Smart pumps can prevent dangerous drug errors

If there were a way you could substantially reduce the risk of infusion pump errors in your ED, would you do so? Surprisingly, although new technology is available that can prevent adverse outcomes from misprogrammed infusion pumps; only a small number of EDs are using this technology.

Cost is one of the biggest obstacles, says Hedy Cohen, RN, BSN, MS, vice president of the Huntingdon Valley, PA-based Institute for Safe Medication Practices. The initial investment is estimated by the Washington, DC-based Health Care Advisory Board at $1 million for a facility.1 Also, you must take time to decide which pump to buy, address programming issues such as building the drug library based on the hospital’s formulary and drug protocols, and educate staff on its use, she notes.

"You don’t take it off the shelf and start using it," says Cohen.

When Spartanburg (SC) Regional Healthcare System implemented the Guardrails Safety Software Suite, a group of ED nurses attended off-site training classes held by the pump’s manufacturer, San Diego-based Alaris Medical Systems, says Becky Williams, RN, an ED nurse at the hospital. (See resources below to obtain more information on smart pumps.) They then taught the rest of the ED staff how to use them, Williams says.  

Money vs. safety

Most EDs don’t have a lot of money available to purchase new technology, "but you have to consider safety when making purchasing decisions," Cohen says. Also, EDs may have contracts in place for existing pumps and may be unwilling to take a financial hit to switch to smart pumps, Cohen adds. Fewer than 5% of EDs currently use smart pumps, she estimates.

It took three decades for infusion pumps with free-flow protection to be standard in EDs, even after serious adverse outcomes and patient deaths were linked to these as early as the 1970s, says Cohen. "There was a simple solution, but it cost money, and here we are at the same crossroads again," she says. "But I don’t think it will take 30 years to switch to smart pumps, because of public pressure to improve safety." Cohen expects the use of smart pumps in EDs to greatly increase in the next two to three years.

"The pumps save time and make patients safer by reducing the risk of human error," says Amber L. Egyud, RN, director of emergency services at Ohio Valley General Hospital in McKees Rocks, PA. "ED staff nurses find the pumps to be user-friendly and extremely efficient."

Shortly after smart pumps were implemented at Ohio Valley, a nurse incorrectly calculated the dosage of nesiritide for a congestive heart failure patient. This potentially devastating error never occurred, because the smart pump alerted the nurse that the dosage was incorrect, says Egyud. "The nurse then let the smart pump do the work, and the medication was administered at the correct drip rate," she says. "Death could have resulted because the dose was calculated by the nurse at double the amount that it should have been."

When seconds count, such as when a patient has a blood pressure of 60/40 and you need to administer intravenous dopamine immediately, the smart pump can potentially save a patient’s life, says Williams. "The pump already has the drug option programmed and will calculate the amount using the patient’s weight," she says.

The pumps eliminate the time spent by staff calculating drip rates, which saves about five to 10 minutes per patient, explains Egyud. "This could be life-saving when you are dealing with a critical patient who is having an acute myocardial infarction or a neurologic injury such as a stroke or aneurysm," she says.

"If it is a high-risk medication such as [eptifibatide], a screen will come up alerting staff to monitor coagulation studies and hematocrit and hemoglobin for bleeding," says Egyud.

All the ED nurse needs to do is choose the right medication and concentration, then enter the patient’s weight, says Egyud. "The smart pump does the rest."

However, that doesn’t mean that your clinical judgment isn’t important, stresses Cohen. "We don’t want anybody to think that this pump is going to take away a nurse’s cognitive thought process," she says. Think of it as a tool, like a seatbelt or airbag, Cohen says. "And as we go down the road, I think we will find it’s an invaluable tool," she adds. 


1. Health Care Advisory Board. Reducing Adverse Drug Events: Costs, Benefits and Challenges of CPOE. First Consulting Group, Washington, DC; 2003.


For more information about use of smart pumps in the ED, contact:

  • Hedy Cohen, RN, BSN, MS, Vice President, Institute for Safe Medication Practices, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006. Telephone: (215) 947-7797. Fax: (215) 914-1492. E-mail.
  • Amber L. Egyud, RN, Director, Emergency Services, Ohio Valley General Hospital, 25 Heckel Road, McKees Rocks, PA 15136-1694. Telephone: (412) 777-6577. E-mail:
  • Becky Williams, RN, Emergency Department, Spartanburg Regional Healthcare System, 101 E. Wood St., Spartanburg, SC 29303. Telephone: (864) 560-6000. Fax: (864) 560-6558. E-mail:

For information on the Guardrails Safety Software Suite for The Medley Medication Safety System, contact:

For information on the Outlook Safety Infusion System, contact:

For information on Colleague CX infusion pumps with the Guardian feature, contact:

  • Baxter International, One Baxter Parkway, Deerfield, IL 60015. Telephone: (800) 422-9837 or (847) 948-2000. Fax: (888) 229-0020 or (847) 946-2016. E-mail: Web: