Note: For an industry sector report on infusion pumps, read the August 2008 issue of DOTmed Business News.

State-of-the-art "smart" infusion pumps are transforming the technology the way PACS is transforming diagnostic imaging. Firmware, which resides on the pump, and software interfaces to hospital systems add safety and efficiency to these essential and plentiful devices. Following is a report on two key manufacturers--B. Braun and Smiths Medical.

B. Braun Launches New "Smart Pump" Line and Syringe Pump Technology

Each day, one patient in every hospital in the country falls victim to a medication error, and those errors injure approximately 1.3 million people annually in the United States, according to the FDA. Among adverse drug events, IV-related errors have the greatest potential for harm since vulnerable acute care patients receive critical medication intravenously.

To combat the major causes of IV pump medication errors, B. Braun Medical Inc. has developed its new flagship, large-volume Outlook® ES Safety Infusion System. The modular "smart pump" products incorporate DoseGuard™ software that allows the hospital to program dose limits to their drug formulary and patient care settings. If a clinician attempts to administer too high or too low a dose, visual and audible alerts notify the clinician that the hospital-defined limits have been exceeded. The modular design reduces potential for errors while improving overall asset utilization.

"The biggest single factor in our industry now is the launch and growth of smart pump technology. The pumps are 'smart' because they are equipped with drug libraries," explained Eric Melanson, Director of Marketing for Infusion Systems, B. Braun Medical Inc., Bethlehem, PA. "We sit down with the [healthcare provider] and ask--what drugs are you administering by IV? The hospital may have a labor and delivery unit, several ORs, a trauma center, NICU [neonatal intensive care]. Each has a list of drugs they use routinely. We determine the name of drug and the concentration and the hospital sets dosing limits, and we build a file and download it to the pump."



The Outlook ES line of pumps, just launched in August 2008, is cleverly organized in an upgradable implementation progression. The line includes the Outlook 100ES, 200ES, 300ES and 400ES. All the pumps feature the company's drug library software. The Outlook 200ES adds DoseScan™ barcode technology. The Outlook 300ES includes all of the features of the 100 and 200 plus wireless capability--the IV pump transmits infusion data to hospital clinical information systems, enabling patient records to be updated in real time. Infusion data can also be transmitted to a handheld PDA. In addition to all of the prior technologies noted, the Outlook 400ES features two-way wireless communication with existing hospital clinical information systems. The IV pump wirelessly transmits infusion data to hospital clinical information systems, and in turn wirelessly receives data from those systems.

The reality is that few hospitals are 100 percent wireless right now, but they need to be able to upgrade seamlessly when the time comes.

"We found that having that continuum of technology is helpful to customers and group purchasing organizations. They may not yet be doing wireless and bar coding [efforts], but they are planning on it, so we have an upgrade path across all those models," Melanson said. "You many have a long laundry list of things you want, but what is your current funding state and what can you really afford?"

As providers ask those questions, they'll likely find a B. Braun system to fit their needs. The Outlook ES series is competitively priced throughout the portfolio.

In addition to the large volume pump technology, the company also has something new in the syringe segment, which has seen few advances in the last decade. (Syringe pumps are often used in small volume, precision, or syringe settings such as NICU or OR.)

B. Braun's Perfusor® SPACE Pumps are popular for their compact size and light weight. At 9 inches by 5 inches and weighing only three pounds, the SPACE pumps can fit easily into a range of environments. The system is designed for higher acuity care facilities, offering a large drug library as well as the capability to build up to 24 pumps in a single bedside tower. Anesthesiologists also benefit from the compact size of the Perfusor SPACE syringe pump in crowded operating room environments, where three pumps easily interlock on a pole clamp.

About B. Braun
B. Braun is a global leader in regional anesthesia, infusion therapy, parenteral nutrition, pharmacy products and services, and a pioneer in passive safety devices and DEHP/PVC-free products. Every day, some 36,000 B. Braun employees worldwide share their knowledge with colleagues and customers to improve working processes in hospitals and medical practices and to enhance safety for patients, doctors and nurses.

