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Intravenous Medication Administration Safety with Smart Infusion Pumps in the Neonatal Intensive Care Unit: An Observational Study

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Abstract

Introduction

Infants in the neonatal intensive care unit (NICU) are among the most vulnerable patient populations and medication errors are a significant source of risk and harm to neonates. Smart infusion pumps have been implemented to support the safe medication administration process; however, the effect of using smart infusion pumps on medication safety in the NICU is still unclear.

Methods

We conducted an observational study with a prospective point-prevalence approach to investigate intravenous (IV) medication administration errors in the NICU at one academic medical center in the USA. Observations were conducted in 48 days in a 3-month data collection period in 2019.

Results

We observed a total of 441 patients with 905 IV medication administrations during the data collection period. The total number of errors was 130 (14.4 per 100 administrations). Of these, the most frequent errors were selecting the wrong drug library entry (5.3 per 100 administrations), unauthorized medication (0.7 per 100 administrations), and wrong dose (0.6 per 100 administrations). Sixty-eight errors (7.5 per 100 administrations) were unlikely to cause harm despite reaching the patient (category C errors), while the rest did not reach the patient.

Conclusion

We identified the medication errors, which was unique to NICU populations, but no harm to the patients were identified. Most errors occurred due to a lack of compliance of using smart pump technology; therefore, potential exists to maximize safety related to medication administration practices in the NICU through hospital policy change and increasing adherence to appropriate use of smart pump technology.

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Acknowledgements

We acknowledge our study collaborators, Christina Meehan for supporting the study and Bridget Betts for collecting the data. This study was funded by Association for the Advancement of Medical Instrumentation (AAMI) in 2018–2019.

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Authors and Affiliations

  1. Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont Street, OBC-3, Boston, MA, 02120-1613, USA

    Kumiko O. Schnock, Catherine S. Yoon, Stuart Lipsitz, David W. Bates & Patricia C. Dykes

  2. Harvard Medical School, Boston, MA, USA

    Kumiko O. Schnock, Stuart Lipsitz, David W. Bates & Patricia C. Dykes

  3. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Sara E. Rostas

Authors
  1. Kumiko O. Schnock
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  2. Sara E. Rostas
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  3. Catherine S. Yoon
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  4. Stuart Lipsitz
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  5. David W. Bates
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Corresponding author

Correspondence to Kumiko O. Schnock.

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Funding

This study was funded by Association for the Advancement of Medical Instrumentation (AAMI) in 2018–2019.

Conflict of interest

Kumiko Schnock and Sara E. Rostas received a research grant from the Association for the Advancement of Medical Instrumentation. Catherine Yoon, Stuart Lipsitz, and Patricia Dykes declare that they have no conflict of interest. David Bates has received research support and consults for EarlySense, which makes patient safety monitoring systems. He receives cash compensation from CDI (Negev), which is a not-for-profit incubator for health IT startups. He receives equity from Valera Health, which makes software to help patients with chronic diseases; CLEW, which makes software to support clinical decision-making in intensive care; and MDClone, which takes clinical data and produces deidentified versions of it. He consults for and receives equity from AESOP, which makes software to reduce medication error rates, and FeelBetter. He has received research support from a grant funded by MedAware and IBM Watson Health, outside the submitted work.

Ethics approval

This study was approved by Mass General Brigham Human Subjects Committee (#2021P000336). All the data collected were de-identified in the electronic data collection tool, which did not include any protected health information.

Consent to participate

Not Applicable.

Consent for publication

Not Applicable.

Availability of data and material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

Not Applicable.

Author’s contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kumiko Schnock, Sara Rostas, Catherine Yoon, Stuart Lipsitz, and Patricia Dykes. The first draft of the manuscript was written by Kumiko Schnock and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

ClinicalTrials registration

Not Applicable.

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Schnock, K.O., Rostas, S.E., Yoon, C.S. et al. Intravenous Medication Administration Safety with Smart Infusion Pumps in the Neonatal Intensive Care Unit: An Observational Study. Drug Saf 47, 29–38 (2024). https://doi.org/10.1007/s40264-023-01365-6

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