Making Patient Safety a Global Reality

Written By: Paula Bowman, RN

As Americans, we really are so fortunate to have leading edge medical technologies, medicines and research all aimed at making healthcare safer, effective, and hopefully more efficient. Of course, healthy economies allow for these advancements to become reality in our healthcare systems. Although our healthcare system is not without flaws, I think we can all agree that our healthcare, technologies, and medicines in the U.S. are more advanced than in many countries. This disparity is evident in the work that our International Sales Team is doing in the Caribbean.

Many of the Caribbean hospitals are under-funded, over crowded, and about 15-20 years behind in medical technologies compared to the U.S. and other progressive countries. They simply do not have the funds to purchase new, safety technologies such as Smart Infusion Pumps. Luckily, Med One Group offers affordable and flexible acquisition models to enable hospitals to bring Smart Pumps into their hospitals and advance patient safety into these markets.

Recently while working with a potential customer, our clinical team discovered an opportunity to promote clinical best practice, which reduced risks to the patient, caregivers, and hospital, as well as improved operational efficiencies and reduced cost. While working with the customer for an on-patient smart infusion system evaluation, we discovered that the hospital was still using Rule of Six for ordering IV medication drips in the NICU. The Rule of Six practice is a physician ordering practice of using patient specific concentration to enable a standardized rate of infusion. Each concentration is specific to the patient essentially enabling backing into a standardized infusion rate. There are more errors associated with calculating patient specific concentrations. Rule of Six is an approximation so the results can be inaccurate.

Compounding medication syringes in the pharmacy helps to reduce risk of contaminated infusions. In the mid 2000’s, because of the numerous medication errors associated with Rule of Six, The Joint Commission established a National Patient Safety Goal to move away from the Rule of Six practice and towards Standard Concentrations. The deadline to comply with this goal was December 31, 2008. Although non-US countries are not subject to The Joint Commission, many Caribbean hospitals do follow the clinical best practices promoted by The Joint Commission. Sometimes, technology drives practice or limits practice. Before smart pump technology, the Rule of Six practice was more common because “dumb pumps” only allowed for programming a rate such as mL/hr. Infusion ordering practices were somewhat driven by the limitation of the available infusion pump technology. The thought was having a standard flow rate would be safer; however, data suggest otherwise. Like many things, some practices stay in place because “that’s the way we’ve always done it” – a very dangerous place to remain - instead of looking at how to leverage new technologies to drive better and safer practices.

Evidence shows that when using standardized concentrations, there are fewer errors in calculating and compounding the medication as well as fewer errors in calculating the infusion rate that will be programmed into the infusion pump. Standard concentrations make pharmacy preparations more accurate, lower pharmacy cost and allow for recording doses in units of measure like milligrams (mg). Having standardized drug concentrations allows for the rate of the infusion to be varied to administer the dose of medication. Therefore, the best practice today is to use standard concentrations for infusions.

Utilizing dose error reduction software in smart infusion pumps requires standard infusion concentrations. Smart pump technology enables clinicians to program the medication dose based on a standard concentration. When the dose is entered into the pump, the rate of the infusion is automatically calculated by the pump based on the dose entered, the concentration, and often times, patient weight. Smart pump technologies perform safety checks on concentrations, the dose and the rate thereby increasing infusion safety significantly. Essentially, the smart pump becomes a third or fourth check in the medication administration process. The Alaris System dose error reduction software, called Guardrails, not only has dose and rate checking capabilities but also limits around the concentrations making it the most sophisticated safety infusion system on the market.

In the case of the on-patient evaluation, the Med One Clinician identified that the customized drug library with standard concentrations did not match physician ordering, medication compounding or infusion practices; therefore, the Med One Clinician called a time out and postponed the evaluation. The Director of Pharmacy, Clinical Pharmacist, Nursing Supervisor, and Neonatologist all gathered to discuss their infusion practices for the first time. The neonatologists and pharmacy agreed that standard concentrations were what they need to move to and ordering in dose versus volume was agreed to. Furthermore, they agreed to move their syringe medication compounding to the pharmacy to be done by the pharmacists versus at the bedside by the nurses. Overall, these practice changes will improve care and patient safety. They will be less prone to harmful medication calculation errors. Compounding medication syringes in the pharmacy helps to reduce risk of contaminated infusions, and overall, uses less drug thereby resulting in cost savings for the pharmacy and hospital. After the hospital executes these changes, we’ll be sure to provide an update.

Although we might have delayed our full evaluation and closing our deal, what is more important is that Med One Group is helping this hospital improve clinical best practice, reduce potential for medication errors in this fragile NICU population, and helping to advance patient safety in a part of our world that has been financially handicapped to facilitate change. We are proud to be making patient safety a global reality.