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Is Perception Reality? Nurses’ Expectations of Smart Pump-EHR Interoperability

Abstract: Voted Top Scoring Poster by ANIA, this survey based study explored the perceptions of medical/surgical and intensive care unit nurses throughout a smart pump-EHR interoperability implementation. While nurses thought interoperability improved safety, was easy to learn and improved programming time, expectations of time/efficiency and programming confidence decreased. This study underscored the impact of interoperability on clinical workflows and the need for continued support long after implementation. The organization’s nurse informaticist is critical to help drive change, manage expectations and measure performance, enlisting super users to address workflow issues in real-time and build confidence.

Reference: Johnston S, Schuster C, Vitoux RR, Bartos D, Curtin CR. Is perception reality? Nurses’ expectations of smart pump-EHR interoperability. Research poster presentation for the American Nursing Informatics Association, Louisville, KY, May 2023.

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Outcomes from a Smart Infusion Pump and Electronic Health Record Integration: Improved Patient Safety, Nursing Efficiency and Return on Investment

Abstract:  A four-time Magnet hospital successfully integrated Space® infusion pumps and the electronic medical record, documenting a 27% decrease in infusion medication events, sustained drug library compliance >95% and a low alert override rate of <5%. Smart pump auto-programming reduced pump programming times by as much as 77% and integration with RTLS reduced staff time spent on asset management by 49%. Improved documentation resulted in a 25% increase in captured outpatient infusion charges which, if annualized, could equal $957,696 in increased gross charges. 

Reference:  Bartos D, Vitoux RR, Schuster C, Curtin CR. Outcomes from a smart infusion pump and electronic health record integration: Improved patient safety, nursing efficiency and return on investment. Journal of Informatics Nursing, 2022; 7(3): 13-19.

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Improving Smart Pump Drug Library Upload Success Using a Best Practice Approach

Abstract:  Steward Health implemented a Drug Library Best Practice approach, including establishment of an enterprise multidisciplinary pump subcommittee, standardization of the infusion drug library across a 34-hospital system and designation of facility pump update safety leads. Data were collected after a baseline drug library push and following implementation of the best practice approach at three hospitals using Infusomat® Space® Large Volume Pump. DoseTrac® Infusion Management Software was used to deploy the drug library, monitor distribution in real time, and track pump drug library upload success – which included 90% of pumps receiving the updated library in three hours and 100% in 10 days. Both technology and practice played a role in this success. 

Reference: LeFever NC, Martin E, Small J, Drelick J, Vitoux RR. Improving smart pump drug library upload success using a best practice approach. Research poster presentation for the IHI Forum, Orlando, FL, December 2022.

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Impact of Smart Pump Interoperability: Reducing Alerts and Improving Safety

Abstract:  A hospital wide EMR Integration with Space® infusion pumps led to measurable, data-based improvements in IV medication safety. Huntington Beach Hospital (HBH) demonstrated these improvements by measuring drug library compliance and alert override data pre and post-integration. HBH increased their already impressive 96% drug library compliance to 98% post integration compared to national average of 81%, and reduced their alert override frequency by 92%, achieving a 9% override response rate compared to national average of 76%. In addition, 1 year post integration there were no reported smart pump related errors.

Reference: Wong S, Maier J, Ahdab A, Cody P, Vitoux R, Johnston S. Impact of smart pump interoperability: Reducing alerts and improving safety. Poster for the American Nursing Informatics Association 2021.

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Smart Pumps. Positive Outcomes.

Abstract:  A retrospective review of data from over 11,000 Space® pumps found an average drug library compliance of 96% and a 2% of infusion time in alarms state. The unique insight of B. Braun’s DoseTrac Analysis Service has helped customers identify high risk practices and optimize drug library compliance. In one facility, drug library changes, combined with process improvements led to a 92% reduction in overrides and sustained a drug library compliance of 97-98%.

Reference: B. Braun Medical Inc. Data on File.

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Studying Air-in-Line Alarms: Fewer Air-in-Line Alarms on the B. Braun Infusomat® Space® Large Volume Pump.

Abstract:  Based on an internal analysis to determine the frequency and rate of air-in-line (AIL) alarms, the innovative Infusomat® Space pump exhibited less than 4 AIL alarms per pump per month and a 7% average AIL rate in 4 acute care hospitals across the U.S. Compared to a competitive pump in one hospital, the Infusomat Space is associated with 67% fewer AIL alarms.

