Using failure mode and effects analysis to plan implementation of smart i.v. pump technology.

PURPOSE: Failure mode and effects analysis (FMEA) was used to evaluate a smart i.v. pump as it was implemented into a redesigned medication-use process. SUMMARY: A multidisciplinary team conducted a FMEA to guide the implementation of a smart i.v. pump that was designed to prevent pump programming errors. The smart i.v. pump was equipped with a dose-error reduction system that included a pre-defined drug library in which dosage limits were set for each medication. Monitoring for potential failures and errors occurred for three months postimplementation of FMEA. Specific measures were used to determine the success of the actions that were implemented as a result of the FMEA. The FMEA process at the hospital identified key failure modes in the medication process with the use of the old and new pumps, and actions were taken to avoid errors and adverse events. I.V. pump software and hardware design changes were also recommended. Thirteen of the 18 failure modes reported in practice after pump implementation had been identified by the team. A beneficial outcome of FMEA was the development of a multidisciplinary team that provided the infrastructure for safe technology implementation and effective event investigation after implementation. With the continual updating of i.v. pump software and hardware after implementation, FMEA can be an important starting place for safe technology choice and implementation and can produce site experts to follow technology and process changes over time. CONCLUSION: FMEA was useful in identifying potential problems in the medication-use process with the implementation of new smart i.v. pumps. Monitoring for system failures and errors after implementation remains necessary.

Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital.

Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to determine the frequency of hallway walking by older adults hospitalized for medical illness. The study was an observational time-sampled study, which was conducted in the hallways of 3 medical units of a 485-bed academic health care center. Each unit was observed weekdays for eight 3-hour intervals covering 8 AM to 8 PM. Before each observation, nursing staff were questioned about walking abilities of patients aged

Admission and discharge mobility of frail hospitalized older adults.

Functional decline during hospitalization is an important clinical problem with potential longlasting undesirable outcomes in frail elders. However, little is known about the change in mobility during hospitalization and the association with discharge status. A Mobility Classification Tool has been developed that categorizes progression of patients' in-hospital mobility using a 5-point scale. The validity and clinical usefulness of this tool was evaluated in a sample of 60 frail older adults hospitalized for medical illness. The tool allows nurses to assess, quantify, and communicate mobility levels and changes in mobility more accurately.