Problems at the Pump or Is the Pump the Problem?

Problems at the Pump or Is the Pump the Problem?

Three major drawbacks associated with legacy smart pump technology

Smart IV pumps were created to help eliminate medication errors. And while some errors have been reduced, others have been introduced by smart pump technology, including programming errors, drug library errors, and ancillary equipment errors.¹ Not only that, but complicated programming and oversensitive alarms associated with these pumps have just added to the burden of already overworked nurses. The Institute for Safe Medication Practices (ISMP) recently revised and expanded its Smart Infusion Pump Guidelines to address some of those issues, and Fresenius Kabi answered with the Ivenix Infusion System.²

Major faults of legacy smart pumps, ISMP guidance, and Ivenix innovations

Fault: Clinicians are able to bypass the dose error reduction systems (DERS). If a smart pump issues a hard stop for a heparin dose that falls outside the limits, but the dose is still clinically appropriate for the patient, the practitioner will likely need to revert to a risk-prone process of manually programming the infusion without engaging DERS.³

ISMP guidance: Organizations should establish a DERS compliance rate of 95% or greater and monitor compliance to maximize intended safety benefits.²

Ivenix innovation: The Ivenix pump defaults directly to DERS and provides visual feedback during programming on the color touchscreen. In a comparison between the BD/Alaris and the Ivenix Infusion System during actual clinical use in a large tertiary care hospital, Ivenix demonstrated 99.8% compliance with DERS.*⁴

Fault: A particularly significant risk is the potential for incorrect head height differential between the primary and secondary infusions. Most infusion pumps currently on the market require users to manually lower the primary medication or fluid bag/bottle below the secondary container. When the differential between the primary container and the higher secondary container is not sufficient, the secondary will not infuse as intended, a medication error that often remains unnoticed until much later, resulting in medication delays or completely missed doses.⁵

ISMP guidance: Use an automated secondary IV infusion management system that is not dependent on head height differential and can ensure secondary flow.

Ivenix innovation: As of 2022, Ivenix is the first and only pump that works based on pneumatic pressure that measures and adjusts flow regardless of bag height changes, patient movement, fluid viscosity, etc. It is designed to be inherently safe and deliver infusions accurately, completely, and consistently under all clinical conditions. It goes where the patient goes while maintaining the clinician-set flow rate.

Fault: Bolus dosing errors due to variability in bolus dose infusion preparation and the complexity associated with bolus dose infusion programming in the pump.

ISMP guidance: Only use a smart infusion pump that allows programming of the bolus dose infusion (or loading dose infusion) and continuous infusion with separate hard limits for each and then automatically switches to the continuous infusion rate once the bolus dose or loading dose infusion has been delivered.

Ivenix innovation: The Ivenix Infusion System supports (DERS) limits with soft, firm, and hard limits for various infusion types, including continuous and bolus. Plus, there are no switch over “beeps” (e.g., when the bolus transitions to continuous infusion), minimizing alarm fatigue.

DERS workarounds, bag positioning requirements, and bolus dosing errors are just some of the faults inherent in legacy smart pumps. Just as the ISMP initiated in-depth analyses into smart pump-related errors, so did Fresenius Kabi. Whereas ISMP’s intent was to publish guidelines to prevent errors, Fresenius Kabi’s was to create a more intelligent smart pump—the Ivenix Infusion System.

Related resources:

• ISMP Guidance: ISMP Guidelines for Optimizing Safe Implementation and Use of Smart Infusion Pumps.
• ISMP featured article: Safety Considerations for Challenges When Using Smart Infusion Pumps.

*Not a direct comparison; convenience sample of 43 infusions; compliance was 41/43 (95.3%), which was significantly lower versus the pneumatic IVSP (P < 0.0001).

References:

1. Kirkendall E, Timmons K, Huth H, Walsh K, Melton K. Human-based errors involving smart infusion pumps; a catalog of error types and prevention strategies. Drug Saf. 2020;43(11):1073–1087.
2. Institute for Safe Medication Practices (ISMP). Safety considerations for challenges when using smart infusion pumps. ISMP Medication Safety Alert! Acute Care. 2022;27(21):1-5.
3. Institute for Safe Medication Practices (ISMP). ISMP Guidelines for Optimizing Safe Implementation and Use of Smart Infusion Pumps. ISMP; 2020. https://www.ismp.org/node/972
4. Penoyer D, Giuliano K, Middleton A. Comparison of safety and usability between peristaltic and pneumatic large-volume intravenous smart pumps during actual clinical use. BMJ Innov. 2022;8:78–86.
5. Giuliano KK, Blake JWC, Bittner NP, Gamez V, Butterfield R. Intravenous smart pumps at the point of care: a descriptive, observational study. J Patient Saf. 2022;18:553–558.