Reference: B. Braun Medical Inc. Data on File. 2019.

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Frequency and Duration of Infusion Pump Alarms: Establishing National Benchmarks

Abstract:  Voted Best Research Article of 2018 by the BI&T Editorial Board. Baseline of infusion pump alarm types, frequencies and duration were established based on data across 29 hospitals using 11,410 B. Braun infusion pumps. While there were 987,240 alarms associated with 568,164 deliveries, pump alarms accounted for only 0.8% of infusion time with an average of 1.74 alarms per delivery and 0.18 alarms per hour; with 60% addressed within 0:01:08. Top alarms by alarm type, care unit, drug name and day of week are discussed.

Reference: Vitoux RR, Schuster C, Glover KR, Dekker M. Frequency and duration of infusion pump alarms: Establishing national benchmarks.  Biomed Instrum Technol, Nov/Dec 2018; 52(6): 433-411.

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Methodology for Ensuring Accuracy and Validity of Infusion Pump Alarm Data

Abstract: This article explains the complexities of collating infusion pump alarm data across multiple hospital datasets and describes a research‐based process to maximize the accuracy and validity of the data. Finding no comparable process in the literature, the researchers created and tested a validation methodology to ensure accurate and valid reporting of infusion alarm data metrics and benchmarks.

Reference: Schuster C, Vitoux R. Methodology for Ensuring Accuracy and Validity of Infusion Pump Alarm Data. Biomed Instrum Technol, 2018; 52(3): 192‐198.

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Perceptions of Infusion Pump Alarms: Insights Gained from Critical Care Nurses

Abstract: The authors developed and used an infusion pump‐specific alarm survey to measure nurse perceptions of pump alarms and compared the results with those reported by studies that measured clinical alarms in general. The findings indicated that nurses overwhelmingly agree that infusion pump nuisance alarms occur frequently and disrupt patient care, but nurses’ perceptions of pump alarms are different from those previously reported for clinical alarms in general.

Reference: Vitoux R, Schuster C, Glover G. Perceptions of infusion pump alarms: Insights gained from critical care nurses. J Infus Nurs, 2018; 41(5): 309‐318.

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Achieving Outcomes with Innovative Smart Pump Technology: Partnership, Planning and Quality Improvement

Abstract: A 5‐time designated Magnet academic medical center partnered with B.Braun Medical to successfully integrate 1327 smart pumps across 45 departments in an aggressive 3‐month timeline. Quality improvement outcomes included 100% drug library compliance across all 6 intensive care units, a decrease in pump alert rate from 4.18% to 0.79% and a decrease in pump programming correction rate from 0.36% to 0.06%.

Reference: Lehr J, Vitoux RR, Zavotsky KE, Pontieri‐Lewis V, Colineri L. Achieving outcomes with innovative smart pump technology: Partnership, planning and quality improvement. J Nsg Care Qual, 2018; April 9 [Epub].

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Types and Frequency of Infusion Pump Alarms: Protocol for a Retrospective Data Analysis

Abstract: Since research related to the types and frequencies of actionable infusion pump alarms remains largely unexplored, this study protocol is designed to provide new insights regarding the types and frequency of infusion pump alarms. Infusion pump alarm data collected and analyzed in this study will be used to help establish a baseline of infusion pump alarm types and relative frequencies.

Reference: Glover KR, Vitoux RR, Schuster C, Curtin CR. Types and frequency of infusion pump alarms: Protocol for a retrospective data analysis. JMIR Res Protoc, 2018; 7(6):e10446

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Collaboration Fuels Success of Infusion Management Interoperability Initiative

Abstract: Improved patient safety and documentation accuracy were achieved at this medical center through smart pump‐EMR integration and process improvement tools, including B.Braun’s DoseTrac real‐time dashboard, reporting and analysis service. Outcomes included > 90% medication scanning compliance, 65% improvement in pump association with the patient, only 1% dose correction incidence and a 50% decrease in infusion errors.

Reference: Razanno L, Box A, Corrick K, McDowell J, Vitoux R. Collaboration fuels success of infusion management interoperability initiative. Biomed Instrum Technol, 2018; 52(1): 38‐43.