Consistently recognized by Frost & Sullivan and KLAS for its medical technology and support services, B. Braun promotes best practices for continuous improvement of healthcare and, through its "Sharing Expertise®" initiative, helps today's healthcare workers address critical issues including environmental responsibility, medication errors reduction and infection prevention. For more information, call 800-854-6851, e-mail us at inquiry(at)bbraun.com or visit B. Braun at www.bbraunusa.com.


Smiths Medical's "Smart" PCA and Syringe Pumps

Today's infusion pumps don't just deliver intravenous fluids and medication in a regulated flow. They also include software to allow hospitals to program their formularies and drug orders and set soft (override-able) and hard (non-override-able) limits on drug delivery in ER, OR, ICU, NICU, and other departments. By adding an overlay of firmware in the pump and software on the hospital's computer network, the pumps become an important partner in improving safety.

Known as Dose Error Reduction Systems, these smart technologies are a "must" to minimize infusion errors, according to ECRI Institute. The smart pumps can warn users of medication delivery errors , calculation errors, and mis-programming that would result in under- or over-medication.

"Smart pumps allow you to program drug libraries or protocol libraries that are specific to each institution's requirements, formulary or order sets," explained Martha Sewall, Vice President of Marketing for the Infusion and Vascular Access Divisions of Smiths Medical. "Ideally the smartest pumps are wireless in their ability to communicate. Once you have safety software with limits and controls you can change and update your entire system quickly."

It's not just a futuristic scenario. The company already offers an ambulatory PCA infusion pump platform that will allow future wireless connectivity, the CADD®-Solis system. (CADD stands for computerized ambulatory delivery device.) The CADD®-Solis is a linear peristaltic pump, which uses a mechanism like a series of fingers that move fluid along with precision. Applications include pain relief medications such as narcotics for post-surgery, trauma, cancer and L&D (labor and delivery). The lightweight pump, about 20 ounces, moves with the patient to encourage faster return to activity, an important aspect of recovery.



But it's the software that really sets the smart pumps apart. In fact, they don't just "listen" to clinician instructions, they also communicate back to the clinicians by displaying messages and feedback based on programming that has been input into the pump. The CADD®-Solis can use two-way communication through its richly detailed monitor display or future wireless capabilities. It can indicate immediate patient care issues to caregivers at bedside, and report data to the hospital information system for quality improvement efforts.

"Traditionally, the caregiver had to provide care in the manner that the pump would allow because the pump was engineered a particular way.... So your forms were written to mimic what that pump did and the caregiver had to follow a prescribed route," said Mark Vaughan, a marketing director at Smiths Medical. "Today, we're empowering clinicians to say 'we want our decision making to look this way,' and the software allows them to configure the pumps to meet their needs as opposed to the clinicians being constrained by what the pump can do."

That's the ultimate use of technology--to enhance human decision-making. And it's perhaps a barrier to adoption for some folks who have 20th century mindsets.

"As electronic management of health care data in a hospital becomes more widely instituted the expectation is that all add-on devices [will be smart]," Sewall suggested. "It started with CT scanners and MRIs--digital data and diagnostics. Now, infusion pumps, pulse oximetry, and other devices will be designed to send data wirelessly to analyze or store it."

The implications are endless such as one machine "talking" to another, for instance to have the patient's pulse become one input to inform the administration of medication. "So it's clinical decision-making using technology. That is a long way off and the FDA is beginning to wrangle with this blurring of the lines between medical devices and information systems."

Note that Smiths Medical is also a market leader in syringe pumps for the neonatal intensive care unit. The company will soon add wireless capability to its other smart pump, the Smiths Medical Medfusion 3500 system. This small, lightweight syringe pump offers medication safety software and a customizable drug library. Hospitals program the smart pump with the NICU drug formulary and dose levels for the tiny patients in this high-risk setting.

About Smiths Medical
Smiths Medical is a supplier of specialist medical devices to global markets. Smiths Medical comprises three product groupings: Safety Devices, Vital Care and Medication Delivery. Smiths Medical customers include hospitals and other healthcare providers worldwide. Smiths Medical employs nearly 7,500 people. For further information visit www.smiths-medical.com