Abstract
Background Processes for delivery of high-risk infusions in pediatric intensive care units (PICUs)
are complex. Standard concentration infusions (SCIs), smart-pumps, and electronic
prescribing are recommended medication error reduction strategies. Implementation
rates in Europe lag behind those in the United States. Since 2012, the PICU of an
Irish tertiary pediatric hospital has been using a smart-pump SCI library, interfaced
with electronic infusion orders (Philips ICCA). The incidence of infusion errors is
unknown.
Objectives To determine the frequency, severity, and distribution of smart-pump infusion errors
in PICUs.
Methods Programmed infusions were directly observed at the bedside. Parameters were compared
against medication orders and autodocumented infusion data. Identified deviations
were categorized as medication errors or discrepancies. Error rates (%) were calculated
as infusions with errors and errors per opportunities for error (OEs). Predefined
definitions, multidisciplinary consensus and grading processes were employed.
Results A total of 1,023 infusions for 175 patients were directly observed over 27 days between
February and September 2017. The drug library accommodated 96.5% of infusions. Compliance
with the drug library was 98.9%. A total of 133 infusions had ≥1 error (13.0%); a
further 58 (5.7%) had ≥1 discrepancy. From a total of 4,997 OEs, 153 errors (3.1%)
and 107 discrepancies (2.1%) were observed. Undocumented bolus doses were most commonly
identified (n = 81); this was the only deviation in 36.1% (n = 69) of infusions. Programming errors were rare (0.32% OE). Errors were minor, with
just one requiring minimal intervention to prevent harm.
Conclusion The error rates identified are low compared with similar studies, highlighting the
benefits of smart-pumps and autodocumented infusion data in PICUs. A range of quality
improvement opportunities has been identified.
Keywords
critical care - pediatrics - error reduction - smart-pumps - information system -
documentation
