Building a smart infusion pump drug library for integration with electronic health records to enhance patient safety
Anita Krishan1,2, Phillip Hopkins1, Louise Payne1, Kadian Fearron1, Reena Mehta1,2
1Critical Care Department, King’s College Hospital NHS Foundation Trust
2Pharmacy Department, King’s College Hospital NHS Foundation Trust
Introduction: Reducing medication errors is a crucial challenge in patient safety, as highlighted by the World Health Organisation (WHO).1 Notably, the National Patient Safety Agency (NPSA) report that 62% of medication-related incidents involve injectable medicines.2 In response, Critical Care are employing innovative technologies, such as electronic prescribing and smart infusion pump systems equipped with Drug Error Reduction Software (DERS). The integrated drug library is essential for DERS to pre-emptively detect selection errors, incorrect rate requests, and general user errors prior to the administration of infusions.
In the absence of a standardised guide to build such a system, this project logs the methodologies employed and processes developed to build and maintain a drug library for smart infusion pumps, integrated with electronic health records. A process map outlining key features, potential pitfalls, and troubleshooting techniques was produced to assist other Critical Care units in replicating or adapting this process.
Objectives: (1) Build an infusion pump drug library, designed for unidirectional integration with electronic health record to enhance the safety of medication administration. Develop and implement standardised operating procedures (SOPs) and training programmes to achieve, validate, and maintain the library’s integrity. (2) Create a standardised drug library design, configuration, testing and integration guide to facilitate replication of this project.
Methods: The project began by identifying key healthcare and technology stakeholders, forming a multidisciplinary team of pharmacists, Intensive Care Unit (ICU) consultants, informatics experts, nurse educators, and analysts. The development was divided into two phases: the first focused on rate-based dosing for continuous infusion drugs, and the second on weight-based dosing. Standardisation of naming conventions and ‘tall man’ lettering was implemented to minimise errors. Each drug was meticulously mapped and validated against Electronic Health Records (EHR) and smart pump specifications. SOPs were established, incorporating change management and validation, followed by user training and acceptability testing through clinical scenarios.
Results: Consistent stakeholder engagement was facilitated through weekly meetings, crucial in achieving the project’s objectives. The rate-based drug library, comprising 85 continuous infusion drugs and 10 for bolus dosing, was successfully integrated with the EHR, enhancing medication administration safety. Significant realignment (35% of EHR entries) and correction (6% for spelling errors) were essential for ensuring library accuracy. The post-implementation data reflected a 66% utilisation rate, exceeding the national average by 12%.3 Additionally, the development of a standardised drug library design and configuration guide was completed, providing a clear and replicable process for similar projects.
Conclusions: The project’s success in developing a rate-based smart pump drug library and a standardised guide demonstrates the efficacy of multidisciplinary collaboration and adherence to robust governance. High utilisation post-implementation and feedback for further fluid range inclusion underline the library’s clinical alignment and scope for enhancement. The creation of a comprehensive process guide, detailing library design, configuration, and testing, fulfils our second objective and offers a valuable resource for other Critical Care units, potentially influencing broader patient safety and care quality practices.
References
1. WHO. The third WHO global patient safety challenge: medication without harm, https://www.who.int/initiatives/medication-without-harm
2. Cousins D; National Patient Safety Agency (Great Britain), Patient Safety Observatory. Safety in doses: medication safety incidents in the NHS. The Fourth Report from the Patient Safety Observatory, National Patient Safety Agency, London, 2007.
3. NAMDET. National DERS and ‘smart pump’ position statement group report 12th November 2020, https://www.flipsnack.com/6B8ED86D75E/ders-report/full-view.html (accessed 22 December 2023).
