A Comparison of Automated Infusion Device Technology to Prevent Medication Errors in Pediatric and Adult Intensive Care Unit Patients

Abstract

Objective

To compare possible differences in the proportion of medication errors associated with high-risk medications that were avoided by the use of automated infusion device (AID) technology in pediatric and adult intensive care unit (ICU) patients. A secondary purpose was to investigate the number of serious adverse drug events (ADEs) identified by root-cause analyses (RCA).

Method

The study included pediatric and adult patients receiving high-risk medications by continuous infusion in an academic medical center with mixed medical-surgical ICUs. A retrospective evaluation of 1 year's data collected prospectively in an AID database was used to compare the proportion of medication errors avoided based on reprogramming events (2.5 times limit as a low threshold) and overrides (10 times limit as high). Information obtained from RCAs was used to compare the proportion of serious ADEs that occurred during the 5-year periods before and after AID implementation.

Results

The pediatric population was 1.68 times (95% confidence interval [CI], 1.18 to 2.38) more likely to require a reprogramming event than the adult acute care population for all high-risk medications combined. Significantly more reprogramming events occurred in the pediatric patients with potassium (relative risk [RR], 2.77; 95% CI, 1.15 to 6.68) and insulin (RR, 2.73; 95% CI, 1.15 to 6.45) infusions. Additionally, there were more overrides in the pediatric compared to the adult population for the high-risk medications (RR, 1.82; 95% CI, 1.32 to 2.53). The number of serious adverse or sentinel events as identified in RCAs decreased from six before (four deemed preventable by AID technology) to three (zero preventable) after AID implementation.

Conclusions

This study demonstrates that AID technology when properly used leads to reductions in medication errors and possibly serious ADEs in critically ill patients receiving high-risk medications. The technology appears to be particularly beneficial in pediatric patients with weight-based dosing strategies. However, the potential for clinicians to override the alerts remains a concern.

Keywords

infusion pumps intensive care units medication error pediatrics

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References

Leape LL, Bates DW, Cullen DJ, et al; ADE Prevention Study Group. Systems analysis of adverse drug events. JAMA. 1995; 274(1): 35–43.

Williams

C.K.

, Maddox

R.R.

Implementation of an i.v. medication safety system. Am J Health Syst Pharm. 2005; 62(5): 530–536.

Husch

, Sullivan

, Rooney

Insights from the sharp end of intravenous medication errors: implication for infusion pump technology. Qual Saf Health Care. 2005; 14(2): 80–86.

United States Pharmacopeia. Summary of information submitted to MEDMARX in the year 2001: a human factors approach to understanding medication errors. http://www.usp.org/pdf/EN/medmarx/2001MEDMARXSummary.pdf. Published 2002. Accessed March 18, 2008.

Institute for Safe Medication Practices. ISMP's list of high-alert medications. http://www.ismp.org/Tools/highalertmedications.pdf. Published 2008. Accessed March 18, 2008.

Thurman

, Sullivan

, Williams

M.A.

, Gaffney

Intravenous medication safety systems help prevent harm and career-ending mistakes. Extensive nursing input helps design easy-to-use system that intercepts critical errors. J Nurs Adm. 2004; 34(suppl): 2–4.

Kopp

B.J.

, Erstad

B.L.

, Allen

M.E.

, Theodorou

A.A.

, Priestley

Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Crit Care Med. 2006; 34(2): 415–425.

Fields

, Peterman

Intravenous medication safety system averts high-risk medication errors and provides actionable data. Nurs Adm Q. 2005; 29(1): 78–87.

Rothschild

J.M.

, Keohane

C.A.

, Cook

E.F.

A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Crit Care Med. 2005; 33(3): 533–540.

10.

Larsen

G.Y.

, Parker

H.B.

, Cash

, O'Connell

, Grant

M.C.

Standard drug concentrations and smart-pump technology reduce continuous-medication-infusion errors in pediatric patients. Pediatrics. 2005; 116(1): e21–e25.

11.

Malashock

C.M.

, Shull

S.S.

, Gould

D.A.

Effect of smart infusion pumps on medication errors related to infusion device programming. Hosp Pharm. 2004; 39(5): 460–469.

12.

Fanikos

, Fiumara

, Baroletti

Impact of smart infusion technology on administration of anticoagulants (unfractionated heparin, argatroban, lepirudin, and bivalirudin). Am J Cardiol. 2007; 99(7): 1002–1005.

13.

Buckley

M.S.

, Erstad

B.L.

, Kopp

B.J.

, Theodorou

A.A.

, Priestley

Direct observation approach for detecting medication errors and adverse drug events in a pediatric intensive care unit. Pediatr Crit Care Med. 2007; 8(2): 145–152.

14.

Bates

D.W.

, Boyle

D.L.

, Vander Vliet

M.B.

, Schneider

, Leape

Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995; 10(4): 199–205.