Smart infusion pump

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Overview

Smart, computerized infusion pumps have developed to the point that they are readily available on the market from a variety of vendors, and for a variety of uses.

It is important to distinguish the different types of pumps by modality. The common modalities are (1) large volume parenteral infusions (LVPs), (2) syringe infusions, (3) epidural infusions and (4) patient-controlled analgesia infusions.

Some pumps are purpose-built exclusively to be used for only a single modality, whereas other pumps have been engineered to support multiple infusion modalities.

Klas recently (2008) reviewed several pump vendor products. The represented vendors were B. Braun, Baxter, Cardinal Health, Hospira, Sigma and Smiths Medical.

Some smart pumps have become network devices, connecting to wireless networks in hospitals and clinics using IEEE 802.11 standards for wireless local area network communications.

In a large health organization, managing a fleet of 100s of smart infusion devices requires teaming by the departments of medicine, nursing, pharmacy, clinical engineering and information technology. There are many pump system management issues to be resolved and data on best practices for change management for smart infusion devices is scarce. Lessons learned include the importance of multi-disciplinary management strategies and oversight, thoughtful and intentional process development for change management of the smart infusion pump drug library data set and careful monitoring of changes applied to the smart infusion pump platform.

The network distribution of new data set information wirelessly to widely distributed smart infusion pump devices is an area of particular concern. While it seems convenient to distibute drug library data set updates for new drugs, changes to standard concentrations and upper and lower infusion rate bounds to infusion pumps using a wireless network, one must consider that this type of distribution will NOT be completed quickly. Instead, the pump devices must be turned on and connected to the network to receive a data set update. Therefore it can take a period of days or longer to disseminate a new data set without intervening to locate all of the smart pump devices, power cycle them and validate a successful data set download has occurred before putting them back into circulation for use. This lag time for data set updates could cause problems but it can be managed and dimished through policies and procedures that require locating each and every smart infusion device in circulation and validating data set downloads over a much shorter period of time, perhaps requiring only a few hours.

Smart Infusion Pump quality data

One fascinating advantage of smart infusion pump technology is the ability to capture information from the pump programming process for later review and analysis. Typically, smart infusion pumps include drug libraries or databases of drug-specific information. These drug libraries can include lower and upper bounds governing safe and appropriate infusion rates for standard infusions as they are defined by the hospital, health-system or clinic. These lower and upper infusion rate bounds are then used to provide administration decision support at the point-of-care. Overridable soft stops and rigid hard stops are both supported by some of the smart pump software.

The smart pump use data that can be collected at the level of the smart infusion pump and then aggregaged into a smart infusion pump database on central server or servers includes records of the administration warnings and alerts that have fired and the administering clinicians responses to those alerts.

Maddox et al. report some of these data in a paper on smart infusion devices for patient-controlled analgesia (PCA). In this study, the PCA pump system included a novel, integrated, continous capnographic quality of respiration monitoring system augmented by pulse-oximetry (see Am J Health-Syst Pharm Vol. 63: Jan 15, 2006). These authors present several cases where automated respiratory monitoring by the PCA smart pump system alerted clinicians early-on to potential narcotic-induced repiratory depression before life-saving measures were needed. The authors also report "examples of averted programming errors" from the smart PCA pump activity database.