Development and Evaluation of an Intravenous Infusion Sequence Annotation System

Area of Science:

• Clinical Informatics
• Pharmacy Practice
• Health Systems Engineering

Background:

• The sequence of intravenous (IV) infusions critically impacts medication efficacy, safety, and healthcare costs.
• Optimizing IV infusion sequencing is a key challenge in hospital pharmacy and nursing practice.
• Manual annotation of IV infusion sequences is time-consuming and prone to errors.

Purpose of the Study:

• To describe and assess a computerized clinical decision support (CDS) annotation system for analyzing IV infusion sequences.
• To evaluate the system's impact on annotation efficiency, cost savings, and resource utilization.
• To transition from manual to automated annotation processes for IV infusions.

Main Methods:

• Development of eight pharmacy infusion knowledge databases based on Hospital Infusion Standards.
• Integration of these databases into a computerized annotation module within an electronic health record (EHR) system.
• Phased implementation: Phase 1 (manual annotation), Phase 2 (computer-aided manual annotation), and Phase 3 (automated computer annotation).

Main Results:

• Significant increases in the percentage of hospital wards, patients, and IV orders annotated from Phase 1 to Phase 2 (p < 0.001).
• Substantial reduction in tubing flushes per ward per day (118.51 vs. 2,115.00, p < 0.001) and associated cost savings in Phases 2 and 3.
• Significant decreases in nursing time spent on tubing flushes and pharmacist annotation time in Phases 2 and 3 compared to Phase 1 (p < 0.001).

Conclusions:

• The computerized infusion annotation system demonstrates high efficiency in sequence annotation.
• Implementation of the system leads to significant savings in tubing flushes and associated costs.
• The CDS system enhances medication administration safety and optimizes resource allocation in healthcare settings.