Ohashi Kumiko, Dalleur Olivia, Dykes Patricia C, Bates David W
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, OBC-3, Boston, MA, 02120-1613, USA,
Drug Saf. 2014 Dec;37(12):1011-20. doi: 10.1007/s40264-014-0232-1.
Smart infusion pumps have been introduced to prevent medication errors and have been widely adopted nationally in the USA, though they are not always used in Europe or other regions. Despite widespread usage of smart pumps, intravenous medication errors have not been fully eliminated.
Through a systematic review of recent studies and reports regarding smart pump implementation and use, we aimed to identify the impact of smart pumps on error reduction and on the complex process of medication administration, and strategies to maximize the benefits of smart pumps.
The medical literature related to the effects of smart pumps for improving patient safety was searched in PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (2000-2014) and relevant papers were selected by two researchers.
After the literature search, 231 papers were identified and the full texts of 138 articles were assessed for eligibility. Of these, 22 were included after removal of papers that did not meet the inclusion criteria. We assessed both the benefits and negative effects of smart pumps from these studies. One of the benefits of using smart pumps was intercepting errors such as the wrong rate, wrong dose, and pump setting errors. Other benefits include reduction of adverse drug event rates, practice improvements, and cost effectiveness. Meanwhile, the current issues or negative effects related to using smart pumps were lower compliance rates of using smart pumps, the overriding of soft alerts, non-intercepted errors, or the possibility of using the wrong drug library.
The literature suggests that smart pumps reduce but do not eliminate programming errors. Although the hard limits of a drug library play a main role in intercepting medication errors, soft limits were still not as effective as hard limits because of high override rates. Compliance in using smart pumps is key towards effectively preventing errors. Opportunities for improvement include upgrading drug libraries, developing standardized drug libraries, decreasing the number of unnecessary warnings, and developing stronger approaches to minimize workarounds. Also, as with other clinical information systems, smart pumps should be implemented with the idea of using continuous quality improvement processes to iteratively improve their use.
智能输液泵已被引入以预防用药错误，并在美国全国范围内广泛采用，不过在欧洲或其他地区并非总是得到使用。尽管智能泵得到广泛使用，但静脉用药错误尚未完全消除。
通过对近期有关智能泵实施和使用的研究及报告进行系统综述，我们旨在确定智能泵对减少错误以及对复杂的用药过程的影响，以及使智能泵效益最大化的策略。
在PUBMED、EMBASE和Cochrane对照试验中心注册库（CENTRAL）（2000 - 2014年）中检索与智能泵改善患者安全效果相关的医学文献，由两名研究人员挑选相关论文。
文献检索后，识别出231篇论文，对138篇文章的全文进行了纳入资格评估。其中，在剔除不符合纳入标准的论文后，纳入了22篇。我们从这些研究中评估了智能泵的益处和负面影响。使用智能泵的益处之一是拦截诸如错误速率、错误剂量和泵设置错误等错误。其他益处包括降低药物不良事件发生率、改善实践以及成本效益。同时，与使用智能泵相关的当前问题或负面影响是智能泵的使用率较低、对软警报的忽略、未拦截的错误或使用错误药物库的可能性。
文献表明智能泵减少但并未消除编程错误。尽管药物库的硬限制在拦截用药错误方面起主要作用，但由于忽略率较高，软限制仍不如硬限制有效。使用智能泵的依从性是有效预防错误的关键。改进机会包括升级药物库、开发标准化药物库、减少不必要警告的数量以及制定更强有力的方法以尽量减少变通方法。此外，与其他临床信息系统一样，应在使用持续质量改进流程以迭代改进其使用的理念下实施智能泵。