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The Crucial Link in Successful Smart Pump Adoption: The Critical Care Nurse

Abstract: Successful adoption of smart pump and related technologies requires ongoing communication, collaboration and partnership to achieve sustainable impact on patient safety outcomes. The authors discuss the phases of smart pump adoption and the role of the critical care nurse in helping to achieve patient safety outcomes and zero IV pump‐related errors.

Reference: Kavanagh T, Tse E, Vitoux R. The crucial link in successful smart pump adoption: The critical care nurse. Can J Crit Care Nurs, 2017; 28(4): 29‐34.

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Hardening Infusion Pump Communication Software for Medical Device Cyber Security

Abstract: A proactive approach is necessary to identify ways that device manufacturers can improve cybersecurity to prevent access to devices and system software. The approach described in this article can be used to identify, neutralize, and lock out unauthorized access, thereby permitting only approved access. This approach includes the following:

  • Hardening to conduct a device cybersecurity risk assessment
  • Researching and monitoring the NIST common vulnerabilities and exposures list to learn about cyber security issues and threats in the OS and applications
  • Configuring system software to manage access for software processes
  • Disabling unused software services and communication ports

Reference: Smigielski R. Hardening infusion pump communication software for medical device cybersecurity. Horizons, 2017; 51(s6): 46‐51.

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Asset Management Case Study

Abstract: McLaren Flint replaced their infusion pumps with B. Braun Space Infusomat pumps and implemented an Infusion pump to RTLS integration in 2017. Learn how McLaren Flint was able to reduce its pump fleet by 33%, increase infusion pump utilization to approximately 80%, and keep a promise to nursing that there would always be a pump available when they needed it. McLaren saved $1 million in avoided pump purchases and gained an RTLS that will be further leveraged for patient flow, staff assistance, and process improvement.

Reference: Midmark-Versus RTLS Case, 2017

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Prevalence and Characteristics of Infusion Pump Alarms in the ICU: A Retrospective Data Analysis

Abstract: Infusion pump alarm data was collected from 9151 pumps used in 55 ICUs across the U.S. Of 291,091 infusion deliveries, there were an average of 2.3 alarms per delivery, an average alarm duration of 1 min. 25 sec., and pumps were in an alarm state only 0.3% of the total infusion time. Alarm frequency was also quantified by alarm type, type of infusion and day of week. 

Reference: Vitoux R, Dekker M, Lehr J, Schuster C, Banko D, Kavanagh T. Prevalence and characteristics of infusion pump alarms in the ICU. Research poster presentation at the AACN NTI, Houston TX, May 2017. 

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Passion for Safety Underpins Healthcare System's Infusion Pump Upgrade

Abstract:  Since 2011, Western Maryland Regional Medical Center has shown continued success in improving patient safety, alarm systems and clinical practice, including sustained drug library compliance rates of 98-100% over 5 years. The Medical Center implemented B.Braun smart pumps with patient ID scan and EMR integration capacity, along with DoseTrac real-time monitoring of infusions from nurses' stations and pharmacy, weekly audits, and analytic services to optimize compliance and improve practice.

Reference: Vockley M. Passion for safety underpins healthcare system’s infusion pump upgrade. 2017; BI&T, Jan/Feb: 46-50. 

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Establishing Benchmarks and Identifying Opportunities to Reduce Alert Fatigue Associated with Smart Infusion Pumps

Abstract:  Alert analysis of over 4 million infusion therapies across 50 U.S. hospitals found only 1% of therapies were associated with dosing alerts, with only a 0.1% correction frequency. This low correction rate indicates a low incidence of programming error associated with single channel pumps with non-numeric keypads. Alert analysis with drug library adjustments and education has helped hospitals achieve up to 99% reduction in alerts, up to 100% drug library use, and a significant reduction in infusion related medication errors.

Reference: Vitoux R, Chang H, Lehr J. Establishing benchmarks and identifying opportunities to reduce alert fatigue associated with smart infusion pumps.  Poster presentation at the American Society of Health-System Pharmacists Midyear Clinical Meeting, Las Vegas NV, December 2015.

