Real-time infusate verification with smartpumps. How do we get there?

Smartpumps are anything but smart. They provide an extra layer of safety to intravenously administered medications to be sure, but they can only do what we tell them. We build the “drug dictionaries” against which all infusions are measured and we ask those administering the medications to abide by the rules associated with programming and using the pumps. Unfortunately that leaves a lot of room for human error and outright flagrant disregard for processes and procedures. I digress, that’s a different post altogether.

Assuming that the provider responsible for setting up the pump follows the rules, and that the medication is correctly prepared by the pharmacy, then we may assume that the smartpump certainly has the potential to prevent errors that may have otherwise been missed. There are plenty of anecdotal reports out there from hospitals where smartpumps have prevented some pretty significant dosage errors associated with opioids and insulin. Not all these errors would have resulted in patient harm, but it’s eye-opening nonetheless.

However, with all that said a smartpump cannot identify an intravenous (IV) medication incorrectly prepared by the pharmacy; without the rare visual queues from certain medications it’s virtually impossible. While most pharmacies have a proven track record of making perfectly safe IV products, mistakes do happen. And as unfortunate as it may be, some of these errors result in patient harm or even death in the most extreme circumstances. Several systems have been developed for use inside the acute care pharmacy to minimize IV compounding errors including robotic IV preparation systems and products like DoseEdge that use bar-code verification during the compounding process . Considering that intravenous medications are perhaps the most dangerous of all medications, I find the use of these items lacking in most acute care pharmacies. However, even with these systems in place there is nothing outside the pharmacy designed to catch an incorrectly prepared IV infusion.

Earlier this year I blogged about a product called ValiMed. The ValiMed system uses Photoemission Spectroscopy to quickly validate medication admixtures, including controlled substances. Depending on the solution being tested the ValiMed system can perform a comparison in anywhere from 1 second to 1 minute with as little as 0.15mL of fluid. It would be interesting to see a system such as this built directly into a smartpump design. The pump could take a sample of the infusate when the medication is loaded into the pump and compare it to the preprogrammed item selected by the caregiver. The pump would delay the infusion until the results are rendered and the nurse has verified the medication and concentration are accurate. Of course this wouldn’t be ideal in a life or death situation where time is of the essence, but for the average IV infusion a minute or two will make no clinical difference to the patient’s care.  On the contrary that minute or two could potentially stop an error from occurring. So back to my original question, how do we get there? That my friend is the million dollar question.