Nuckols Teryl K, Bower Anthony G, Paddock Susan M, Hilborne Lee H, Wallace Peggy, Rothschild Jeffrey M, Griffin Anne, Fairbanks Rollin J, Carlson Beverly, Panzer Robert J, Brook Robert H
The RAND Corporation, Santa Monica, CA, USA.
J Gen Intern Med. 2008 Jan;23 Suppl 1(Suppl 1):41-5. doi: 10.1007/s11606-007-0414-y.
Patients in intensive care units (ICUs) frequently experience adverse drug events involving intravenous medications (IV-ADEs), which are often preventable.
To determine how frequently preventable IV-ADEs in ICUs match the safety features of a programmable infusion pump with safety software ("smart pump") and to suggest potential improvements in smart-pump design.
Using retrospective medical-record review, we examined preventable IV-ADEs in ICUs before and after 2 hospitals replaced conventional pumps with smart pumps. The smart pumps alerted users when programmed to deliver duplicate infusions or continuous-infusion doses outside hospital-defined ranges.
4,604 critically ill adults at 1 academic and 1 nonacademic hospital.
Preventable IV-ADEs matching smart-pump features and errors involved in preventable IV-ADEs.
Of 100 preventable IV-ADEs identified, 4 involved errors matching smart-pump features. Two occurred before and 2 after smart-pump implementation. Overall, 29% of preventable IV-ADEs involved overdoses; 37%, failures to monitor for potential problems; and 45%, failures to intervene when problems appeared. Error descriptions suggested that expanding smart pumps' capabilities might enable them to prevent more IV-ADEs.
The smart pumps we evaluated are unlikely to reduce preventable IV-ADEs in ICUs because they address only 4% of them. Expanding smart-pump capabilities might prevent more IV-ADEs.
重症监护病房（ICU）的患者经常发生涉及静脉用药的不良药物事件（IV-ADEs），而这些事件往往是可以预防的。
确定ICU中可预防的IV-ADEs与具有安全软件的可编程输液泵（“智能泵”）的安全功能相匹配的频率，并提出智能泵设计的潜在改进建议。
通过回顾性病历审查，我们检查了两家医院将传统泵更换为智能泵之前和之后ICU中可预防的IV-ADEs。当智能泵被编程为输送重复输注或超出医院定义范围的持续输注剂量时，会向用户发出警报。
1家学术医院和1家非学术医院的4604名重症成年患者。
与智能泵功能相匹配的可预防IV-ADEs以及可预防IV-ADEs中涉及的错误。
在识别出的100起可预防IV-ADEs中，有4起涉及与智能泵功能相匹配的错误。2起发生在智能泵实施之前，2起发生在之后。总体而言，29%的可预防IV-ADEs涉及用药过量；37%涉及未能监测潜在问题；45%涉及问题出现时未能进行干预。错误描述表明，扩展智能泵的功能可能使其能够预防更多的IV-ADEs。
我们评估的智能泵不太可能减少ICU中可预防的IV-ADEs，因为它们仅能解决其中的4%。扩展智能泵的功能可能预防更多的IV-ADEs。
