Product Design’s Effect on Data Integrity

By Matt Hutchings, senior director, Marketing & Innovation, ICU Medical; part of the HIMSS Interoperability Showcase™ initiative

The HIMSS Interoperability Showcase, part of the HIMSS Global Conference & Exhibition, demonstrates interoperability – the ability for different technology systems to communicate – in real-time with actual products in the marketplace. The following guest post shares the impact seamless data exchange can have on patients, providers and caregivers.

Matt Hutchings

Is the design of your infusion pump affecting the accuracy and integrity of your infusion data?

If it’s interoperable with your electronic health record (EHR), it might be.

Even in a mainstream environment (not interoperable), not all infusion pumps function the same in terms of flow rate and secondary set up. In an environment with IV-EHR interoperability, these issues are amplified, impacting not only medication delivery, but also the accurate documentation of patient data in the EHR. Specifically, the mechanics of how your infusion pump delivers fluid can make a difference in accuracy for both primary and secondary deliveries. And that can make an impact on data integrity.

Flow Rate Accuracy

An infusion pump with a peristaltic pumping mechanism relies on gravity and fluid dynamics for accuracy. Both intake and outlet pressure impact flow rate. Manufacturers of peristaltic pumps specify a certain medication container height that generates a specific intake pressure. These pumps also are designed to estimate a certain downstream pressure, which could be impacted by patient-pump level, flow rates and other factors.

In contrast, infusion pumps with a volumetric pumping mechanism draw fluid directly from the medication container and are not relying on gravity for flow control. These pumps also can account for variations in intake and outlet pressure, making them much less susceptible to variations in flow rate. A variation in flow rate leaves open the potential for inaccurate delivery of infusions.

Secondary Set-up Errors

Secondary infusions have additional needs in order for the infusions to be delivered accurately and on time. A dual channel cassette-based delivery system coupled with a volumetric pumping mechanism does not rely on gravity to draw medications. There’s no need to adjust IV container head height to assure your secondary infusions are delivered properly. This delivery system can even detect upstream occlusions in secondary lines, removing the potential for secondary set up errors.

Secondary lines with peristaltic pumps, however, connect to the primary line above the pump. So, not only is there a height requirement between the medication container and the pump, there’s also a height differential between the primary and secondary containers to ensure fluid is delivered from the secondary rather than the primary container. If the differential is not sufficient, or a proximal occlusion occurs in the secondary line, the pump may begin drawing fluid from the primary bag at the programmed secondary rate. These types of secondary setup errors have been shown to occur in 48 percent of secondary infusions.

Data Integrity

Interoperability between smart infusion pumps and an EHR creates significant safety and efficiency enhancements. With interoperability, you have infusion documentation – which is the automatic transmission of infusion data to the patient’s medical record, enabling more trust in the accuracy and integrity of the data sent to the EHR.

However, when a secondary setup error occurs and a peristaltic pump with IV-EHR interoperability is in use, that pump can’t recognize the error. The infusion documentation shows the secondary infusion delivered as programmed, rather than what has actually occurred. In this instance, you not only face a medication error, but also a documentation error.

With automated infusion documentation, the information displayed in the patient’s record is assumed accurate and timely. When the infusion documentation does not accurately reflect what the pump actually delivered, clinical decision-making can be impacted and potentially lead to adverse events.

Advances in interoperability deliver benefits as well as unintended consequences. Physical product design choices can impact the accuracy and integrity of the delivery system. Utilizing a cassette-based delivery system with a volumetric pumping mechanism might be key to maximizing the impact of an interoperable infusion platform for both primary and secondary deliveries, leading to more confident decision-making while providing the opportunity for safer patient care.

Sponsored content. The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.


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