Drug error reduction software that acts like rumble strips and guardrails on the side of roads is helping Waikato DHB deliver patient medications more safely.
Research indicates that Waikato District Health Board leads the world in the use of drug error reduction software (DERS), thanks to a small team willing to take a different approach.
Waikato DHB was the first in New Zealand to bring in the use of drug error reduction software for all its syringe drivers and large volume infusion pumps. Those are the pumps that deliver fluids such as medications or nutrients into a patient’s body in controlled amounts.
It is obviously crucial to get the dose right – and that is where DERS comes in. By adding specialised software into the pump, clinical staff are alerted if the amount of medication is not appropriate.
For eight years the Infusion and Related Therapies team – nurse specialists Lynette Lennox and Jennifer Heretini – have worked on introducing the software and associated policies and guidelines, and educating staff on its use.
Now it is paying dividends.
Research by Lennox shows Waikato DHB is leading the world, with the software used 81 percent of time at Waikato DHB, compared to 69 percent average internationally.
Lennox believes the good uptake here is because the Waikato programme is nurse-led, with Lennox and Heretini working closely with pharmacy, biomedical engineering and nursing and midwifery staff.
“We are nurses so we know how nurses and midwives use these pumps and how the process will work best every step of the way.
“That means staff are more willing to use it, and it fits in with how they work.
“In other places here and worldwide, DERS programmes are usually led by hospital pharmacy staff, but here it is a team approach with pharmacists, biomedical engineers and clinical staff led by specialist nurses, and that has worked well.”.
The DERS software used at Waikato DHB is the Alaris product called Guardrails, but there are many similar products used worldwide.
“The software works like the rumble strips along the side of a road that alert motorists when they are getting close to the edge, and then the metal guardrails that actually prevent a motorist from driving over the edge,” explains Lennox.
In the same way, the Guardrails software flags up a warning if the dose entered into the pump is not usual for that particular medication. It prompts the person setting up the pump to double check – “did I get that right? am I sure I want to do that?” and perhaps make an adjustment.
If the amount is unsafely outside the recommended dose, the software does not allow the person to proceed.
“Guardrails is a safeguard against human error,” Lennox says, “It makes sure patients will be administered a safe dose of medication.”
Reducing medication errors is a key issue in improving patient safety and is part of the national patient safety programme Waikato DHB is very committed to.
“Currently Guardrails is used by our staff more than 80 percent of the time,” Lennox says. The person setting up the infusion pump – usually a nurse, midwife or anaesthetic technician, but sometimes a doctor – enters the data, and the software records and responds to that information. There is always an opt out option in cases of emergency or when the drug is not yet in the Guardrail “library”.
“Every 18 months we collect up all the infusion pumps and download the data. That’s how we know how often it is being used and how well we are doing.”
Lennox says the next download and data analysis will happen in May/June this year, and she is expecting a further increase in use of Guardrails.
Lennox reported her research findings to the recent biannual Intravenous Nursing Conference which was attended by more than 150 delegates mainly from New Zealand, Australia and the UK, and she was awarded the conference’s Best Presenter prize.