Automation and interoperability of a nurse-managed insulin infusion protocol as a model to improve safety and efficiency in the delivery of high-alert medications

The administration of high-alert medications requires the use of enhanced systems to prevent errors. One commonly used system relies on independent verification of dose changes by a second clinician, a human double check. This system is inefficient, and while it may reduce, it does not eliminate error. We postulate that the ability to integrate interoperable medication infusion pumps and electronic medical records systems with existing dose adjustment algorithms can improve the safety and efficiency in the delivery of high-alert and other medications. We followed step-wise systems engineering practices to develop and build a novel system, the Smart Agent, to semi-autonomously administer intravenous insulin according to our hospital's protocol for nurse-managed insulin infusion in the intensive care units. The prototype system used a commercial medication infusion pump and our existing electronic health record. We believe that this model of interoperable systems integration can be incrementally and broadly developed in the future to improve the safety and workflow of medication infusions.