高警示药物给药和静脉智能输液泵：临床实践的描述性分析。

High-alert medication administration and intravenous smart pumps: A descriptive analysis of clinical practice.

机构信息

Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN, 47907, USA.

Bouvé College of Health Sciences, 360 Huntington Avenue, Boston, MA, 02115, USA.

出版信息

Res Social Adm Pharm. 2019 Jul;15(7):889-894. doi: 10.1016/j.sapharm.2019.02.007. Epub 2019 Feb 22.

DOI:10.1016/j.sapharm.2019.02.007

PMID:30827935

Abstract

BACKGROUND

The Institute for Safe Medication Practices (ISMP) describes high alert medications (HAM) as medications that represent a heightened risk of patient harm when used in error. IV smart pumps with dose error reduction systems (DERS) were created to help address medication administration errors. Compliance with DERS provides a measure of how accurately a hospital uses smart pump technology to reduce IV medication error.

OBJECTIVE

The primary purpose of this research was to use the REMEDI dataset, an aggregate, multi-hospital database inclusive of smart pump analytics, to improve the current understanding of clinical practices for IV HAM administration.

METHODS

Descriptive analyses and analysis of variance (ANOVA) were used to test for differences in the mean DERS alert override rate, and mean DERS alert override to reprogram ratio between non-HAM and HAM overall, by hospital system, and by pump type.

RESULTS

High mean override rates for non-HAM (73.8%) and HAM (75.8%) and high override to reprogram ratios for both non-HAM (7.30) and HAM (9.92) were seen. No significant differences were found in override rates (p = 0.23) and override to reprogram ratios (p = 0.06) between non-HAM and HAM. By hospital system, significant variability in override rates and override to reprogram ratios were seen. By pump type, there were no significant differences in the mean override rates (Baxter: p = 0.09; BD p = 0.34; ICU Medical p = 0.18) and the mean override to reprogram ratios (Baxter p = 0.84; BD p = 0.03; ICU Medical p = 0.63) between non-HAM and HAM.

CONCLUSIONS

These findings indicate that the majority of alerts generated are bypassed by clinicians at the point of care, a symptom of alert fatigue. Given the potential for significant patient harm with HAM and the high DERS alert override rates that routinely occur during IV medication administration, this study provides further support for clinician-driven IV smart pump innovation to improve alert fatigue.

摘要

背景

安全用药实践研究所（ISMP）将高危药物（HAM）定义为在用药错误时会对患者造成更高伤害风险的药物。具有剂量误差减少系统（DERS）的静脉智能输液泵旨在帮助解决给药错误。遵守 DERS 为医院使用智能输液泵技术减少静脉用药错误的准确性提供了衡量标准。

目的

本研究的主要目的是使用 REMEDI 数据集，这是一个包含智能输液泵分析的聚合、多医院数据库，以提高对静脉 HAM 给药临床实践的现有认识。

方法

采用描述性分析和方差分析（ANOVA），检验非 HAM 和 HAM 之间、各医院系统之间以及各输液泵类型之间的 DERS 警报覆盖率平均值和 DERS 警报覆盖率与重新编程率的平均值是否存在差异。

结果

非 HAM（73.8%）和 HAM（75.8%）的平均覆盖率较高，非 HAM（7.30）和 HAM（9.92）的覆盖率与重新编程率较高。非 HAM 和 HAM 之间的覆盖率（p=0.23）和覆盖率与重新编程率（p=0.06）无显著差异。按医院系统划分，覆盖率和覆盖率与重新编程率存在显著差异。按输液泵类型划分，非 HAM 和 HAM 之间的平均覆盖率（Baxter：p=0.09；BD：p=0.34；ICU Medical：p=0.18）和平均覆盖率与重新编程率（Baxter：p=0.84；BD：p=0.03；ICU Medical：p=0.63）无显著差异。