Utilizing a real-world data set to assess titration practices for high-alert medications delivered via continuous...

Smart infusion pumps provide dose error reduction systems (DERS) designed to intercept dosing and/or programming errors; however, DERS may not be able to capture all potential errors. Through analyzing the logged activity data of these devices, valuable insights for dose titration practices and risks during administration of high-alert continuous infusions can be determined.

Data were extracted from the Bainbridge Health Infusion Pump Network for the period of January through December 2022. Continuous infusions for adult patients of common, titratable, high-alert medications were selected.

Data from the Bainbridge Health Infusion Pump Network, comprising 20 health systems across the US, yielded 347,170 infusions for analysis. The 9 medications identified for review were dexmedetomidine, dobutamine, fentanyl, heparin, insulin, midazolam, norepinephrine, propofol, and vasopressin. Data for 1% of infusions were suggestive of 10-fold dose programming errors, 1% of infusions exceeded suggested maximum doses, and infusions of 4 out of the 9 medications were often titrated too quickly.

This first-of-its-kind data analysis identified safety gaps that can help establish greater standardization of appropriate titration parameters for high-alert medications. These standards can further optimize drug libraries and enhance DERS to increase medication safety in the use of smart infusion pumps.