Developing a System for Integraded Automatic Control of Mutiple Infusion Pumps: The Multiplex infusion system

Most errors in ICUs are related to intravenous (IV) therapy. Previous studies suggested that hard to operate infusion pumps and the high cognitive workload for ICU nurses contribute to these errors. Conventional IV therapy requires separate lumens for incompatible IV drugs. This often requires the placement of additional catheters, which increases infection risk and physical discomfort for the patient. In this thesis, a control system for multiple infusion pumps is proposed to reduce the problems with conventional IV therapy. The core idea behind this ‘Multiplex infusion’ system is reducing the number of required lumens by optimizing the number of IV drugs that are administered through a single lumen. A feasibility analysis showed that the Multiplex infusion system could significantly reduce the number of required lumens. A user interface for this system was designed with the goal of reducing the likelihood of errors by partially automating several tasks. In order to compare the usability of the new user interface with that of the conventional method of manually controlling multiple infusion pumps, a user based usability analysis was performed. Results indicated that the new user interface had an overall better usability and a significantly lower error rate.

[1]  K Henriksen,et al.  Observing Nurse Interaction with Infusion Pump Technologies -- Advances in Patient Safety: From Research to Implementation (Volume 2:Concepts and Methodology) , 2005 .

[2]  G. Capellier,et al.  Medication errors at the administration stage in an intensive care unit , 1999, Intensive Care Medicine.

[3]  Christopher D. Wickens,et al.  Multiple Resources and Mental Workload , 2008, Hum. Factors.

[4]  Huib de Ridder,et al.  Designing for enhanced interpretation, anticipation and reflection in the intensive care unit , 2004, 2004 IEEE International Conference on Systems, Man and Cybernetics (IEEE Cat. No.04CH37583).

[5]  Neville A Stanton,et al.  Hierarchical task analysis: developments, applications, and extensions. , 2006, Applied ergonomics.

[6]  N. Taatgen,et al.  The problem state: a cognitive bottleneck in multitasking. , 2010, Journal of experimental psychology. Learning, memory, and cognition.

[7]  Elisabeth Burdick,et al.  A controlled trial of smart infusion pumps to improve medication safety in critically ill patients1 , 2007, Critical care medicine.

[8]  Dario D. Salvucci,et al.  Multitasking and monotasking: the effects of mental workload on deferred task interruptions , 2010, CHI.

[9]  J. Reason.  Human error: models and management , 2000, BMJ : British Medical Journal.

[10]  James Reason,et al.  Human Error , 1990 .

[11]  Dario D. Salvucci,et al.  Threaded cognition: an integrated theory of concurrent multitasking. , 2008, Psychological review.

[12]  S. Chevret,et al.  Iatrogenic complications in adult intensive care units: A prospective two‐center study , 1993, Critical care medicine.

[13]  Jonathan Back,et al.  Choosing to interleave: human error and information access cost , 2012, CHI.

[14]  H. Stelfox,et al.  Clinical review: Medication errors in critical care , 2008, Critical care.

[15]  Mark T. Bolas.  Designing the user in user interfaces , 2014, UIST.

[16]  Brian P. Bailey,et al.  If not now, when?: the effects of interruption at different moments within task execution , 2004, CHI.

[17]  Jonathan Histon,et al.  A User-Centered Evaluation of three Intravenous Infusion Pumps , 2004 .

[18]  Dorian M. Raymer,et al.  Spontaneous knotting of an agitated string , 2007, Proceedings of the National Academy of Sciences.

[19]  T. Brennan,et al.  Incidence of adverse events and negligence in hospitalized patients. , 1991, The New England journal of medicine.

[20]  H. Isenberg,et al.  Central catheter infections: single- versus triple-lumen catheters. Influence of guide wires on infection rates when used for replacement of catheters. , 1988, The American journal of medicine.

[21]  Joseph S. Dumas,et al.  User-based evaluations , 2002 .

[22]  D. Bates,et al.  The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care* , 2005, Critical care medicine.

[23]  Vimla L. Patel,et al.  Using usability heuristics to evaluate patient safety of medical devices , 2003, J. Biomed. Informatics.

[24]  Jennifer Hardy,et al.  Communication loads on clinical staff in the emergency department , 2002, The Medical journal of Australia.

[25]  Anna-Lisa Osvalder,et al.  Setting the Requirements for a User-Friendly Infusion Pump , 2000 .

[26]  Karin Garmer,et al.  Usability Evaluation of a New User Interface for an Infusion Pump Developed with a Human Factors Approach , 2000 .

[27]  J. Gregory Trafton,et al.  Memory for goals: an activation-based model , 2002, Cogn. Sci..

[28]  Y. Donchin,et al.  A look into the nature and causes of human errors in the intensive care unit , 2022 .

[29]  Pascale Carayon,et al.  Using failure mode and effects analysis to plan implementation of smart i.v. pump technology. , 2006, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[30]  Jacob S. Tripp,et al.  Reduction of peripherally inserted central catheter-associated DVT. , 2013, Chest.