University of Massachusetts Amherst, Institute for Applied Life Sciences and College of Nursing, Amherst, Massachusetts (Dr Giuliano); Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida (Dr Penoyer and, formerly, Ms Bennett); Parkview Regional Medical Center, Fort Wayne, Indiana (Ms Mahuren).
Karen K. Giuliano, PhD, MBA, RN, FAAN, is a fellow in the American Academy of Nursing and a six-sigma green belt. She holds a BSN and PhD in nursing from Boston College, a nurse practitioner degree from the University of Massachusetts, and an MBA in global management from Babson College. She completed her postdoctoral research fellowship on intravenous (IV) infusion device safety at Yale University. Dr Giuliano actively contributes to many professional organizations and works with small, medium, and large companies on medical product development and innovation. In addition, her own interdisciplinary program of research is focused in 2 main areas: nonventilator hospital-acquired pneumonia and IV infusion safety using IV smart pumps. With a clinical background in critical care and 25+ years of global experience in the development of new medical products, Dr Giuliano is passionate about improving health care through innovation. Her expertise includes human-centered design and clinical outcomes research.
J Infus Nurs. 2021;44(3):128-136. doi: 10.1097/NAN.0000000000000415.
This descriptive observational study was conducted to increase understanding of medication administration practices during actual clinical use between 2 commonly used, different types of intravenous (IV) smart pumps. Compliance with manufacturer-recommended setup requirements for both primary and secondary infusions and secondary medication administration delay was compared between a head-height differential system and a cassette system. A total of 301 medication administration observations were included in this study: 102 (34%) for the linear peristaltic IV smart pump (medical-surgical: N = 51; critical care: N = 51) and 199 (66%) for the cassette pump (medical-surgical: N = 88; critical care: N = 111). Results found a 0% compliance for primary line setup and 84% compliance for secondary line setup and 1 omitted medication due to a closed clamp with the linear peristaltic system. For the cassette system, there are no head-height requirements. Two roller clamps were found to be in the closed position on initiation of the secondary infusion, but the clinician was alerted by an alarm, so no medication delays occurred. These findings support that the current system requirements for flow rate accuracy using head-height differential systems are difficult to achieve consistently at the point of care. There is a need for additional human factor designed technology to replace manual actions to improve the process of care for nurses and the safety of care for patients.
这项描述性观察研究旨在深入了解两种常用的不同类型静脉（IV）智能输液泵在实际临床使用中的给药操作。本研究比较了高低差系统与盒式系统在满足制造商推荐的主输液和辅助输液设置要求，以及辅助药物给药延迟方面的合规性。这项研究共纳入了 301 次药物给药观察：102 次（34%）为线性蠕动式 IV 智能输液泵（普通外科：N=51；重症监护：N=51），199 次（66%）为盒式输液泵（普通外科：N=88；重症监护：N=111）。结果显示，线性蠕动式系统的主管路设置合规率为 0%，辅助管路设置合规率为 84%，由于夹闭导致 1 种药物未给药。对于盒式系统，没有高度要求。在启动辅助输液时，发现有两个滚轮夹处于关闭位置，但由于警报声响起，临床医生及时注意到了这一情况，因此没有发生药物延迟。这些发现表明，目前使用高低差系统来确保流速准确性的系统要求在护理现场很难始终如一地得到满足。需要额外的人为因素设计技术来取代手动操作，以提高护士的护理流程和患者护理的安全性。
