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A very small but growing number of hospitals have begun integrating their infusion pumps with their information systems and patient records. integrating your pumps can dramatically reduce infusion-related medication errors. But there are a number of significant barriers. Find out how the three main approaches to integration work, and learn some best practices for tackling the challenges.

Patient-controlled analgesic infusion pumps give patients the ability to self-administer pain-relieving medication as needed within the limits set by a physician. The most significant risk associated with these pumps is the possibility of oversedation, potentially leading to life-threatening narcotic-induced respiratory depression. We examine nine pumps, basing our ratings on safety and ease of use.

The infusion pump component of the Medrad Continuum MR infusion system contains ferromagnetic materials and may be pulled into the MR system's bore if not adequately secured. Users need to be aware that neither the pump nor any other components should be removed from the system within the scan room. Additionally, before bringing the system into the scan room, users should verify that the system is free of damage and that the pump and its mounting bracket are both firmly secured.

Health technology offers countless benefits. It also presents numerous risks. Most of these can be avoided--with work. But in a constantly changing environment, it's not always easy to know where best to concentrate your efforts. Our annual list will help you make smart decisions about your safety initiatives during 2012.

If users of Moog Medical's Zevex Infinity series feeding pumps--the EnteraLite Infinity and the Infinity Orange--use an incorrect key-press sequence while attempting to address a downstream occlusion alarm, the pump's display may mimic normal operation even though the unit is not delivering feeding solution. Although Moog states that it has not received any reports of injury related to these devices, failure to deliver nutrition may result in hypoglycemia, which can have severe outcomes for patients who have difficulty maintaining their blood sugar levels. Users of these pumps should become familiar with this issue and with the guidance offered in the products' operator manuals. This behavior is similar to that of the Nutricia Flocare Infinity series enteral feeding pumps--also produced by Moog Medical--which we described in the May 2011 issue of Health Devices.

Gravity flow--potentially resulting in a dangerous overinfusion--may occur with the B. Braun Infusomat Space infusion pump if the infusion set's free-flow clamp is not correctly inserted in the pump. The manufacturer is currently evaluating measures to reduce the likelihood of this error. In the interim, facilities should ensure that users are familiar with proper use of the pump and are trained to recognize signs that the infusion set was loaded incorrectly.

Due to a software issue, the Moog Curlin 6000 CMS infusion pump may activate an error code associated with a hardware failure (error code 45) when no such failure exists. When this occurs, the unit will stop infusing, and the user may be unable to restart it. Moog has announced plans to release new software in the coming weeks to address this problem. Until the software is available, facilities whose units exhibit this error code should contact Moog for guidance.

Due to an issue in manufacturing, downstream occlusion (DSO) sensors in some Smiths Medical CADD-Solis infusion pumps may drift out of calibration, potentially resulting in erroneous alarms that disable the units. Hospitals experiencing the problem should return affected units to Smiths Medical for recalibration (free of charge) and should consider testing all their CADD-Solis pumps during routine maintenance to ensure that they alarm appropriately for downstream occlusions.

Elastomeric pain pumps work on purely mechanical principles to deliver analgesic medications to ambulatory patients. They are simpler and more cost effective than electronic pumps, but also less sophisticated. Learn the pros and cons of these pumps, and find out how they fared in our testing.

Smiths Medical Medfusion 3010a syringe pumps that aren't equipped with the latest software version (2.0.6) could overinfuse if the "recall last settings" function is used following an infusion in volume/time mode. If your facility has pumps equipped with software versions older than 2.0.6, contact Smiths Medical to obtain an upgrade.

Under certain conditions, Arthrex AR-6400 and AR-6475 arthroscopic irrigation/distention pumps can create pressures within the patient's joint that are more than twice the desired pressure without alerting the clinician, increasing the potential for serious patient injury due to extracapsular solution infiltration. Facilities need to thoroughly understand the behavior of these pumps and determine whether the clinical benefits of using them outweigh the solution-infiltration concerns. If your facility is not comfortable with the behavior of these pumps, use an alternative pump.

The Model 8000 versions of the CareFusion Alaris Point-of-Care (PC) and Medley PC may, in rare cases, display an incorrect total dose value when programmed to deliver a bolus. The manufacturer states that its investigation of the problem is ongoing but recommends that users of affected pumps carefully verify that the bolus dose has been programmed correctly before initiating a delivery.

Syringe pumps are less widely used than general-purpose infusion pumps, but they still provide a significant number of crucial infusions. We believe that, just as with general-purpose pumps, syringe pumps should be purchased only if they incorporate a dose error reduction system.This Evaluation reviews four syringe pumps that have such a system, and our findings focus primarily on how well those systems perform.

In this article, we present our combined criteria for four different types of commonly used infusion devices: general-purpose, syringe, PCA, and ambulatory. These criteria provide a helpful resource for hospitals considering a pump purchase.

This list of 10 high-impact hazards was compiled by ECRI Institute to help healthcare facilities prioritize their efforts to protect patients and staff from injuries that can occur during the use of medical devices and systems.

Patient-controlled analgesic (PCA) infusion pumps allow patients to self-administer doses of pain-relieving medication as needed, rather than having to summon a caregiver. The most significant risk when using these pumps is overmedication leading to narcotic-induced respiratory depression. Several current PCA pumps offer advanced error-reduction features designed to minimize the odds of an accidental overdose: dose error reduction systems, bar-code readers, and computer-based pump-programming systems that entail downloading infusion protocols via a hardwired connection to a PC. The availability of these features plays a dominant role in our ratings. We tested 11 pumps from seven suppliers. Two pumps are rated Preferred because they offer easy-to-use advanced error-reduction features that have been proven effective in a hospital setting. Two other pumps offer computer-based programming and are rated Acceptable, although we note that not all facilities may be able to accommodate the workflow necessary to use the computer-based programming. The remaining pumps are rated Not Recommended because they lack advanced error-reduction features; although most of these pumps perform acceptably, better choices are available.

