Product Assessment

By Jason Hess and Stacilee Whiting

Many organizations are eyeing smart pumps as a possible solution to new patient safety mandates and to the ever-increasing burden placed on nurses. But underlying factors regarding the purchase exist, such as finding out what benefits pumps offer and how an organization can make good decisions.

Many organizations are considering smart pump purchases based partially on recommendations from organizations such as the Institute of Medicine (IOM), which encourages smart pumps to resolve high medication errors. In fact, in 2006, the IOM reported, “when all types of errors are taken into account, a hospital patient can expect on average to be subjected to more than one medication error each day.” The report also states “much of the harm is preventable” and suggests that hospitals “make greater use of information technology in prescribing and dispensing medications ... including the adoption of smart infusion pumps.”

In addition, the Joint Commission has defined national patient safety goals to prevent medical errors, including pump-related errors. The national patient safety goals, as defined by the Joint Commission, are a series of specific actions that accredited organizations are expected to take to prevent medical errors. These actions are designed to help avoid the following:

• Patient misidentification
• Miscommunication among caregivers
• Surgery on the wrong body part
• Unsafe use of infusion pumps
• Medication mix-ups
• Problems with equipment alarm systems.

Themes from previously published material suggest that the most serious and life-threatening potential adverse drug events are IV drug-related—a factor that has apparently accelerated the adoption of smart pumps.

Providers indicate that bar-code point-of-care (BPOC) solutions exist today for the “Five Rights” (the right medication, right patient, right dose, right route and the right time)  checking at the bedside when giving oral solid medications, and that progress in truly tying this into the closed-loop process is taking place; but what about similar technology for medication given through IV infusions?

Potential infusion-related errors include wrong drug, wrong patient and wrong dose. Questions have been posed around why more stringent checks aren’t in place for administering infused medications, and why infusion pumps are not tied more to the closed-loop process with data from pumps being sent to nurse documentation systems as electronic medical administrative records. And what about the facilitation of orders being sent directly to individual pumps?

Orem, Utah-based KLAS, a research firm specializing in medical equipment and health care IT, performed a study on smart pumps, vendor and product performance, and providers’ satisfaction with the products.

Finding value

The immediate value of smart pumps is that one can take advantage of the pumps in a stand-alone environment. An organization can preload drug libraries, predefine best practices for each IV infusion, automatically alert a nurse when pump programming is outside of defined limits, and—if using bar coding—automatically identify the medication, its concentration and program the recommended infusion rate. If an organization uses wireless features, dose alert settings can be modified instantly (instead of tracking down each pump and manually uploading changes), and information on how the smart pumps are being used can be tracked with very little effort.

In KLAS’ Smart Pumps study, the most frequently mentioned smart pump benefit that providers report is “reduced errors/patient safety.” Surprisingly, the second most frequent response is “it’s too soon to tell.” This response suggests that there is more here than meets the eye with regard to the successful implementation and use of smart pumps.

One problem is that most organizations do not use wireless networks. Without wireless connectivity, staff must physically locate each pump when data or drug library changes are desired. Thus, many sites have chosen not to perform consistent data pulls or library updates. In addition, while smart pumps can offer much patient safety improvements, some providers say their smart pumps are used simply as “dumb or basic pumps” because the dose error reduction systems could be skipped altogether or turned off, and a nurse could start the infusion in basic mode without relying on the help of the soft and hard limits or drug libraries. This could be another reason some providers say it’s too soon to know if they’ve achieved quantifiable benefits.

Of course, the safe delivery of IV infusion medications also has unique technological challenges. From those who are using smart pumps, reports of missing product functionality include: Wireless connectivity and interfaces to related clinical systems such as pharmacy for orders and medication reconciliation, nursing documentation and automatic updates to the pumps’ drug libraries and bar-code positive identification for nurse, patient and medication. Overall though, 93 percent of providers who have purchased smart pumps say they would buy the products again.

Smart choices

If an organization decides to purchase a smart pump, there are a few important steps to take before making a purchase decision. First, speak to others who have implemented and used smart pumps recently about the cost and length of the implementation, training and if nurses use the “smart” features on the pumps.

Next, review your organization’s primary goals, and determine what issues are most important in a smart pump implementation and long-term use.

Many organizations form a task force to assess these issues and discuss possible product solutions and their anticipated effect on the organization’s priorities. Review contractual and cost issues, your organization’s primary goals, and how each vendor/product fits into your overall goals.

