Survey Results: Smart Pump Data Analytics Pump Metrics that Should Be Monitored to Improve Safety
Between November 2017 and March 2018, ISMP conducted three surveys to learn about current practices with smart infusion pumps that have dose error-reduction software (DERS). Smart pumps can vastly improve medication safety by providing customizable libraries with dose limits and administration rates specific to medications and care areas. When the library is engaged, alerts can be generated when infusions are programmed outside these preset limits. The results of the first two surveys were published in our April 5, 2018 newsletter (Smart pumps in practice: Survey results reveal widespread use, but optimization is challenging). In this newsletter, we report on the results of the third survey, which focused on how pump data is being used to improve compliance and safety. Following the survey results, we offer a short discussion on pump analytics, a description of basic and advanced smart pump metrics to consider for review, and external resources available to assist you with smart pump analytics.
Survey Results
Respondent profile. ISMP thanks the 126 pharmacists (69%), nurses (19%), and others (12%) who completed the survey. Most (95%) respondents work in hospitals of varying bed size, with only 9% from hospitals with fewer than 100 beds, 52% from hospitals with 100-499 beds, and 36% from hospitals with 500 beds or more. Four out of every five respondents (81%) reported that they have direct participation in the review of available data from their organizations’ smart infusion pumps.
Frequency of data review. One in 10 respondents indicated that smart pump data is never analyzed in their organization. For most (60%) of these respondents, no data is available for review; for the others (40%), the data is available but never analyzed. For respondents who analyze pump data (n = 110), 52% review data quarterly and 26% review data monthly. Few respondents fall outside of the previously stated review periods, with only 6% reviewing data more often than monthly, and only 16% reviewing data less often than quarterly.
Resources and time. Almost all respondents (96%) reported that they believe reviewing pump data is essential to quality improvement. However, only about half of all respondents reported that their organization provides dedicated staff (56%) and dedicated time (48%) for reviewing pump data. More than half (59%) of the respondents reported spending less than 2 hours on pump data review each month. Another 34% of the respondents spend between 2-8 hours each month. Only 7% reported spending 9 hours or more on data review each month. Almost half (47%) of all respondents reported participating in a pump data analytics collaborative community or obtaining help from a pump vendor or external company to analyze their pump data.
Focus of analysis. Most organizations (95%) that analyze pump data focus on compliance with engaging the library and DERS. Approximately two-thirds of respondents assess alert frequency (64%) and reported that this is part of a larger alert fatigue reduction initiative (67%) in their organization. Only about half of the respondents analyze the action taken in response to an alert (51%) or use the data to investigate errors and adverse outcomes (48%) or to identify good catches (48%). Additional areas of focus reported in the “Other” category (12%) included interoperability compliance, improving clinical practices, and electronic health record (EHR) and library agreement.
Expertise and tools. Only 22% of respondents are fully confident that their organization has the necessary time, expertise, and tools to fully extract meaningful conclusions from smart pump data. Another 52% feel they are somewhat capable of data analysis. However, more than a quarter (26%) of respondents do not believe they have the requisite skills, tools, or time for meaningful data analysis.
Respondents who review pump data were most confident in their abilities to identify the top 10 medications by alert frequency (77% fully confident) and the number and type of overridden alerts (74% fully confident). They were less confident in their abilities to identify alerts due to programming infusions below minimum concentration limits (59% fully confident) and medications that have a low frequency of use but a high rate of alerts (39% fully confident). Approximately three-quarters of respondents (74%) are unable to identify risky practices associated with smart pump usage, such as unnecessary nurse dilution of products, which results in a nonstandard concentration.
Post-analysis actions. Respondents (83%) who analyze pump data reported that most of what is being learned is being used to update or change the drug library. Only 16% of respondents reported that data analytics has led to educational programs, and only 13% had made updates or changes in policies, procedures, and practices.
