Smart infusion pump technology (SIPT) was designed to enhance safety with intravenous medication administration, but has introduced new patient safety risks and harm when nurses initiate workarounds that bypass SIPT safety features. This study sought to develop a grounded theory explaining nurses' experiences with SIPT, their perceptions of safety features, the rules and resources used in response to safety features, the actions taken in response to SIPT workflow blocks, and conditions contributing to nurse-initiated workarounds. Corbin and Strauss's (2008) grounded theory approach guided this study. Semi-structured interviews were conducted with 28 nurses who used SIPT across 13 adult patient care areas in a single Midwest teaching hospital. The grounded theory Nurse-Technology Interplay was developed through constant comparison analysis of transcribed interview data. The four categories of interacting with SIPT, making meaning, taking action, and consequences, were linked through relational statements and theoretically integrated to develop the grounded theory. The grounded theory explicates the continual interplay that occurs as nurses interact with SIPT, and the cognitive and physical processes used to resolve workflow blocks in the context of care delivery. Interacting with SIPT reflected the learning curves faced by nurses, the context of patient-care unit characteristics, and encountered workflow blocks. Making meaning reflected the cognitive processes used by nurses as they encountered workflow blocks with SIPT, and was influenced by individual perspectives, as well as shared learning. Taking action often occurred simultaneously with making meaning, and represented processes of doing, such as rechecking programming activities, seeking assistance, or engaging in workarounds. Consequences of using SIPT included patient outcomes with medication administration and the impact on practice as nurses experienced disruptions in care delivery, dependency on SIPT, a loss of calculation skills, and alarm overload. The grounded theory of Nurse-Technology Interplay provides an understanding of how nurses make sense of, and respond to, workflow blocks with SIPT safety features. The study yielded valuable insights into the complexity of SIPT implementation and the challenges nurses face while providing safe, effective, patient-centered care in the midst of juggling competing priorities. The findings have implications for nursing practice and nurse leaders. Critical to moving forward is a more purposeful approach to SIPT education and training within a patient safety framework, a systematic evaluation of organizational processes that impact SIPT, optimization the SIPT drug library to facilitate nurses' work, and promotion of a learning organization that capitalizes on the lessons that can be learned from workarounds.

Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Submitted by MICHELE CRISTINA BATISTON (mbatiston@bol.com.br) on 2018-08-08T22:41:37Z No. of bitstreams: 1 dissertaçao_mestrado_michele_batiston.pdf: 621517 bytes, checksum: 9fb79643cf6fe14c3e097f3181fa7d8e (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-08-09T14:06:35Z (GMT) No. of bitstreams: 1 batiston_mc_me_bot.pdf: 621517 bytes, checksum: 9fb79643cf6fe14c3e097f3181fa7d8e (MD5) / Made available in DSpace on 2018-08-09T14:06:35Z (GMT). No. of bitstreams: 1 batiston_mc_me_bot.pdf: 621517 bytes, checksum: 9fb79643cf6fe14c3e097f3181fa7d8e (MD5) Previous issue date: 2018-07-12 / O objetivo deste trabalho foi avaliar a evidência científica disponível sobre o uso das bombas de infusão inteligentes em pacientes hospitalizados. Foi realizado um estudo, de acordo com Diretrizes Metodológicas propostas pelo Ministério da Saúde para a elaboração de pareceres técnico-científicos (PTC). Foi realizada uma busca até 14 de novembro de 2017 nas bases de dados The Cochrane Library, EMBASE, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e de Avaliações de Tecnologias de Saúde (ATS), não houve restrição de idioma e ano de publicação do artigo. Os resultados das bases de dados foram agrupados e eliminados os estudos em duplicatas. Em seguida, aplicados os critérios de elegibilidade para os títulos e resumos, restando 51 estudos para leitura completa. Após leitura dos artigos na íntegra, foram selecionados 6 estudos, que incluíram revisão sistemática sem metanálise, três estudos observacionais sem comparador e dois estudos observacionais do tipo antes e depois. Os estudos não apresentaram dados conclusivos para redução do número de eventos ocorridos. Para a interceptação de erros/prevenção de erros, os estudos demonstraram que a bomba inteligente interceptou e impediu diversos erros como frequência, dose e programação erradas. Para os custos, o estudo de revisão sistemática sem metanálise inclui um estudo que apresentou redução de custos da Bomba de Infusão Inteligente pelos possíveis eventos adversos evitáveis. A recomendação é incerta, indicando a necessidade de elaboração de novos estudos como ensaios clínicos randomizados e avaliações econômicas. / Title: Intelligent Infusion Pump versus Conventional Infusion Pump: Comparison of cost and safety. Recommendation for the use of technology: ( ) In favor of (X) Uncertain ( ) Against Brief justification for the recommendation: Studies with little scientific evidence, the costs with the materials, the need to qualify, the construction of a library, among other strategies. Population: Patients hospitalized Technology: Intelligent Infusion Pumps Comparator: Conventional Infusion Pumps Search and analysis of scientific evidence: A search was performed to 2017, November 14 in the databases The Cochrane Library, EMBASE, PubMed and Latin American, Caribbean Literature in Health Sciences (LILACS) and the Health Technology Assessment (ATS). There was no language restriction and year of publication of the article. The results of the databases were grouped and the duplicate studies were eliminated. Then, the eligibility criteria for titles and abstracts were applied, leaving 51 studies for complete reading. After reading the articles in full, 06 studies were selected. Summary of results of selected studies: Six studies were included: one systematic review without meta-analysis, three observational studies without comparator, and two before-after observational studies. The studies did not present conclusive data to reduce the number of events that occurred. For error interception / error prevention, studies have shown that the smart pump intercepted and prevented various errors such as frequency, dose and wrong programming. For costs, the systematic review study without meta-analysis includes a study that presented cost savings of the Smart Infusion Pump for possible avoidable adverse events. Quality of Evidence: The included studies were considered of low evidence quality. Synthesis of Economic Information: The average cost of the inputs of conventional peristaltic infusion pumps is R $ 17.00 (equipment only), for intelligent peristaltic pumps it is R $ 38.00 (value of equipment only, pumps syringe infusion are conventional or intelligent use the same input that costs on average $ 8.50 (20 ml syringe and extender).

The subject of this thesis is a design of the volumetric infusion pumping unit specifically used for a human medicine purposes. The pumping unit is constructed by the linear peristaltic pump. The document focuses on mechanical design and disposition of particular components of unit and placement of electronic sensors and contacts. The thesis is elaborated as a part of infusion pump development project for a limited company.

No description available.

This thesis evaluated the effects of two types of training on nurses’ ability to safely and efficiently administer IV medications using a smart infusion pump. A high fidelity simulated nursing unit was created in which nurses recruited from the University Health Network programmed a series of infusions after receiving training. A training script modeled after the pump vendor’s training sessions was created and tested first on 24 nurses. The results were analyzed for deficiencies in safety and efficiency from a human factors and education perspective and a new training script was created and tested on a group of 23 nurses. No significant differences were found between training groups on measures related to safety, but significant differences were found in nurse efficiency and behaviour in some aspects of pump programming. This study sets a precedent for human factors evaluation being used in tandem with existing training practices and lays the groundwork for further exploration on this topic.

This thesis evaluated the effects of two types of training on nurses’ ability to safely and efficiently administer IV medications using a smart infusion pump. A high fidelity simulated nursing unit was created in which nurses recruited from the University Health Network programmed a series of infusions after receiving training. A training script modeled after the pump vendor’s training sessions was created and tested first on 24 nurses. The results were analyzed for deficiencies in safety and efficiency from a human factors and education perspective and a new training script was created and tested on a group of 23 nurses. No significant differences were found between training groups on measures related to safety, but significant differences were found in nurse efficiency and behaviour in some aspects of pump programming. This study sets a precedent for human factors evaluation being used in tandem with existing training practices and lays the groundwork for further exploration on this topic.

