Authors (including presenting author) :
Lee CC(1), Liu CW(1), Chong CH(2), Kwan CK(1)
Affiliation :
(1) Department of Oncology, United Christian Hospital (2) Pharmacy Department, United Christian Hospital
Introduction :
Administration of systemic anti-cancer treatment requires a high level of concentration and precision to ensure patient safety. Infusion pump alarms alert oncology nurses to address issues during infusion. However, locating the source of an alarm using only auditory sense can lead to alarm fatigue, especially when multiple pumps’ alarm triggered simultaneously. In addition, chemotherapy infusion setup depends on manual input of rate and volume of the infusion by nurses, requiring independent double checks by two nurses to ensure accuracy. This manual process is prone to human error. To address these challenges, an electronic dashboard system integrated with Plum 360 Smart Infusion Pumps was implemented in the Chemotherapy Day Centre (CDC) at UCH.
Objectives :
- To ensure accurate chemotherapy infusion using an electronic smart system - To reduce alarm fatigue for nursing staff - To develop a traceable data base of infusion record for quality assurance
Methodology :
- A multidisciplinary workgroup comprising doctors, nurses and pharmacists was formed to oversee the implementation and monitoring of the smart system. - Dose Error Reduction Software (DERS) was installed in the Plum 360 smart infusion system to prevent medication errors. The system utilizes an electronic drug library with a pre-set volume and rate limits for each chemotherapy regime, minimizing human error. - A central electronic dashboard was installed in the CDC to allow real-time monitoring of infusion process. The dashboard enables nurses to locate alarm sources instantly, reducing alarm fatigue. - A comprehensive training program was conducted for nurses and pharmacists to ensure proper system usage. - Regular maintenance and reviews were conducted to ensure the system’s functionality and reliability. Review on system log can also provide data revealing the number of potential medication incident. - Staff’s satisfaction survey was conducted after 3 months of implementation. Compliance rate was also measured to evaluate staff usage of drug library.
Result & Outcome :
Result & Outcomes
The smart dashboard system has been operational since June 2024.
Key outcomes include:
- Checking of central dashboard allows reduction in nurse round from Q15 minute to Q30 minute (4 rounds to 2 rounds per hour), improved the working efficiency.
- Each round takes 60 steps (2 minutes) in current CDC (84 m2) to ensure infusion pumps’ functionality.
Total time gained = 2 minutes x 2 (2 round saved per hour) x 8 (working hour per day) = 32 minutes per day.
- The estimated time saved in the new CDC (570 m2) is around 217.1 minutes.
570 ÷ 84 x 2 = 13.6 minutes (time consumption per round) x 2 x 8 = 217.1 minutes
- There were 23 times (0.2%) the system alerted nurses for incorrect time setting before proceeding chemotherapy and the nurses adjusted back to correct setting, preventing possible medication error.
- Over 10,000 infusion programs retrieved between June and December 2024.
- Drug library compliance rate is over 90% (indicating high staff adherence to system usage).
- Zero reported medication incidents during the implementation period.
Evaluation and feedback were collected from frontline staffs (n = 22) with 5-point Linkert scale.
- Q1: The dashboard allows you to locate the alarm faster, reducing alarm fatigue. Mean score = 3.863.
- Q2: The system can reduce human error from manual input. Mean score = 3.775.
- Q3: The dashboard system can improve work efficiency of administration of chemo. Mean score = 3.638.
Conclusion
The implementation of the smart infusion pump dashboard system has significantly improved medication safety by preventing human errors, reducing alarm fatigue, and enhancing work efficiency. Future developments, such as auto-programming features that use QR code scanning to set infusion parameters automatically, could further enhance safety and streamline operations.
