Are smart pumps smart?

[tokmom, BSN, RN]

I just found out that I have been volunteered to be on the new smart pump committee. I have never used them. Can someone fill me in on how they are 'smart?' Let's say I have a Heparin drip. What would it tell me?

Pro's and cons?

Thanks!

[Redhead28]

If you actually take the time to program the drug and patient weight it would tell you if you are in a safe range for this medication. The problem with the "smart" part of the pump is, you can override the programing and just start the infusion without entering the drug. Like any other technology the information is still put in by a human so a mistake can be made by the person entering the information or by them overriding the pump's smart feature.

If your facility does not need new pumps the "old" plums work just fine without the smart capability.

[fiveofpeep]

oh and an important safety concern is the concentration

make sure the nurse plugs in the concentration correctly! I have found meds incorrectly programmed countless times so that the patient is really getting more or less than you think they are because you programmed propofol as 100mg/ml instead of 10mg/ml for example.

huge errors can be made if you dont input the conc. in correctly.

[Rabid Response]

I have found that the "smart" pumps that we use in my ICU are only as smart as the nurse who sets them up.

[StayLost, BSN, RN]

One of the greatest benefits is if you are titrating a drug that is measured in, lets say mcg/kg/min, it will do all the calculations for you. You can titrate by either ml/hr or mcg/kg/min instead of having to do the math.

As for the previous poster stated, I haven't encountered that problem being that almost all of our medications have standard concentrations, which are the only ones programed. So, as long as you click on Propofol correctly you are pretty set. The only thing I can think of is if a special higher concentration bag is ordered to reduce the amount of fluid for a CHF or Renal pt, which wouldnt have a preset med and we would use the manual mode. And just like emar, people learn how to bypass the safety software.

[HiHoCherry-O]

I actually really like the smart pumps. The drug library is "tailored" to the unit i.e. ICU drug library, ED drug library, Med-Surg etc which is managed by our pharmacy. Pharmacy can add drugs if we find we are using a specific one a lot; they can also set it up so that the most important or frequently used drugs are at the top of the drug list. I work in the ICU so we have one of the most extensive drug libraries. I also have the option of choosing the concentration used i.e. double strength etc. It also has selections based on peripheral admin vs central line admin.

Cons: it is true that the pump is only as smart as the person who uses it. Our assistant manager actually goes around periodically to check that the meds infusing are actually set up via the library. There are some instances in which we program the pump not using the library such as when we need to give an amiodarone bolus (even though it is in the drug library, we typically give it faster than the library is set up to do). Sometimes the tubing is touchy and will alarm "occlusion" even though there is not one. You just have to play with the plumset a little and it will work again.

It is easy to become complacent. Just be diligent about double checks, making sure the correct medication and strength was chosen.

[adiplomadinosaur]

For the most part, they are only as good as the programmer. The ones we use, have more bells and alarms to answer and the tubings are more pliable causing obstruction alarms. We also have a problem with them communicating with our pharmacy.

[BittyBabyGrower, MSN, RN]

Our pharmacy worked with the company and had all our med info put in (concentrations, etc). We still have to have a second person verify what we put into the pump though. I love that you can titrate quickly, esp drips with odd concentrations. It alerts you if the dose is out of range.

[classicdame, MSN, EdD]

our nursing staff and pharmacy worked with the vendor to create all sorts of parameters for pumps being used in various depts (like ED vs Nursery). There is more to it than drugs - volume and pressure for instance.

We have a policy that the nurse is NOT to use the generic infusion option. If they do, and there is a negative outcome, they are on their own.

Any machine is dependent upon the human factor. Better make a point of learning to use it to your own benefit.

[fiveofpeep]

I think it would be great if you had to double check when you input drugs/conc. We have had mistakes between dopamine and dobutamine for example

[iNurseUK, RN]

These devices are only ever as smart as the person using 'em.

Now my Mac (a nice MacPro) with bells, whistles and a 50MB Broadband connection is smarter than I am (especially if I have been on nights) it knows the news, the time, the date and what the weather is like in the Outer Hebrides.

Would I let it nurse my patients?.....erm well no. It's a machine. A SMART machine granted but like any other machine it can only do what a human directs it to do.

Nursing has become increasingly reliant on technology. It sometimes fails or malfunctions and it needs to be monitored. A case at my own hospital recently had an (admittedly old) volumetric infusion pump delivering a chemo drug at three times the programmed rate. Luckily someone noticed and the pump was changed for a newer one before any harm was done.

Technology is great. I love my own computer and all the devices that make life easier at work but you gotta watch they don't bite ya on the butt.

[bobber]

true story: Walked into a room where a triple smart pump went into failure all at once. No big deal? Well the levophed was going through it and the time it took to unload and locate a new pump put the patient at risk. I saw the sbp go from 90 when we entered the room to 50 when the iv was resumed. smart pumps scare me but what can we do?