Making SMART infusion pumps SMARTER

Hywel Dda University Health Board use SMART intravenous infusion pumps which include a drug library of pre-programmed infusion limits. This library reduces the risk of infusing medicines too quickly or at too high a dose.

The pumps also store data from each infusion which enables medicines safety colleagues to identify areas which need additional training to improve infusion safety.

This project has enabled the purchase of a number of ‘Wi-Fi’ batteries which connect the pumps to the health board IT network to automatically update the drug library and access the stored data for analysis and drive improvements locally and across Wales.

Project Aims:

To explore the benefits of connecting infusion pumps to the health board network by asking some simple questions:

• What would we learn from using this technology?

• How would this learning help us to improve infusion safety?

• What is the compliance rate of the drug library (DL)?

• What drugs are having infusion limits breached and why?

• How do we make an instant change to the drug library and/or modification data?

Challenges:

• IT infrastructure and engagement

• COVID led to loss of data collection from the wards

• Loss of on-site support from Braun

• Pumps moved to other wards

• An incident with insulin propelled our project team to update all infusion pumps manually as a priority. We received “high level” support and buy in which triggered a rapid review of the library and modification data. It also initiated multiple conversations around infusion practice, infusion limits, pump configurations and emphasised the lack of knowledge and investment around the resource and expertise required for this to happen.

Key Outcomes:

• Data stored in the pumps provides valuable intelligence on infusion practice on the front line. The data revealed near misses on various drugs e.g. insulin furosemide

• Datix reports have revealed a trend of antibiotic administration errors where the patient’s allergy status wasn’t checked before administration. This technology enabled us to put a risk reduction message on the antibiotic profile to remind the nurse to “check allergy status.” We will be monitoring the Datix reports to measure this intervention.

• A change of formulation occurred for the treatment of phosphate deficiency. The technology enabled us to reflect this in the DL by adding the new formulation.

• Drug administration information has changed since 2016 for various drugs including some antibiotics. The data revealed rate limit breeches for these drugs. This demonstrates the importance of timely DL updates.

• Critical Care implemented new drug charts with pre-populated standardised drug concentration and infusion rates. The DL was changed to reflect this and support nurses and clinicians with their practice

• Facilitated communication with clinicians, nurses, pharmacy, clinical engineering and industry to rationalise and standardise administration of IV infusions.

Next Steps:

With the arrival of COVID-19, all health boards in Wales have adopted a sharing culture. This has allowed us to increase our number of Wi-Fi enabled pumps. We will deploy these extra pumps to Critical Care where we can demonstrate instant changes to the DL.

During COVID-19, there have been huge challenges with the procurement of critical care drugs. Across Wales there is a drive to standardise concentrations of certain drugs, preserve the supply chain and reduce waste e.g. noradrenaline. The technology will enable us to update the DL instantly to reflect these changes during this unprecedented time.

Our Exemplar Experience:

Being a Bevan Exemplar has made us realise that anything is possible even when resources are tight!

Team Feedback:

Contact:

Dianne Burnett: Dianne.M.Burnett@wales.nhs.uk, @BurnettDianne

Stephen Farrington: Stephen.Farrington@wales.nhs.uk

Chris Hopkins: Chris.L.Hopkins@wales.nhs.uk, @Chrisyhopkins

B. Braun Medical Ltd: @BBraunUK