Anesthesia professionals frequently make mistakes when calculating drug doses, with inexperienced residents and older faculty at increased risk (Anesth Analg 2019;128:1292-9). Smart I.V. infusion pumps are designed to reduce the risk of medication errors. These devices use a preprogrammed drug library to minimize dosing errors and can alert the user if an infusion rate exceeds specified parameters. Unfortunately, the use of this technology has still not completely eliminated medication errors in the OR or ICU. One study found that medication errors occurred in 60% of infusions using a smart pump. Errors included unlabeled medications, unauthorized medications, incorrect rate or dose, and failure to use the smart pump library, among others (BMJ Qual Saf 2017;26:131-40). Although few of the errors could have caused patient harm, this study demonstrated that the risk of error is still high despite the introduction of new technology.
It is easy to say that clinicians should actively search for sources of error in automation, but it may be hard to do in practice. Inattentional blindness may prevent even a trained observer from seeing something that is unexpected, (Psychol Sci 2013;24:1848-53) so it is not unreasonable to expect that even an experienced clinician may miss an incorrectly programed pump or ventilator. One way to prevent this complication is to evaluate multiple distinct data points to ensure that the programming is correct (Anesthesiology 2020;133:653-65). When programming an infusion pump, check the weight-based programed infusion rate and compare that to the rate in milliliters per minute (or hour). An infusion that will take significantly less or more time than expected to complete may be a warning that the pump has been incorrectly programed. Although this may not protect the clinician against small errors (e.g., 1.5 vs. 2 mcg/kg/hr) it will prevent larger, potentially catastrophic errors, such as may occur when entering 8 kg instead of 80 kg for the patient's weight or when the concentration of the infusion is different from the pump's programming.