Handling errors in conventional and smart pump infusions: A systematic review with meta-analysis

Moreira, Ana Paula Amorim; Carvalho, Márglory Fraga de; Silva, Roberto Carlos Lyra da; Marta, Cristiano Bertolossi; Fonseca, Eliana Rosa da; Barbosa, Maria Tereza Serrano

doi:10.1590/S1980-220X2018032603562

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Review • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2018032603562 copy

Handling errors in conventional and smart pump infusions: A systematic review with meta-analysis^* * Extracted from the thesis: “Incorporação tecnológica no contexto da saúde: uma análise de custo efetividade das bombas de infusão na insulinoterapia intravenosa”, Universidade Federal do Estado do Rio de Janeiro, Programa de Pós-Graduação em Enfermagem, 2017.

Errores de manejo en la bomba de infusión convencional y smart pump: revisión sistemática con metaanálisis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To identify the scientific evidence on the frequency of handling errors of conventional and smart pump infusions in intravenous insulin therapy in intensive care units.

Method:

A systematic review with meta-analysis conducted in the Virtual Health Library, MEDLINE via PubMed, Scopus and Web of Science databases. Articles were assessed regarding the level of evidence by applying the Oxford Center for Evidence-Based Medicine Evidence Scale.

Results:

Twelve (¹²12. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359-67. DOI: 10.1056/NEJMoa011300
https://doi.org/10.1056/NEJMoa011300... ) publications were selected which met the eligibility criteria. The programming error rate using the conventional infusion pump ranged from 10% to 40.1%, and the smart pump technology error rate ranged from 0.3 to 14%. The meta-analysis of two studies favored the smart pump in reducing the relative risk of programming errors by 51%.

Conclusion:

Based on selected articles, the smart pump reduces the risk of programming errors.

Descriptors:
Infusion Pumps; Insulin; Medication Errors; Critical Care Nursing; Intensive Care Units; Review

Programming errors
Conventional pump	Total volume and infusion rate values in milliliters/hour (ml/h) programmed differently from those recommended by the institutional insulin protocol.
Smart pump	Programmed values below the relative limit (drug sub-dose offer), values above the absolute limit ("over" dose of the drug) and errors related to dose calculation based on the patient's weight out of the previously established (IU/kg/h; Mcg/kg/min) in the library.
Actions related to programming errors
Error correction	Cases in which the values were reprogrammed before the beginning of the infusion and/or when the complete infusion cancellation occurred.
Error evolution	In cases where the programmed doses overlapped, meaning that the user is aware that the values are out of the ideal parameters, either by the values contained in the drug library, or by the insulin protocol values and still maintains the original dose/flow rate and starts the infusion.