Challenges. We received close to 100 comments about the biggest challenges faced with analyzing smart pump data. Most of the challenges were associated with the usefulness of the pump data and the resources and expertise needed to extract and analyze meaningful information. For example, dozens of comments were either about not having enough pump data available for analysis or having too much data available for analysis. Many respondents also noted that the pump data available to them was not linked to individual patients, practitioners, units, or even hospitals if pump data reports were system-wide. Respondents also reported that data on basic infusions was unavailable, or that the analysis of pump data was not being shared with frontline staff. Challenges related to resources often described a lack of time, skill, and interest in pump data analytics, and undefined roles. Many respondents also noted that high compliance rates with engaging the library were misleading because many drugs were not built in the library and were being administered outside of the DERS.
Discussion
Most US hospitals have invested in smart pumps with DERS. This technology has been on the market for more than 15 years; however, its safety benefits are not fully realized. Complacency and a low perception of risk associated with omitting certain drugs and fluids (solutions) from the library, failing to engage the library for available drugs and fluids, and overriding the DERS alerts, has permeated some healthcare facilities.
Smart pumps can capture extensive details about how they are being used and the alerts generated by this technology. For example, most smart pumps can capture the following data about each alert:1
- Facility
- Patient care unit or care profile
- Drug or fluid
- Device identifier
- Infusion type
- Programmed value
- Hard or soft limit
- Above or below a preset limit
- Drug limits
- Action taken in response to an alert
- Library used
- Time stamp
- Times limit (degree to which the programmed value is over/under the library limit)
- Other infusion- and limit-specific data (e.g., diluent volume, volume to be infused, drug amount, infusion rate, infusion duration, concentration)
Understanding, analyzing, and acting on this data is the primary way to maximize the remarkable safety benefits of this technology. Our survey respondents agree. Practically all believe that reviewing pump data is essential to improvement. However, many do not feel they have the dedicated staff, time, expertise, or tools to do this well. Those who review pump data frequently focus on library compliance and have acted on the data by adjusting the drug library and reducing nuisance alerts. While these attributes of pump use are important to safety, there is a wealth of untapped yet meaningful pump data that can be used to further improve medication safety.
Recommendations
To help organizations analyze, understand, and act on their smart pump data, we have provided a list of basic pump metrics that should be monitored at least quarterly by all organizations that use smart infusion pumps (Table 1). For organizations that are already conducting such analyses, we have also provided a list of advanced pump metrics to further improve medication safety (Table 2). We have also included some basic information on where you can find external help with smart pump data analytics.
Metric |
Rationale |
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Compliance with engaging the library (or interoperability between pumps and EHRs), by:
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Alerts, by:
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Action taken in response to an alert:
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Metric |
Rationale |
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Percent of all drugs/fluids available in the drug library (number of drug and fluid types available in the library/total number of drug and fluid types which are orderable in the EHR), by:
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Library updates
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Alerts, by:
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Action taken in response to an alert:
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Investigative reports, for:
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Library limits, compared to:
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External assistance with data analytics. Organizations can seek assistance with smart pump data analytics from external resources. First, different smart pump manufacturers offer data reports and analytic tools that vary in quality, quantity, and price. The organization is expected to conduct the analysis using the data reports provided by the manufacturer along with any available analytic tool. However, all data and tools provided by pump manufacturers are restricted to a single organization, without an opportunity for data sharing and collaborative learning. Contact your pump vendor for more information.
Another option for help with smart pump analytics is through membership in the Regenstrief National Center for Medical Device Informatics (REMEDI) Infusion Pump Collaborative. REMEDI is a vendor-neutral community of practice focused on smart pump technology and infusion therapy safety. REMEDI has compiled a database of more than 36 million alerts and compliance data representing almost 145 million infusions. Members have access to their own data and other hospitals’ data, including drug library details, alert data, and compliance data. REMEDI membership is currently provided at no cost to those willing to share their smart pump data and knowledge.
A final option known to ISMP is Bainbridge Health. Bainbridge Health provides software and clinical support services that can help hospitals achieve their medication safety goals while reducing the burden on employees to conduct pump data analysis. Their automated data analytics is combined with a team of clinicians who provide hospitals with detailed clinical interpretations, recommendations, and supportive benchmarking data to help them maximize their smart pump technology. This more hands-on approach to assistance with data analytics is provided for a fee.
Reference: 1) Catlin AC, Malloy WX, Arthur KJ, et al. Comparative analytics of infusion pump data across multiple hospital systems. Am J Health Syst Pharm. 2015;72(4):317-24.