Table 3

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

NodeOrderTranscribe and dispenseAdminister 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.
FeaturesCPOE with decision support receives and supports with logic accurate appropriate order, dosing ranges, interactions, allergiesPharmacy system receives electronicallyDispensed medication is read by a bar code scanner (BCMA) which results in automatic programming of the infusion pump
Communicates order to PISProfiled order communicates to EMR and populates the eMAR for later charting of administrationBar 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 errorsTranscription errorsWrong patient or no patient ID band
Lost ordersPrescribing errors which missed first screenInfusion pump programming errors
Undocumented verbal ordersDelay of medication administration due to failure of nurse to notice new ordersPrescribing 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