AUTHORS	YEAR/ COUNTRY	TITLE	DESIGN	RESULTS	Oxford Centre for Evidence-Based Medicine evidence scale
Schnock K O et al.^{(¹⁶16. Schnock KO, Dykes PC, Albert J, Ariosto D, Call R, Cameron C. et al. The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study. BMJ Qual Saf. 2017;26(2):131-40. DOI: 10.1136/bmjqs-2015-004465 https://doi.org/10.1136/bmjqs-2015-00446... )}	2017/ United States	The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study	Observational, multicenter Cross-sectional	SP programming errors: 5.1% CP programming errors: 10.3%	4C
Goulding C; Bedard M.^{(¹⁷17. Goulding C, Bedard M. Safety implications of the dose change alert function in smart infusion pumps on the administration of high-alert medications. Can J Crit Care Nurs. 2015;26(4):23-7.)}	2015/ Canada	Safety implications of the dose change alert function in smart infusion pumps on the administration of high-alert medications	Observational, cross-sectional	SP error correction: 2% Evolution of SP errors: 58%	4C
Mansfield, J; Jarrett, S.^{(¹⁸18. Mansfield J, Jarrett S. Using smart pumps to understand and evaluate clinician practice patterns to ensure patient safety. Hosp Pharm. 2013;48(11):942-50. DOI: 10.1310/hpj4811-942 https://doi.org/10.1310/hpj4811-942... )}	2013/ United States	Using Smart Pumps to Understand and Evaluate Clinician Practice Patterns to Ensure Patient Safety	Case report	SP programming errors: 7.5% SP error correction: 16% Evolution of errors in SP: 84%	4C
Cousins D; Cartwright E. ^{(¹⁹19. Cousins D, Cartwright E. Implementing and evaluating the patient safety benefits of dose error reduction software in electronic infusion devices in an NHS Hospital Trust. Br J Nurs. 2013;22 Sup13:9-14. DOI: https://doi.org/10.12968/bjon.2013.22.Sup13.9 https://doi.org/10.12968/bjon.2013.22.Su... )}	2013/ England	Implementing and evaluating the patient safety benefits of dose error reduction software in electronic infusion devices in an NHS Hospital Trust	Observational, cross-sectional	SP programming errors: 1.4% SP error correction: 21.5% Evolution of errors in SP: 66.3%	4C
Kastrup M et al.^{(²⁰20. Kastrup M, Balzer F, Volk T, Spies C. Analysis of event logs from syringe pumps: a retrospective pilot study to assess possible effects of syringe pumps on safety in a university hospital critical care unit in Germany. Drug Saf. 2012;35(7):563-74. DOI: 10.2165/11597350-000000000-00000 https://doi.org/10.2165/11597350-0000000... )}	2012/ Germany	Analysis of Event Logs from Syringe Pumps	Observational, Retrospective, Cross-sectional	SP programming errors: 0.85% SP error correction: 6.5% Evolution of errors in SP: 87.6%	4C
Cayot -Constantin et al.^{(²¹21. Cayot-Constantin S, Constantin JM, Perez JP, Chevallier P, Clapson P, Bazin JE. Assessment of the usefulness to use a software supervising continuous infusion rates of drugs administered with pumps in ICU and estimation of the frequency of rate of administration errors. Ann Fr Anesth Reanim. 2010;29(3):204-8. DOI: 10.1016/j.annfar.2009.10.025 https://doi.org/10.1016/j.annfar.2009.10... )}	2010/ France	Assessment of the usefulness to use a software supervising continuous infusion rates of drugs administered with pumps in ICU and estimation of the frequency of rate of administration errors	Observational, cross-sectional	SP¹ programming errors: 11%	4C
Evans R S. et al.^{(²²22. Evans RS, Carlson R, Johnson KV, Palmer BK, Lloyd JF. Enhanced notification of infusion pump programming errors. Stud Health Technol Inform. 2010;160(Pt 1):734-8. DOI: 10.3233/978-1-60750-588-4-734 https://doi.org/10.3233/978-1-60750-588-... )}	2010/ United States	Enhanced Notification of Infusion Pump Programming Errors	Observational, cross-sectional	SP programming errors: 14% CP² programming errors: 10.7% CP error correction: 3.8%	4C
Hennings S et al.^{(²³23. Hennings S, Romero A, Erstad BL, Franke H, Theodorou AA. A comparison of automated infusion device technology to prevent medication errors in pediatric and adult intensive care unit patients. Hosp Pharm. 2010;45(6):464-71. DOI: 10.1310/hpj4506-464 https://doi.org/10.1310/hpj4506-464... )}	2010/ United States	A Comparison of Automated Infusion Device Technology to Prevent Medication Errors in Pediatric and Adult Intensive Care Unit Patients	Observational, Retrospective, Cohort	SP programming errors: 0.3% SP error correction: 0.4%	2B
Nuckols TK. et al.^{(²⁴24. Nuckols TK, Bower AG, Paddock SM, Hilborne LH, Wallace P, Rothschild JM, et al. Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events. J Gen Intern Med. 2008;23 Suppl 1:41-5. DOI: 10.1007/s11606-007-0414-y https://doi.org/10.1007/s11606-007-0414-... )}	2007/ United States	Programmable Infusion Pumps in ICUs: An Analysis of Corresponding Adverse Drug Events	Observational, Retrospective, Cohort	SP programming errors: 33%	2B
Husch M et al.^{(²⁵25. Husch M, Sullivan C, Rooney D, Barnard C, Fotis M, Clarke J, et al. Insights from the sharp end of intravenous medication errors: implications for infusion pump technology. Qual Saf Health Care. 2005;14(2):80-6. DOI: 10.1136/qshc.2004.011957 https://doi.org/10.1136/qshc.2004.011957... )}	2005/ United States	Insights from the sharp end of intravenous medication errors: implications for infusion pump technology	Observational, cross-sectional	SP programming errors: 10.5% SP error correction: 0.3%	4C
Rothschild JM et al.^{(²⁶26. Rothschild JM, Keohane CA, Cook EF, Orav EJ, Burdick E, Thompson S, et al. A controlled trial of smart infusion pumps to improve medication safety in critically ill patients. Crit Care Med. 2005;33(3):533-40. DOI: 10.1097/01.CCM.0000155912.73313.CD https://doi.org/10.1097/01.CCM.000015591... )}	2005/ United States	A controlled trial of smart infusion pumps to improve medication safety in critically ill patients	Randomized clinical trial	SP programming errors: 5% Evolution of errors in SP: 2.1% CP programming errors: 10% Evolution of errors in CP: 1.7%	1B
Calabrese A et al.^{(²⁷27. Calabrese AD, Erstad BL, Brandl K, Barletta JF, Kane SL, Sherman DS. Medication administration errors in adult patients in the ICU. Intensive Care Med. 2001;27(10):1592-8. DOI: 10.1007/s001340101065 https://doi.org/10.1007/s001340101065... )}	2001/ United States	Medications administrations errors in adult patients in the ICU	Observational, cross-sectional study	CP programming errors: 40.1%	4C

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E-mail: reeusp@usp.br

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[1] Corresponding author:
Ana Paula Amorim Moreira Rua Vereador Duque Estrada, 109/408, Santa Rosa CEP 24240-210 - Niterói, RJ, Brazil moreira.ana78@gmail.com