Improving Patient Safety Through EMR-smart Pump Interoperability: A Mixed-methods Study in an Australian Health Service.

Abstract

Smart infusion pumps are widely used to reduce medication errors. When integrated with electronic medical records (EMR), they support a closed-loop medication management system. This study evaluates the impact of EMR-smart pump interoperability on patient safety and user acceptability in a multicenter Australian health service. A comparative study was conducted using baseline data from a tertiary hospital without smart pump integration (December 2021 to July 2022) and post-implementation data from the newly established digital cardiac hospital (March 2023 to December 2023). Both sites utilized a coronary care-specific medication library to ensure consistency. The evaluation focused on key indicators such as medication library compliance, the frequency of pump reprogramming and high-risk medication alerts, the number of keystrokes required for programming, and the rate of alert overrides. An anonymous survey captured nursing staff perceptions related to satisfaction, workflow efficiency, and confidence in using the pump systems. Following the implementation EMR-smart pump interoperability, medication library compliance improved significantly, rising from 93% to 97%, P <.0001. Alerts related to pump reprogramming and high-risk medications also increased, suggesting enhanced safety monitoring. At the same time, programming became more efficient, with the average number of keystrokes required dropping from 13±3.4 to 3±1.2, P <.0001. However, despite these gains, survey responses revealed a decline in clinician's perceived ease of use (from 90% to 45%, P <.0001) and confidence in programming (93% to 65%, P <.0001). While the rate of cancelled infusions alerts (20% vs. 14%, P <.0001) and all other nonspecific pump alerts (23% vs. 16%, P <.0001) reduced. The integration of EMR-smart pump interoperability enhances medication safety by increasing the frequency of clinical alerts and reducing manual data entry. However, this advancement may introduce usability challenges that impact staff confidence and workflow. These findings highlight the importance of balancing technological integration with user experience to optimize patient safety outcomes.