One of the U.S. National Patient Safety Goals promulgated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is to "improve the safety of using infusion pumps" by ensuring that pumps are protected against free-flow. In this Guidance Article, we provide ECRI's updated guidance for achieving this goal. Free-flow refers to the uncontrolled delivery of an infusion to a patient when a controlled or metered delivery was intended. For more than 20 years--in numerous articles presented in Health Devices and its sister publication Health Devices Alerts--ECRI has offered guidance to help hospitals avoid the dangers of free-flow. The current article is the latest in a series of reports addressing JCAHO's goal; it describes the dangers, provides updated guidance for interpreting JCAHO's goal, and categorizes the available pump models according to the level of free-flow protection offered. This report supersedes Health Devices Alerts Special Reports S0008 (August 23, 2002), S0018 (March 21, 2003), and S0029 (November 14, 2003).

Over the last three years, infusion pump suppliers have begun introducing dose error reduction systems. The primary function of these systems is to reduce pump programming errors and associated injuries to patients. However, these systems can offer other benefits as well. In this article, we describe ways that hospitals can use dose error reduction system data to improve patient care and staff efficiency. We also detail the fees that accompany this new software and discuss the potential for increasing patient safety using wireless capabilities.

This study updates ECRI's previous Evaluations of general-purpose infusion pumps, most notably those published in the October 2002 and October 2003 Health Devices. It features the results of our findings for the new dose error reduction system now included with the Hospira (formerly Abbott) Plum A+ with MedNet, and it includes updated information for the previously evaluated models that also include this safety feature. General-purpose infusion pumps allow the controlled delivery of liquid medications and other solutions to patients through intravenous (i.v.) or epidural routes. Dose error reduction systems, which are now available on several pump models, represent a significant advancement in infusion pump technology. ECRI believes that such systems can help hospitals reduce potentially fatal pump programming errors, and we recommend that hospitals purchasing new general-purpose infusion pumps consider only those models that offer a dose error reduction system.

Failure mode and effects analysis (FMEA) is one method hospitals can use to comply with the requirement by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that they conduct at least one proactive risk assessment of a high-risk process each year. While it is not the only means of satisfying the requirement, FMEA is an established and widely used procedure and is the model suggested by JCAHO. FMEA is not, however, a simple procedure. To help our readers better understand the challenges involved, ECRI conducted its own FMEA as an exercise. The high-risk process we analyzed was setting up and programming infusion pumps for intravenous delivery of medications. In this article, we describe each step we carried out, the principles underlying our decision making along the way, and the lessons we learned. After reviewing our account, the reader should understand what an FMEA is and what it should accomplish, know how to choose and define a process for analysis, and grasp the key elements of a successful FMEA from start to finish.

One popular new method for building safeguards into the medication administration process is the use of a bar-coded medication administration (BCMA) system. Clinician use the system's bar-code scanner to scan labels on the medication packaging and on the patient's identification wristband. In this way, the system verifies that administered medications match provider orders at the point of care. BCMA systems have received a lot of media attention and manufacturer promotion. However, they aren't yet a practical option for most hospitals. Although they offer great potential to help prevent administration errors, current systems have significant limitations. To realize maximum patient safety benefit, an ideal BCMA system should be capable of both point-of-care medication verification and automatic programming of infusion pumps. No current system offers both capabilities. In this article, we discuss these and other limitations and list objectives that need to be met to make commercial BCMA systems successful. We also give advice to help hospitals reduce medication error now and prepare for future implementation of integrated BCMA systems.

General-purpose infusion pumps deliver liquid medications and intravenous (i.v.) fluids to patients through i.v. or epidural routes at specified flows. They are most often used when greater accuracy or higher flows are needed than can be provided by a manually adjusted gravity administration set. In this Evaluation (which updates our October 2002 study), we present our findings for two newly evaluated pumps: the B. Braun Outlook 100 and Outlook 200. The Outlook 200 is the first general-purpose infusion pump to offer a new type of safety feature: an automated programming system. This system scans bar-coded labels on i.v. fluid containers and on patient (and sometimes clinician) identification and automatically programs this information into the pump. Unfortunately, the 200's system has not yet been successfully implemented in a clinical setting.

General-purpose infusion pumps deliver liquid medications and other solutions to patients through intravenous (i.v.) or epidural routes at specified flows. They are most often used when greater accuracy or higher flows are needed than can be provided by manually adjusted gravity systems. In this Evaluation (which updates our February 1997 and April-May 1998 studies), we present our findings for four newly evaluated pumps from three suppliers: the Abbott Plum A+, the Alaris Medley Medication Safety System (MSS), and the Baxter Colleague CX and 3 CX. We also summarize our findings and update our ratings for 22 additional models. As our findings show, the factors that distinguish one pump from another are not performance issues, but rather patient safety considerations. Most of the currently available pumps perform reliably and accurately when properly used. However, not all models offer the same level of protection against pump programming errors and other events that can lead to i.v. medication errors. The pumps that we now recommend for consideration all incorporate a new type of safety feature that warns users when a programmed dose falls outside pre-defined "safe" limits. We call this feature a dose error reduction system. In addition, the recommended models all offer set-based free-flow protection that cannot be defeated. Pumps that lack one or both of these features are now rated either Not Recommended or Unacceptable.