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Sujan M, Habli I. BMJ Qual Saf. 2021;Epub May 27.
This commentary discusses the use of “safety cases” to communicate the safety of a product, system or service in industry (e.g., aviation, defense, railways). Using an example of a smart infusion pump, the authors discuss how to apply this concept in healthcare to support the safe adoption of digital health innovations.
Jt Comm J Qual Patient Saf. 2021;47(6):394-397.
Smart infusions pumps with built-in dose error reduction software (DERS) are designed to protect against dosing errors that result in patient harm. This alert summarizes recommendations to enhance the effective implementation and use of smart infusion pumps such as drug library maintenance and pump error report monitoring.

MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administration; January 15, 2021. 

Vinca alkaloid misadministration is a persistent problem that results in patient harm and death. This alert raises awareness of label changes that aim to mitigate accidental spinal administration of the high-alert chemotherapy agent by supporting infusion bag administration only. 
Kirkendall ES, Timmons K, Huth H, et al. Drug Saf. 2020;43(11):1073-1087.
This systematic review catalogued and mapped the types of human errors related to smart pumps and associated error-prevention strategies. Error categories included (1) undocumented errors, (2) drug library errors, (3) programming errors, (4) administration errors, and (5) ancillary equipment errors. The authors mapped these errors to existing, standardized medication error classification and found that some errors (e.g., drug library errors) are introduced by the implementation of smart pump technology and some may be the result of workarounds. A range of prevention strategies were identified and mapped to the error types. These findings can serve as a toolkit for clinical use and development of best practices.  
Ann D. Gaffey, RN, MSN, CPHRM, DFASHRM is the President of Healthcare Risk and Safety Strategies, LLC. Bruce Spurlock, MD is the President and CEO of Cynosure Health. We spoke with them about their role in the development of the Making Healthcare Safer III Report and what new information they think audiences will find particularly useful and interesting.

Institute for Safe Medication Practices. Horsham, PA: Institute for Safe Medication Practices; 2020.

Smart pumps are widely available as a medication safety tool yet there are challenges affecting their reliable use. This guideline expands on earlier recommendations  to support smart pump use in both hospitals and the ambulatory setting. The material provides recommendations that address infrastructure, drug libraries, quality improvement data, workflow and electronic health record interoperability concerns.
DeLaurentis P, Walroth TA, Fritschle AC, et al. Am J Health Syst Pharm. 2019;76(17):1281-1287.
Smart infusion pumps have the potential to improve medication safety, but research suggests that errors remain common and that careful consideration must be given to both design and implementation of such technology. Researchers conducted a survey of five health systems in Indiana to better understand smart infusion pump users' views and knowledge regarding the drug library update process. They identified significant knowledge gaps, especially around the steps necessary to update the drug library.
Pinkney SJ, Fan M, Koczmara C, et al. Crit Care Med. 2019;47(7):e597-e601.
This simulation study examined critical care unit nurses' performance in identifying intravenous medications using different equipment types. Researchers found that line labels (attached to each line of tubing) and organizers (which prevent tubing from tangling) significantly improved the accuracy of medication identification compared to usual care. Use of smart pumps required more time and did not improve medication identification accuracy, suggesting that line labels and organizers are an inexpensive and feasible method to enhance medication safety.
Blandford A, Dykes PC, Franklin BD, et al. Drug Saf. 2019;42(10):1157-1165.
Intravenous medication infusions are an important target for safety interventions. Many infused medications, such as opioids and chemotherapy, require vigilant adherence to protocol to prevent harm. Technical solutions to infusion errors such as computerized provider order entry, barcode medication administration, and smart infusion pumps have been implemented with some success. Investigators compared infusion errors in the United States, where all three technical interventions are common, to the United Kingdom, where those technical interventions are rare. Minor errors were common in each country, but only 0.8% of infusions placed patients at serious risk of harm. Although the details of errors in both countries differed in detail, rates of error and harm were similar. A WebM&M commentary described a chemotherapy infusion error that caused renal failure.
Hsu K-Y, DeLaurentis P, Bitan Y, et al. Journal of patient safety. 2019;15:e8-e14.
Smart infusion pumps store drug safety information, but this data must be periodically updated. This study demonstrated significant delays in updating the drug information for smart infusion pumps. These delays resulted in failure to alert for two high-risk medication cases, but neither case led to patient harm.
Bowdle TA, Jelacic S, Nair B, et al. British journal of anaesthesia. 2018;121:1338-1345.
This pre–post study of errors in anesthesia compared self-reported errors before and after implementation of a medication safety bundle that included smart infusion devices and barcode medication administration. Wrong-medication errors declined after barcoding was introduced, consistent with prior studies.
Giuliano KK, Su W-T, Degnan DD, et al. Journal of patient safety. 2018;14:e76-e82.
Although smart pumps can reduce medication errors, user overrides and workarounds prevent safety features from operating as intended. Researchers used informatics data from 7 hospital systems including a total of 44 hospitals for a 1-year period to determine compliance with built-in dose-error reduction systems and drug libraries. They found differences in compliance both within and across systems. They also found a positive association between pump compliance and type of pump used as well as a positive association between the number of drug library profiles and pump compliance.
MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administration; November 14, 2018.
This safety announcement raises awareness of pump failures, dosing errors, and other potential safety issues associated with implanted pumps. Recommendations to enhance safety include review of medication labeling to select appropriate medicines and concentrations as well as open discussions with patients about risks associated with pump and medication options.
Walroth TA, Smallwood S, Arthur K, et al. Am J Health Syst Pharm. 2018;75(12):893-900.
Nuisance drug alerts generated by smart infusion pumps can detract from safe care delivery by contributing to alert fatigue and interruptions. This commentary reviews a consensus initiative to decrease insignificant alerts across six health systems. The authors describe how the group standardized smart pump drug library management processes to refine dosage recommendations, policy development, alert review, and data usage to reduce alerts in acute care facilities. A past PSNet perspective discussed the importance of addressing hazards associated with smart pump utilization.
Smart pumps are employed throughout health care, but their design can challenge safety. Reporting results of a national survey, this newsletter article outlines how smart pump data is being used to improve compliance and suggests ways organizations can enhance the value of analytics to inform frontline practice improvement. A previous WebM&M commentary discussed a smart infusion pump error that resulted in patient harm.
Giuliano KK. Crit Care Nurs Clin North Am. 2018;30(2):215-224.
Usability weaknesses can contribute to intravenous medication administration errors. This review explores problems in the design and use of intravenous smart pumps that challenge safe use. The author recommends employing innovation with an emphasis on human factors engineering to improve smart pump safety and usability.
Smart pumps offer both benefits and drawbacks that can affect medication safety. This newsletter article explores missteps related to lack of compliance with setting hard stops to protect patients when using unique intravenous medication concentrations. Recommendations to prevent errors include using standardized dosing concentrations as often as possible, adhering to metric unit dosing requirements, and verifying pump programming settings.