Organizational, Cultural, and Psychological Determinants of Smart Infusion Pump Work Arounds: A Study of 3 U.S. Health Systems.

OBJECTIVES: We investigated nurse perceptions of smart infusion medication pumps to provide evidence-based insights on how to help reduce work around and improve compliance with patient safety policies. Specifically, we investigated the following 3 research questions: (1) What are nurses' current attitudes about smart infusion pumps? (2) What do nurses think are the causes of smart infusion pump work arounds? and (3) To whom do nurses turn for smart infusion pump training and troubleshooting? METHODS: We surveyed a large number of nurses (N = 818) in 3 U.S.-based health care systems to address the research questions above. We assessed nurses' opinions about smart infusion pumps, organizational perceptions, and the reasons for work arounds using a voluntary and anonymous Web-based survey. Using qualitative research methods, we coded open-ended responses to questions about the reasons for work arounds to organize responses into useful categories. RESULTS: The nurses reported widespread satisfaction with smart infusion pumps. However, they reported numerous organizational, cultural, and psychological causes of smart pump work arounds. Of 1029 open-ended responses to the question "why do smart pump work arounds occur?" approximately 44% of the causes were technology related, 47% were organization related, and 9% were related to individual factors. Finally, an overwhelming majority of nurses reported seeking solutions to smart pump problems from coworkers and being trained primarily on the job. DISCUSSION AND CONCLUSIONS: Hospitals may significantly improve adherence to smart pump safety features by addressing the nontechnical causes of work arounds and by providing more leadership and formalized training for resolving smart pump-related problems.

Stability of an extemporaneously prepared clopidogrel oral suspension.

PURPOSE: The stability of an extemporaneously prepared clopidogrel oral suspension was studied. Methods Clopidogrel oral suspension (5 mg/mL) was prepared using clopidogrel bisulfate tablets, Ora-Plus, and Ora-Sweet. Six 2-oz samples were prepared; three were stored at room temperature and three under refrigeration. One milliliter was withdrawn from each sample, diluted to 10 mL with methanol, and exposed to high-frequency sound waves in a water bath to ensure complete dissolution of clopidogrel. A 300-microL sample was then withdrawn, diluted with mobile phase to an expected concentration of 15 microg/mL, and assayed in duplicate using high- performance liquid chromatography immediately after preparation and at 7, 14, 28, and 60 days. The stability of the clopidogrel suspension was determined by calculating the percentage of the initial concentration remaining on each test day. Stability was defined as retention of at least 90% of the initial concentration. RESULTS: At least 97% of the initial clopidogrel concentration remained throughout the 60-day study period, regardless of storage conditions. There were no detectable changes in color, odor, taste, or pH and no visible microbial growth in any sample. The preparation was palatable, with a slightly gritty consistency and a slightly bitter aftertaste; the bitterness intensified slightly between 28 and 60 days but remained fairly mild. CONCLUSION: Extemporaneously compounded suspensions of clopidogrel, 5 mg/mL, in a 1:1 mixture of Ora-Plus and Ora-Sweet were stable for at least 60 days when stored in amber plastic bottles at room temperature and under refrigeration.