In addition, it’s important to do some detailed research on vendor performance. Companies such as KLAS offer study findings comparing vendors and products on several crucial issues.

For instance, KLAS studied smart pump product and vendor performance on 40 indicators that providers consider important to help with purchase decisions. The findings (see page 39) that may help your organization see how smart pump products and vendors are currently rated by those who use them.

During the Smart Pumps study, KLAS asked participants why they did or did not choose vendors. The resulting win/loss analysis shows that product functionality is the most important factor in a provider’s decision. Next in importance is the prior relationship a provider had with the vendor in question.

Other factors that play a part in purchase decisions are cost-contract, nurse preferences and technology. Organizations are learning that nursing input is essential for making the best product choice and for successful use and implementation.

Product and technology ratings

For the KLAS study, providers rated their smart pump vendor/product on a number of factors, including product and technology issues. The ratings were based on a scale from one to nine, with nine being the highest possible score.

Most vendors scored fairly well in areas related to the product and the attendant technology. System response times appear to be appropriate for nurses’ needs, and the products are reported to work as promoted.

However, it is clear that one vendor fell far short of the average score in all but one indicator. This stresses the importance of evaluating each vendor based on specific factors that are important to the organization and its goals.

Service ratings

Providers also rated their smart pump vendor on specific service factors. The factors included crucial issues such as “real problem resolution” and “quality of implementation.” As with the product-technology scoring, the service ratings were based upon a scale of one to nine, with nine being the highest possible score.

Two vendors received their lowest service score on the issue of addressing production errors quickly. The other two vendors received their lowest service scores for “quality of documentation” and “proactive service.”

These are important issues to consider when evaluating smart pump vendors. The good news is that most vendors scored well on “implementation within budget/cost” and “implementation on time.” In the smart pumps arena, these tend to be less troublesome areas, though they are always important issues to consider.

Success ratings

Products and vendors were also scored on success ratings. Success ratings encompass issues such as whether a vendor lives up to a provider’s expectations and whether the product is worth the effort and the money. As with the previously mentioned ratings, success ratings are based on a scale of one to nine.

While the overall average for success ratings falls short of those for product technology and service ratings, it is still a reasonably high scoring area. However, as always, the vendor an organization chooses makes a large difference.

For instance, in the area of contracting, the scores range from a high of 8.7 (a very high score) to 5.6. Once again, depending upon an organization’s goals, this may be a crucial score and well worth research to find out what other providers have experienced in their contracting process.

In general, it appears that providers aren’t giving rave reviews over categories such as “helps your job performance” or “vendor is improving.”

However, in the case of job performance, it is possible that avoiding errors is hard to quantify and nurses may appreciate help that the respondents didn’t specifically recognize. More studies will be needed to address this issue in the future.

At this point, it is generally acknowledged that smart pumps help decrease medication administration errors.

Business indicators

To help evaluate a vendors’ long-term viability, providers answer 12 yes/no questions concerning business factors such as whether they would purchase the product again or whether they would recommend the product to a colleague.

Interestingly, while the contracting experience was troublesome for some providers, 100 percent felt that their contract was fair and complete. Working with some vendors may require extra attention to the contract, but providers seemed to feel that the end result is good, while others also felt the contracting process was positive.

While the majority of study respondents did not consider their smart pumps vendor to be their best vendor, 69 percent considered the vendor to be their second-best vendor when compared with all other vendors. Another item of interest is that only 9 percent of one vendor’s customers reported that enhancements were released in a timely manner, compared with 100 percent for two other vendors and 67 percent for another.

While the lowest-scoring vendor clearly has some issues, 100 percent of their customers say they were not nickel-and-dimed by the vendor. But priorities must be weighed to determine which issues are of utmost importance to the organization and which vendors deliver best on those issues.

Each vendor shows strengths and weaknesses in the 40 indicators that KLAS studied. Once an organization has determined their top priorities, purchasing decisions can be made based upon the specified priorities and goals.

With due diligence in research, site visits and reaching out to those who have made similar purchase decisions, providers can make the best decision for their organization.  

Jason Hess is the Director of Clinical Ancillary Systems and Stacilee Whiting is the Manager of Corporate Publishing at KLAS Enterprises in Orem, Utah. Health care providers can receive free access to many study findings through KLAS’ web site, which has an online database covering performance scores on hundreds of health care IT and medical equipment products. Visit www.healthcomputing.com to receive a free membership.

This article first appeared in the August 2007 issue of Materials Management in Health Care.

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