduces Errors: https://www.apsf.org/article/smart-pump-technology-reduces-errors/