Way beyond pump v/s gravity arguments
There is an interesting discussion titled ‘Pump Vs Gravity’ in an online group exclusive for nurses. The discussion starts with a question post from a dedicated Nurse, who works in oncology/haematology department. Puzzled to see all chemo and biologics in her workplace run via gravity only, she asks “Is this unusual?”. And then paused a question whether the rest of the community uses a pump or gravity for chemo and biologics.
In the comments section, some nurses said running chemo on gravity is too risky as the prescription rates are very precise and even a slight variation medicine might cause serious harm. Many admitted that they use gravity drips only but it is an undesirable way of administering cancer drugs. A rational health practitioner observed, probably the hospitals are trying to save money spend on pumps and thus puts the safe administration all on the shoulders of the nurse with little or no protection in place. Many nurses use and advice to use flow regulators for longer infusions.
As many nurses in the discussion rightly pointed out, Chemotherapy agents have a narrow therapeutic index; even minor errors potentially can cause serious harm. And, hence it has to be considered as a “high-alert” medication. Almost every available literature on safe practices for chemotherapy insists medication through infusion pumps. But, even the best technology cannot eliminate errors completely.
Examples of chemotherapy errors include chemotherapy administration to the wrong patient, chemotherapy under- and overdosing, and incorrect route, rate, and time of administration. If treatment plans and chemotherapy orders are not verified during each treatment, errors may be repeated during subsequent chemotherapy treatments and go undetected throughout an entire treatment course. And moreover, sometimes the complicated interface of this automated interfaces lead to lethal administration errors as in these cases reported by ISMP safe medication alert.
Experts recommend using precision infusion apparatus and identification systems to reduce administration errors in chemotherapy, besides having an accurate, unambiguous order and continuous staff training. To avoid prescription errors, many recent studies advice to use smart infusion devices with expandable medicine libraries.
However, adoption of high-end IOT infusion pumps for every chemotherapy may not be a viable solution, considering the number of cancer patients increase per year and expected to rise by 70% in the next two decades, according to WHO. And it is high time to look into alternatives — new age affordable precision infusion solutions — for chemotherapy.