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Updated: Jul 16, 2026
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Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Targeting reduction of intravenous smart pump programming alerts: Insights from real-world use
Lori T Armistead1, Dan D Degnan2, Karen K Giuliano3
1Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA.
Summary
Most intravenous smart pump (IVSP) alerts are overridden, especially for high-alert medications (HAMs). Understanding these IVSP alert patterns is crucial for reducing alert fatigue and potential patient harm.
Area of Science:
- Medical Informatics
- Patient Safety
- Pharmacology
Background:
- Intravenous smart pumps (IVSPs) utilize dose error reduction systems (DERS) to prevent programming errors.
- A significant number of IVSP alerts are overridden, posing risks of patient harm or stemming from non-actionable alerts.
Purpose of the Study:
- To characterize the types and responses of alerts generated by IVSPs.
- To analyze alert data from a large cohort of IV infusions across multiple US hospitals.
Main Methods:
- Retrospective analysis of over 62 million IV infusions from 107 US hospitals.
- Categorization of IVSP alerts and their corresponding responses.
- Analysis stratified by medication class and top 30 alert-generating medications.
Main Results:
- The overall alert-to-infusion ratio was 1:13.6, increasing to 1:6.2 for high-alert medications (HAMs).
- Dose (45.6%) and duration (34.6%) alerts were most frequent, with 72.5% of all alerts being overridden (74.9% for HAMs).
- Key medications like propofol and fentanyl showed high alert rates and low alert salience, indicating frequent overrides.
Conclusions:
- High rates of IVSP alert overrides, particularly for HAMs, necessitate further investigation.
- Understanding alert frequency, types, and override behaviors is essential for optimizing IVSP systems.
- Reducing unnecessary alerts and mitigating alert fatigue are critical for enhancing patient safety.
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