Smart pumps: a pathway to better care?

Anna Clark, director of pharmacy at HealthTrust Europe, explains why now is the time for more hospitals to consider the benefits of smart pumps.

After the COVID-19 crisis, many hospitals – both private and public – are seeking ways to streamline their provision of healthcare to minimise waiting times and reduce disruption. As we move away from lockdown and into the next phase of the pandemic, it is vital that the NHS can get elective care operations back up and running to prevent unnecessary deaths and significant financial losses.

It is well known that health secretary Matt Hancock has a strong interest in using technology to help combat unnecessary delays and disruption in the NHS. For example, in early 2019, the Department of Health and Social Care set up NHSX. This division largely focuses on the data side of technology, with an emphasis on data sharing and transparency. Staff in the NHS have frequently flagged that patient data is not shared effectively among doctors and nurses, forcing some to rely on handwritten notes despite other records existing elsewhere. But while the focus of NHSX on data is welcome, it is also important that the NHS and other healthcare providers think about the ‘bricks and mortar’ hospital technology that needs re-examining in the wake of COVID-19.

Currently, patient safety incidents cost the NHS an estimated £2 billion a year in extra bed days. In addition, hospital-acquired infections add a further £1 billion to these costs. So, what measures can healthcare providers like the NHS take to reduce such incidents?

One example would be to facilitate the widespread use of smart pumps. Unlike regular infusion pumps, smart pumps are embedded with software aimed at reducing drug dosing errors through the presence and use of something known as a ‘drug library’. These drug libraries are filled with the most common types of I.V. medication. The embedded software then programmes intravenous infusion rates against pre-allocated limits for each drug in the drug library, reducing the risk of infusion rates that are too high or too low. While these smart pumps are in use in some parts of the NHS, the use of the technology is not widespread.

To understand the significance of smart pump technology and its potential to maximise patient safety, it is necessary to understand what a ‘traditional’ intravenous pump is and how one is used. This older technology can be found in most medical settings, from hospitals to care homes and, for some people, in their own residence as part of their home care. Other types of pump fall into this broad category, but the key difference is that these pumps do not benefit from the Dose Error Reduction Software (DERS) mentioned earlier. This means that an attempt from a nurse or doctor who, in human error, attempts to administer a dose that is too large will be intercepted, prevented, and flagged by the software.

Several studies, in fields from neonatal to intensive care, have shown the efficacy of smart pumps in maximising patient safety. One of the key challenges for hospital chiefs is recognising the need to embrace the most-up-to-date technology, in recognition of the financial savings that will be made in the long run by preventing unnecessary deaths. In 2018, the Metro newspaper reported that thousands of elderly NHS patients could have died prematurely due to drugs being administered by an out-of-date IV infusion pump. This incident, some doctors said, could have meant an entire day's dose of drugs was being delivered in just one hour to some patients.

Of course, smart pumps do not completely eradicate the chance of unsafe doses of drugs being administered. A 2014 study published in Drug Safety concluded that the smart pumps reduce but do not eliminate programming errors. The main reason for this, the study said, is the high number of overrides. If healthcare providers and innovators alike can work together to boost staff training while also minimising workarounds within the technology itself, it is likely that the risk of administering unsafe doses will continue to go down.

At HealthTrust Europe, all our infusion pumps are equipped with Dose Error Reporting Software (DERS). Our access to market leading suppliers also means that all our infusion pumps allow for automatic calculations of drug dose specific to the patient and auto-programming of parameters, meaning the product is safer and cheaper to run. At HealthTrust Europe we recognise that, in order for healthcare providers to yield the benefits of smart pumps, it is vital that all suppliers are rigorously vetted in terms of their quality and value for money.

Smart pumps have been proven to intercept errors such as the wrong rate, wrong dose, and pump setting errors. They also reduce adverse drug event rates and, importantly, improve cost effectiveness. One study, focusing solely on the NHS, concluded that one-third of infusion pump incidents of ‘at least moderate severity’ would have potentially been prevented by a standalone smart pump.

There are certainly logistical challenges involved in the widespread use of smart pumps across health settings in the UK. However, it is important that, in the wake of COVID-19, hospitals and other care settings can rise to the challenge and recognise that technology – while sometimes a challenge to implement – will ultimately save lives, contribute to further innovation, and huge financial savings.