Daleen Penoyer, PhD, RN, CCRP
Senior Director, Center For Nursing Research
Center for Nursing Research and Advanced Nursing Practice
Orlando Health
Orlando, Florida
Disclosure information not submitted.
Karen Giuliano, PhD,RN,FAAN
Professor
University of Massachusetts, United States
Disclosure information not submitted.
Aurea Middleton, BSN,RN
Clinical Research Coordinator
Orlando Health, United States
Disclosure information not submitted.
Title: Comparison of two IV Smart Pump Systems for Safety and Usability during Actual Clinical Use
INTRODUCTION: Intravenous smart infusion pump systems (IVSP) are used to administer IV medications in acute and critical care settings. While IVSPs have dose-error reduction systems (DERS), serious errors and adverse drug events occur and are a significant patient safety issue with multiple Class I recalls. Common errors occur when programming or bypassing DERS, particularly in critical care, where multiple infusions are common. The two most common IVSP technologies in current use are peristaltic (PERI) head-height differential and cassette-driven pneumatic (PNEU) systems. In 2020, the ISMP recommended that secondary medications be administered via systems not requiring a head-height differential due to higher error rates as compared to cassette systems and issues found with gravity-fed systems. The purpose of this study was to compare safety and usability in operation between these 2 types of IVSPs in clinical use.
Methods: A prospective, comparative, observational and survey study design was conducted using the BD/Alaris™ (PERI) and Ivenix™ (PNEU) IVSPs at a large tertiary hospital. Safety was measured by observing medication errors, secondary medication set-up, DERS compliance, and interruptions. Usability was assessed by the System Usability Scale (SUS), complexity by NASA-TLX, alerts/alarms, programming timing, and a user survey. Hypothesis: PNEU IVSP would have more safety and usability over the PERI.
Results: 158 direct observations of IVSP use with the 2 IVSPs showed 11 (6.9%) errors in the PERI vs 0 in the PNEU IVSP (P=0.018). 9% of infusions had interruptions, 43% resulting in delays or errors. DERS compliance was 76%-95.3% in the PERI vs 99.8% in the PNEU IVSP (n=1779; P< 0.0001). The PERI pump had 0% secondary setup compliance vs 100% with PNEU IVSP. Mean programming time was 44.2 secs in the PERI (n=69) vs 32.3 secs in the PNEU (n=67) IVSP (P < 0.0001). NASA-TLX scores were lower in the PNEU vs PERI (20.06 vs 38.09; P = 0.007) IVSPs and SUS was higher (77.16±13.2 vs 61.68±18; P< 0.004). The PERI IVSP had fewer alarms vs the PNEU pump (139% vs 190%), however the PNEU pump had fewer alarms requiring nursing interventions (41.3% vs 88%). Subject feedback was favorable towards the PNEU pump.
Conclusions: The PNEU IVSP had better safety and usability metrics when compared to the PERI IVSP in clinical use.