Targeting reduction of intravenous smart pump programming alerts: Insights from real-world use

Intravenous smart pumps (IVSPs) use dose error reduction systems (DERS) to trigger alerts when an IV infusion is programmed outside the pump's drug library limits. Many IVSP alerts, however, are overridden, either by mistake, thereby potentially causing patient harm, or because they are clinically nonactionable. The purpose of this study was to describe the alert types and alert responses from IV infusions administered over 2 years in 107 US hospitals.

A retrospective analysis of alerts from more than 62 million IV infusions was conducted. The IVSP alerts and alert response types were described for all infusions, by medication class, and for the 30 medications with the most alerts.

The alert-to-infusion ratio was 1 to 13.6 (0.074) for all infusions and 1 to 6.2 (0.160) for high-alert medications (HAMs). Dose alerts and duration alerts were the most common (45.6% and 34.6%, respectively). Most alerts (72.5%) were overridden (versus infusions being canceled or reprogrammed), with 74.9% of HAM infusion alerts being overridden. The override-to-reprogram ratio was 7.10 for all infusions and 8.99 for HAM infusions. The alert salience was 0.275 for all infusions and 0.251 for HAM infusions. Key medications with a high alert-to-infusion ratio, mostly dose alerts, and low alert salience were propofol, hydromorphone, oxytocin, midazolam, norepinephrine, and fentanyl.

This study expands on the IVSP alert data published to date and highlights 3 key measures of alert override rates, including alert salience. Understanding the frequency and types of IVSP alerts and alert responses is critical for reducing unnecessary IVSP alerts and reducing alert fatigue.