(1355) Optimizing Analgesic Administration With Smart Pumps: A Value-Based Care Strategy

Introduction: Infusion pumps are widely used to administer fluids and medications, with increasing evidence supporting their role in reducing medication errors and enhancing efficiency. This value-based initiative evaluates the impact of activating in-line bolus functionality, enabling the administration of bolus doses from existing continuous infusions.

Methods: Data was collected over 4 months post go-live to estimate annualized cost savings. The number of vials saved was determined by counting the bolus events recorded in the medication administration records. Cost savings from unused vials were calculated from the number of vials saved multiplied by their wholesale acquisition cost. Efficiency cost savings were estimated by measuring the average time (4 minutes) a bedside nurse spent dispensing, drawing, administering, and disposing of the unused portion of the medication for each bolus event. Total savings were calculated by combining the efficiency savings (time saved) with the cost savings from the vials saved.

Results: The in-line bolus functionality was activated for continuously infused analgesics (hydromorphone, fentanyl, morphine) and the sedative midazolam. Most boluses administered were hydromorphone (94.8%), followed by fentanyl (1.9%) and morphine (1.8%). In the first four months post-activation, 1,509 vials were saved, with an estimated annualized rate of 5,688 vials/yr, resulting in a total savings of $13,246. Projected time efficiency savings was $35,341/yr based on local workforce compensation data for clinical nurses ($93.2/hr). The total annualized savings, with the functionality activated were estimated at $48,587.

Conclusions: This project evaluates the impact of activating in-line bolus functionality of smart infusion pumps across all ICU regions. The moderate savings are likely underestimated as only four medications were included and savings from waste and environmental impact were not considered. Future work should explore the impact on other medications (e.g., vasoactive agents) and assess whether rapid bolus administration improves patient outcomes. Additionally, in-line bolus functionality appears to be a promising intervention during medication shortages and may enhance clinician wellness by reducing time on tasks and increasing bedside presence.