Background: Intravenous medicine administration errors in oncology pose significant risks. Smart infusion pumps with dose-error-reduction software, known as BD AlarisTM Guardrails™, help prevent infusion programming errors. A limitation in practice was identified at a large private hospital; the oncology medicine library (OML) encompassed a limited selection of high-risk cancer-care medicines. Despite multiple clinical checks, the risk of human error during administration persists. Pre-implementation, Guardrails parameters were largely absent in cancer-care infusions.
Method: A quality improvement project was endorsed to review, update and expand the existing OML. A multidisciplinary working-party comprising chemotherapy nurse consultants, oncology, medication-safety, and informatics pharmacists was established. Utilising eviQ, the Australian Injectable Drugs Handbook, and local guidelines, infusion parameters (dose limits, infusion times, clinical advisories) were programmed for local protocols. Complex dosing regimens were addressed via consultation and testing. An education package was developed for nursing staff and subsequently delivered by the oncology-nurse educator.
Impact on practice: The expanded OML resulted in 49 new profiles created, representing a 700% increase over the seven existing profiles. These profiles were further expanded into 97 sub-profiles tailored to specific treatment protocols, particularly for medicines with variable dosing/administration times, rate titrations, adjustment for co-morbidities or weight/BSAbased dosing (methotrexate has nine sub-profiles). Seventeen new clinical advisory notes were added. Pre-implementation, 25.84% of infusions within the oncology department (7407/28670) were given without Guardrails over a 3-month period (Nov 24-Jan 25). This reduced to 17.59% (4234/24070) in the 3-month period following implementation. Since the updated OML release, over 800 cancer-care infusions have been safely delivered via dose-errorreduction system.
Discussion: Ongoing monitoring allows for library refinement. This project demonstrates the impact of an interprofessional, evidence-based approach to enhance medication safety in oncology through optimised smart infusion pump technology, offering a model for other institutions.