Table 4 Resolutions for the barriers to rate control of intravenous (IV) medications suggested by the included studies
Categories by NCC MERPa | Resolutions for the barriers to rate control of IV medications |
|---|---|
Human factors | - Appropriate monitoring and equipment check of the HCPs in the anesthetic department [20] - Supervision by a specialist and skilled assistance in the anesthetic department [20] - Rising anesthetists’ awareness of the continued integrity of vascular access systems [21] - Checking correct tip placement and labels of lines by the HCPs in the anesthetic department [21] - Establishing a stronger pharmacology knowledge base for nursing students and nurses [38] - Raising HCPs’ awareness to ensure appropriate setup, maintenance, and integration of smart pumps [35] |
Design | - Supply products with a high safety standard by the manufacturers [23] - Short-term and long-term software and hardware changes to address failure modes with the new infusion pump [24] - The use of the appropriate site-specific drug profile through the new infusion pump [24] - Integration with barcoding and CPOE with the smart pump [26] - Incorporating real-time vital signs and laboratory data with the smart pump [26] - Automating monitoring and titration tasks with the smart pump [26] - Careful development and testing of smart pumps [26] - Drug dictionary in smart pumps reviewed by interdisciplinary committee members routinely and maintained up-to-date, evidence-based practice [30] - Assessing smart pump logs by the biomedical engineering department [30] - Investigating either physical or mechanical issues or human errors related to smart pumps by the biomedical engineering department [30] - Using smart pumps as part of an integrated system with barcode scanning and interfacing with electronic systems and reducing reliance on gravity feed [33] |
Contributing factors (system related) | - Coordinated approach from practitioners, regulators, and the pharmaceutical industry [23] - Training for end users of the new infusion pump [24] - Healthcare FMEA between multiple institutions for discussion of best practices among pediatric oncology centers [25] - Different safety systems tailored for outpatient and inpatient chemotherapy settings [25] - Increased communication between adult and pediatric chemotherapy delivery systems to prevent similar errors from occurring [25] - A multidisciplinary approach that involves a change in hospital culture [28] - Collaboration with pharmacists to implement evidence-based interventions [28] - Increased training and supervision of new nurse graduates [40] - More obstetricians and nurses during the night shifts [2] - Improving nurses’ working procedures and implementing a clinical decision support tool that generates recommendations about adequate infusion rates [29] - Implementation of BCMA and e-MAR [29] - Integrated systems that are successfully implemented and utilized to get the full benefits of the safety system [30] - Reviewing reports related to smart pumps by the patient safety committee [30] - Hospital leadership working with a smart pump vendor to improve their products [30] - Changing work practices (taking more time for drug administration, using short infusions to administer some medication) [37] - Promoting a safety culture around medication, including drug preparation and administration [37] - Implementation of electronic prescribing systems, barcode medication administration, and pharmacist-led training program [37] - Multidisciplinary team with strong leadership endorsed by hospital managers for successful quality improvement [37] - Interventions that are more automated and less reliant on human memory and vigilance to prevent interruption-related errors [31] - Providing standard work conditions, such as a standard ratio of nurses to patients by hospital managers [38] - Improving the relationship between the nurses and physicians by hospital managers [38] - Facilitating the 24-h presence of clinical pharmacology experts for responding to medication questions by hospital managers [38] - Interoperability between currently implemented healthcare information technologies [32] - Implementation of point and calling methods and increasing compliance [39] - Development and implementation of the intervention bundle developed incorporating the expertise of the multidisciplinary research team [34] - A multidisciplinary approach when evaluating and procuring infusion pump [35] - A process to regularly collect safety-related-data, review the data, and create solutions to address pump-related concerns [35] - A multidisciplinary approach to identify and implement effective interventions to prevent medication-related harm in children [36] |