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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

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Abstract

Background: Medication errors occur in approximately one out of five doses in a typical hospital setting. Patients in the intensive care unit (ICU) are particularly susceptible to errors during the application of intravenous drugs as they receive numerous potent drugs applied by syringe pumps.

Objective: The aim of this study was to analyse the effects on potential harmful medication errors and to address factors that have potential for improving medication safety after the introduction of a standardized drug library into syringe pumps with integrated decision support systems.

Methods: A team of physicians and nurses developed a dataset that defined standardized drug concentrations, application rates and alert limits to prevent accidental overdosing of intravenous medications. This dataset was implemented in 100 syringe pumps with the ability to log programming errors, alerts, reprogramming events and overrides (‘smart pumps’). In this retrospective pilot study, all pump-related transaction data were obtained from the pump logs, by downloading the data from the pumps, covering 20 months of use between 1 April 2008 and 30 November 2009. Patient data were gathered from the electronic patient charts. The study was performed in a cardiothoracic ICU of the Charité University Hospital, Berlin, Germany.

Results: A total of 7884 patient treatment days and 133601 infusion starts were evaluated. The drug library with the features of the dose rate was used in 92.8% of the syringe pump starts, in 1.5% of the starts a manual dosing mode without the use of the drug library was used and in 5.7% of the starts the mode ‘mL/h’, without any calculation features, was used. The most frequently used drugs were vasoactive drugs, followed by sedation medication. The user was alerted for a potentially harmful overdosing in 717 cases and in 66 cases the pumps were reprogrammed after the alert. During the early morning hours a higher rate of alarms was generated by the pumps, compared with the rest of the day.

Conclusions: Syringe pumps with integrated safety features have the capacity to intercept medication errors. The structured evaluation of the bedside programming history in log recordings is an important benefit of smart pumps, as this enables the users to obtain an objective measurement of infusion practice, which can be used to provide team feedback and to optimize the programming of the pumps. Further research will show if the combination of these data with physiological data from ICU patients can improve the safety of pump-driven intravenous medication.

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Acknowledgements

This study was sponsored as an institutional grant by Alaris Asena CC, CareFusion, Rolle Switzerland. The company did not design the study nor did they have influence on the results or interpretation of the results. Claudia Spies has provided expert testimony for the Ethical Committee of the Vienna Faculty of Medicine, has received grants from Abbott, Aspect, Baxter, Fresenlus Kabi, Wyeth, Argus, BDA, BMBF, Deutsche Krebshilfe, DLR and the Germany Research Society, and has received inner university grants. She has also received payment for lectures, including service on speakers’ bureaus, from Abbott, Braun, Baxter, Essex Pharma and GlaxoSmithKline. Claudia Spies has also received payment for travel, accommodation and meeting expenses from Abbott, Aspect, Baxter, Fresenlus Kabi and Wyeth. T. Volk has received grants, lecture payments or travel expenses from Abbott, Arrow, AstraZeneca, Baxter, Bayer, B. Braun, CSL Behring, Dr. Köhler Chemie, Fresenius, GE, GlaxoSmithKline, Mitsubishi, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Pulsion, Thermo Scientific, European Union, Saarland Ministry of Economic Affairs and the Germany Research Society. All other authors have no other conflicts of interests to declare.

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Authors and Affiliations

  1. Campus Virchow-Klinikum and Campus Charité Mitte, Department of Anaesthesiology and Intensive Care, Charité-University Medicine Berlin, Augus-tenburger Platz 1, 13353, Berlin, Germany

    Marc Kastrup, Felix Balzer &  Claudia Spies MD (Professor of Anesthesiology and Intensive Care Medicine, Head of Department, Charité-University Medicine Berlin)

  2. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg, Germany

    Thomas Volk

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  1. Marc Kastrup
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  2. Felix Balzer
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  4. Claudia Spies MD
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Correspondence to Claudia Spies MD.

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Kastrup, M., Balzer, F., Volk, T. et al. Analysis of Event Logs from Syringe Pumps. Drug Saf 35, 563–574 (2012). https://doi.org/10.2165/11597350-000000000-00000

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