<p>Formal methods such as Event-B are a widely used approach for developing critical systems. This thesis demonstrates that creating models and proving the consistency of the models at the requirements level during software (system) development is an effective way to reduce the occurrence of faults and errors in a practical application. An insulin infusion pump (IIP) is a complicated and time critical system. This thesis uses Event-B to specify models for an IIP, based on a draft requirements document developed by the US Food and Drug Administration (FDA). Consequently it demonstrates Event-B can be used effectively to detect the missing properties, the missing quantities, the faults and the errors at the requirements level of a system development. The IIP is an active and reactive time control system. To achieve the goal of handling timing issues in the IIP system, we made extensions of an existing time pattern specified using Event-B to enrich the semantics of the Event-B language. We created several sets to model the activation times of different events and the union of these time sets defines a global time activation set. The tick of global time is specified as a progress tick event. All the actions in an event are triggered only when the global time in the time tick event matches the time specified in the event. Time is deleted from the corresponding time set, but not the corresponding global time set while the event is triggered. A time point is deleted from the global time set only when there are no pending actions for that time point. Through discharging proof obligations using Event-B, we achieved our goal of improving the requirements document.</p> / Master of Computer Science (MCS)

Objetivo: Este estudo objetivou avaliar a precisão de infusões de medicamentos em dois modelos de Bomba de Infusão (BI), de equipo específico do fabricante e de equipo universal, a concordância entre estes dois modelos e sua relação de custo e efetividade. Método: Foi realizado um ensaio clínico randomizado em pacientes internados em um hospital geral universitário de 740 leitos. As unidades de internação foram randomizadas através de sorteio simples para cada modelo de equipamento e os pacientes foram incluídos de acordo com indicação de uso de BI, conforme protocolo institucional. Os tipos de erros e reações adversas foram classificados por meio de algoritmos. Foi calculado o custo de cada sistema de bomba de infusão, pela vida útil da tecnologia. Resultados: Em 55 pacientes foram acompanhadas 310 infusões, 117 no grupo da bomba de infusão de equipo universal e 193 na bomba de infusão de equipo especifico. Houve semelhança (p=0,40) entre o tempo programado e o observado nas infusões por meio da bomba de equipo específico (-2,1 ± 19 min) e universal (0,08 ± 23 min). Percentualmente, também não foi observada diferença (p=0,70) entre a infusão por bomba de equipo específico (-0,15±3,8%) e universal (0,1±6,3%). Foram observados 14 (4,5%) erros de medicação, semelhantes (p=0,58) entre os tipos de BI. Os custos cumulativos entre os dois sistemas de bombas se equivaleram em 30 meses, sendo que após 11 anos, foram significativamente maiores para bomba de equipo específico em 184,29%. Conclusão: Ambos modelos de BI avaliadas mostraram-se igualmente seguras para administração EV de fármacos, sendo o modelo de equipo universal mais vantajoso economicamente ao longo da vida útil dos equipamentos. / Objective: This study aimed to evaluate the accuracy of drug infusion in two models of infusion pumps (IP), one with a specific IV set and other with universal IV set, the correlation between these two models and their relation of cost and effectiveness. Method: A randomized clinical trial was conducted in hospitalized patients in a university general hospital of 740 beds. The ward units were randomly chosen for each type of equipment, and patients were included according to indication for use of IP, based on institutional protocol. The types of errors and adverse reactions were classified by means of algorithms. The costs of each system for IP, was calculated considering the useful life of the technology. Results: 310 infusions were monitored: 117 in the universal infusion pump group and 193 in the specific equipment group, in 55 patients. The average difference between the scheduled time and the actual one in the infusions was -2.1 ± 19 min. and 0.08 ± 23 min. (p = 0.40) for the universal equipment and specific equipment, respectively, which means an average error of -0.15% ± 3.8% for the universal equipment and 0.10% ± 6.3% for the specific equipment, with no difference between the two types of pump. Fourteen (4.5%) medication errors were observed during the administration of medication, similar between the two types of IP. The cumulative costs between the two pump systems were equivalent in 30 months, and after 11 years the costs were meaningfully higher for the specific equipment pumps in 184,29 %. Conclusion: The infusion pumps do not show meaningful difference in accuracy between scheduled time and the actual one qualifying them as safe for the drugs observed. Cumulative costs were significantly distinct between both pieces of equipment.