Table 3

Conceptual model of technology support for a complete medication safety system for IV medication administration

Node	Order	Transcribe and dispense	Administer and monitor
CPOE, computerized prescriber order entry; PIS, pharmacy information system; EMR, electronic medical record; eMAR, electronic medication administration record.
*Without interface to other systems, currently available smart pumps are limited to this feature.
Features	CPOE with decision support receives and supports with logic accurate appropriate order, dosing ranges, interactions, allergies	Pharmacy system receives electronically	Dispensed medication is read by a bar code scanner (BCMA) which results in automatic programming of the infusion pump
	Communicates order to PIS	Profiled order communicates to EMR and populates the eMAR for later charting of administration	Bar code reader requires input in full agreement from three sources: EMR (the order), patient wristband (patient ID), and the medication in the pump
		Dispensed medication carries bar coded label with patient name, drug, dose, rate,route, start time, interval	“Smart” pump discerns doses programmed outside preset limits specific to a drug and clinical location*
			Pump communicates information on administered medication back to eMAR
			EMR may automatically generate related nursing tasks, e.g. vital signs at intervals appropriate to the medication, or orders such as follow up lab work
Examples of errors which can be prevented
	Prescribing errors	Transcription errors	Wrong patient or no patient ID band
	Lost orders	Prescribing errors which missed first screen	Infusion pump programming errors
	Undocumented verbal orders	Delay of medication administration due to failure of nurse to notice new orders	Prescribing errors if any have missed earlier screens
			Wrong or missing label on dispensed medication
			Omitting/forgetting to document administered medication
			Omitting/forgetting post-medication monitoring and labs