Infusion pumps and long-term IV therapy in the home environment

May 09, 2018
By Julie Andrews

The FDA defines an infusion pump as “a medical device used to deliver fluids into a patient’s body in a controlled manner.”

Traditional infusion pumps fall into three main categories: large volume infusion pumps; ambulatory infusion pumps; and syringe infusion pumps. These pumps are used primarily in hospitals, long-term care facilities, infusion clinics and occasionally home settings. With the recent emphasis on improved patient outcomes and decreasing 30-day readmissions, the ability to continue longer-term IV therapy in the home is becoming a more viable option both for the patient and provider.

Specialty infusion pumps consist of insulin infusion pumps, enteral pumps also known as feeding pumps and implantable infusion pumps like those used for insulin, chronic pain management or chemotherapy. Studies have shown that insulin pumps alone have led to improved quality of life, physical health and personal and family lives. The implantable infusion pump is now covered by Medicare when the appropriate criteria have been met and sufficiently documented.

Smart pumps
Programmable infusion pumps first appeared in the early 1970s. They enabled a specific rate to be entered into the pump for delivery of fluids. These pumps could accept infusion rates in the ranges of 0.01 to 999 mL/hr., and with some systems, even higher. Although there were definite advantages over the previous methods of gravity flow, or using clamps to regulate the drip rate, these programmable pumps still left wide opportunity for errors. With such a wide range of “acceptable” infusion rates, the pump could not alert the practitioner to the potential scenario of 10 being entered instead of 1.0. The American Journal of Hospital Pharmacists (2008) states that errors in medications delivered intravenously are twice as likely to cause patient harm.

Smart pumps with medication safety software entered the market in the early 2000s. This new technology enabled hospitals to customize specific care areas for certain medications to be infused and hospital-specific dose ranges for each medication. In addition, if the identified ranges are exceeded, or an incorrect patient care area selected on the pump, the software creates an alert that can be a hard stop or overridden depending on each facility’s parameters.

While smart pumps improved infusion medicine, there remained several opportunities for error that the new generation of pumps did not address. The Five Rights of medication administration that every practitioner learns early in their training (right drug, right dose, right route, right patient and right time) were still not being addressed by the new smarter pumps. In addition, documentation of the medication administration was left as an additional step in the practitioner’s workflow.

Barcode administration was introduced in conjunction with the smart pump to help reduce the errors associated with the Five Rights. Barcode administration allows the practitioner to scan the patient, medication and themselves to ensure the right drug, right dose, right route and right patient, and document the right time in real time.

The Joint Commission has included in its 2018 Hospital National Patient Safety Goals (NPSG) two items that can be directly improved using a smart integrated infusion pump. They are:

• Identify patients correctly.
• Use medication safely.

Moving forward with smart pump technology requires integration with the barcode administration technology, the hospital’s IT network and the EMR. This is the first step in being fully integrated and truly reducing medication errors in healthcare.

Julie Andrews
Considerations when looking at the purchase of infusion pumps should include, but not be limited to:

• Interoperability with a facility’s current IT network.
• Compatibility with the EMR system.
• Current in-house equipment and ability to upgrade or expand.
• Software upgrade and maintenance costs.
• Capabilities of in-house BME departments to service equipment or the purchase of service contracts from the OEM.

About the author: Julie Andrews is a clinical analyst at MD Buyline.