Isabel Muñoz Ojeda is a pharmacist, Pharmacy Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Marina Sánchez-Cuervo is a pharmacist, Pharmacy Department, Hospital Universitario Ramón y Cajal.
Crit Care Nurse. 2023 Aug 1;43(4):30-38. doi: 10.4037/ccn2023271.
The risk of medication errors in intensive care units is high, primarily in the drug administration phase.
Management of high-alert medications within intensive care units in the study institution varied widely. The aim of this quality improvement project was to protocolize and centralize the management of high-alert medications in acute care settings and to implement smart intravenous infusion pump technology in intensive care units.
The project was conducted in 4 phases: (1) protocolization and standardization of intravenous mixtures, (2) centralization of intravenous mixture preparation in the Pharmacy Department, (3) programming of the smart pumps, and (4) dissemination and staged implementation of intravenous mixture protocols. Smart pumps (Alaris, CareFusion) were used to deliver the medicines, and the manufacturer's software (Alaris Guardrails, CareFusion) was used to analyze data regarding adherence to the drug library and the number of programming errors detected.
Morphine, remifentanil, fentanyl, midazolam, dexmedetomidine, and propofol were included. After implementation of the smart pumps, 3283 infusions were started; of these, 2198 were programmed through the drug library, indicating 67% compliance with the safety software. The pumps intercepted 398 infusion-related programming errors that led to cancellation or reprogramming of drug infusions.
Protocolization and centralization of the preparation of high-alert sedative and analgesic medications for critically ill patients and the administration of these drugs using smart pump technology decrease variability of clinical practice and intercept potentially serious medication errors.
重症监护病房（ICU）的用药错误风险较高，主要发生在给药阶段。
研究机构的 ICU 中高警示药物的管理差异很大。本质量改进项目的目的是制定和集中管理急性护理环境中的高警示药物，并在 ICU 中实施智能静脉输液泵技术。
该项目分 4 个阶段进行：（1）静脉混合液的方案制定和标准化，（2）将静脉混合液的制备集中在药剂科，（3）智能输液泵的编程，以及（4）静脉混合液方案的传播和分阶段实施。使用智能输液泵（Alaris，CareFusion）来输送药物，并使用制造商的软件（Alaris Guardrails，CareFusion）来分析关于药物库和检测到的编程错误数量的依从性数据。
纳入了吗啡、瑞芬太尼、芬太尼、咪达唑仑、右美托咪定和丙泊酚。在智能输液泵实施后，开始了 3283 次输液；其中，有 2198 次通过药物库进行了编程，表明对安全软件的遵从性为 67%。输液泵拦截了 398 次与输液相关的编程错误，这些错误导致药物输液被取消或重新编程。
对危重症患者的高警示镇静和镇痛药物的制备进行方案制定和集中化，以及使用智能输液泵技术进行这些药物的给药，可减少临床实践的变异性，并拦截潜在的严重用药错误。
