New technology and solid nursing judgment are combined at Oaklawn Hospital to maintain the highest possible level of patient safety when handling intravenous infusions.
In recent weeks, a new “smart pump” system has been initiated, increasing the safeguards for patients who receive IV fluids and IV medications. Oaklawn has evaluated such technology for years, waiting for it to demonstrate sufficient evidence of a positive impact on safety, said Kathleen Walsh, assistant chief nursing officer at the hospital.
Oaklawn recently obtained 112 units of the Sigma Spectrum Infusion System, a second-generation pump manufactured by Baxter International Inc. The devices now track the infusion of about 300 different drugs in regular use at the hospital, said Walsh and Oaklawn pharmacist Kellie DeLong.
Earlier systems monitored little more than the flow of liquid, but digitally programmed pumps distinguish among medications and ensure precise limits are considered, Walsh said. The new pumps take over for a technology for which replacement equipment no longer is available.
Many patients receive multiple intravenous infusions during a hospital stay, and each must be administered carefully to ensure total safety, Walsh said.
Intravenous medications are nearly three times more likely to cause patient harm or death when compared to other medications – and approximately 90 percent of hospitalized patients receive them, according to a 2008 report in the American Journal of Health-System Pharmacy.
While medication errors – called “adverse drug events” – cost an average of several thousand dollars per incident, the impact on patient safety was sufficient motive for Oaklawn to upgrade its approach to IV supervision, Walsh said.
Oaklawn’s acquisition of the pumps came at a time when the devices and their software could be efficiently integrated with the hospital’s improved electronic medical records system, she said.
As a result, the state-of-the-art pumps are poised to catch any potential administrative errors through a software program that closely monitors dosage limits and gives feedback to nursing professionals, she said.
The software accesses a customized “drug library” built and wirelessly maintained by Oaklawn pharmacist Kellie DeLong. The software incorporates established dosage limits and delivers warnings and alerts at the time the medication is administered. The drug library also is customized to Oaklawn’s patient population.
“For example, dosage limits in pediatric patients are less than in the adult population, and in Critical Care or the Emergency Department, drug limits may allow for faster rates of administration, or higher concentrations,” DeLong said.
The software also gathers information to identify ways to improve patient safety, she said.
“My job is to bridge the gap between information technology and clinical practice, and to help determine where to focus medication-safety efforts and innovative technology. Given the potential impact of improving patient safety and patient care, smart-pump technology was something I felt a strong responsibility to implement at Oaklawn,” DeLong said.
Having proper dosage levels pre-programmed “also means you’re less likely to have an error,” Walsh said. “A mistake could be something as simple as hitting the wrong key. The pump has a quick way of communicating that to the nurse. And we’ve already seen results since August that show that the new system is working just as we expected.”
Specialists from the pumps’ manufacturer helped train more than 170 of Oaklawn’s nurses for a week before “going live” with the new equipment in August, Walsh said. Other staff members made sure related IV equipment, such as tubing, was up to date and compatible with the devices.
“There’s nothing simple in a hospital, but it went off without a hitch,” she said, crediting the planning of Oaklawn’s interdisciplinary team, the trainers and the quality of the product itself. “It went very smoothly.”
Because electronics can’t do all the work, the human element remains vital, Walsh said, pointing to the expertise of staff such as vascular access coordinator Jewel Lammers, whose expertise was invaluable during the transition.
“Jewel represents the intersection between the technology and the real-world clinical application,” Walsh said. “She has the latest clinical knowledge in accessing veins and follows the literature on intravenous therapy and safety very closely. Since she cannot manage the IVs of all patients, she teaches others how to improve.”
The Sigma Spectrum devices now are in use throughout the hospital, including Oaklawn’s operating rooms, Emergency Department, Birth Center and inpatient units.