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Improve Infusion Safety and Reduce Alarm Fatigue in the ICU

Abstract: Over a 3 year study period, Mount Sinai Beth Israel health system steadily reduced their smart pump drug library alerts using B. Braun’s DoseTrac Infusion Management Software and Analytic Service. Alerts were reduced 70% overall in 2013, and an additional 58% in 2014 across the 4 hospitals.

Reference: Sullivan C. Improve infusion safety and reduce alarm fatigue in the ICU. Presentation at the American Association of Critical-Care Nurse National Teaching Institute, Denver, CO.

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Smart Pump Wireless Technology: An IQ Boost for the Pump

Abstract: Mount Sinai Beth Israel Hospital used B.Braun smart pumps with DoseTrac real time monitoring and analytics to improve patient safety, reduce alerts by 45-88%, improve practice and achieve 100% drug library utilization in ICU.

Reference: Sullivan C, Palillo E. Smart pump wireless technology: An IQ boost for the pump.  Poster presentation at the American Association of Critical-Care Nurses National Teaching Institute Annual Conference, Denver CO, May 2014.

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Use of "Smart Pumps" In a Cardiac Surgery Intensive Care Unit Improves Patient Safety and Reduces Alerts

Abstract: Beth Israel Hospital:  Wireless integration of B.Braun smart pumps with DoseTrac  provided real time monitoring and retrospective reporting on dosing trends and practices in a CSICU. Six month data analysis identified  interventions to reduce alerts and resulted in 45-88% alert reduction across 5 targeted infusions.

Reference: Palillo E, Sullivan C, Geller CM. Use of smart pumps in a cardiac surgery intensive care unit improves patient safety and reduces alerts. Poster Presentation at the FACTS-Care Cardiovascular-Thoracic Critical Care Annual Conference, Washington, D.C.,  2013.

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Forget Smart Phones- What You Need Are Smart Pumps

Abstract: Beth Israel Hospital:  Major NYC medical center selected B.Braun smart pumps for safety features including DoseTrac real time monitoring and wireless reporting software, ease of use and single channel device.  Achieved 100% drug library utilization in Critical Care and significant reduction in alerts through dosing limit modifications, education and weekly DoseTrac reports.

Reference: Sullivan C. Forget smart phones – What you need are smart pumps! Presentation at the American Association of Critical-Care Nurse National Teaching Institute, Boston, MA, 2013.

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Smart Pumps: Achieving 100% Drug Library Compliance and Averting Medication Errors

Abstract: B. Braun smart pump technology integration with DoseTrac real time monitoring and retrospective reports resulted in improved medication safety, faster recognition and response to alarms and preventing patient harm. Outcomes included  100% compliance across 4 drug library metrics and 7 ADEs averted in first 3 months of implementation. (presentation)

Reference: Ruhl C, Grogg C. Smart pumps:  Achieving 100% drug library compliance and averting medication errors. Presentation at the American Association of Critical-Care Nurse National Teaching Institute, Boston, MA, 2013.

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Improving Medication Infusion Safety Through Technology and Practice

Abstract: In just 3 years post implementation, Lutheran Medical Center achieved 0 infusion-related medication events using B.Braun smart pumps and DoseTrac Data Analysis Service. Other outcomes included 100% compliance with dose mode (drug library), 100% weight-based ordering practice, 0 alerts with heparin or insulin and low incidence of programming errors (0.5%).

Reference: Raso R, Velletri J, DiCrescento S.  Improving medication infusion safety through technology and practice. Presentation at the American Organization of Nurse Executives 42nd Annual Conference, San Antonio, TX, 2009.

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B. Braun's Outlook 400ES

Abstract: University of Illinois Medical Center used B. Braun DoseTrac alert reports to identify potential medication errors and make changes to drug limits, achieving near 100% compliance with one of the drug libraries in the ICU areas.

Reference: Garofalo J. Product spotlight: B.Braun’s Outlook 400ES. Pharmacy Purchasing & Products, 2009;6(11).

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Making the Most of Data for Patient Safety

Abstract: Within the first year of implementing B.Braun smart pumps and DoseTrac Data Analysis Service, Lutheran Medical Center experienced a very low incidence of manual programming errors and achieved a 57% decrease in infusion related medication events.

Reference: Raso R, Velletri J, DiCrescento S. Making the most of data for patient safety. Patient Safety & Quality Healthcare Magazine, May/June 2007; 32-35.

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