An IV pump malfunction caused a patient to receive only half the prescribed medication dose for over 7 hours, and the issue was not caught because the pump's volume-to-be-infused (VTBI) reading was inaccurate, leading to delayed patient stabilization.
Existing IV pumps have safety alarms but fail to detect discrepancies between programmed VTBI and actual volume delivered, leading to under-infusion without clear alerts. The alarm system can be falsely triggered or bypassed manually, masking a critical defect.
Workarounds Described
- manually draining the bag and line to measure remaining volume
- adding extra volume to infused amount to compensate for alarm
- relying on double-sign-off at shift change to catch inconsistencies
- switching out the pump entirely as a diagnostic step
Implied Software Gaps
- Real-time volumetric infusion monitoring that cross-references programmed dose vs delivered volume and alerts on discrepancy
- Independent sensor-based verification of pump performance without relying on pump's internal VTBI reading
- Integration of pump data with patient electronic medical record to flag potential under-infusion trends over time
InfusionGuard Pro
InfusionGuard Pro is a smart IV infusion monitor that attaches to existing pumps to independently track volume delivered using a non-invasive flow sensor. It cross-checks against pump settings and alerts in real-time when actual delivery diverges from prescribed dose, preventing silent under-infusion. Unlike relying solely on pump internal sensors, it provides an independent verification layer.
- Clamp-on ultrasonic flow sensor for real-time volumetric measurement
- Wireless integration with hospital EMR and pump data
- Automatic alert if delivered volume deviates >5% from programmed VTBI
- Battery backup and self-check diagnostics
Existing Solutions Mentioned
Want to go deeper?
Sign up to save ideas, run AI analysis, and track opportunities in your personal workspace. Founding members get full access.
Join BetaSolutions (0)
Discussion (0)
No comments yet