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Infusion Therapy
Governance, protected time and clinical adoption, not technology, are proving to be the factors that decide whether infusion safety programmes deliver.
Medication errors remain a significant patient safety challenge in England, with an estimated 237 million errors occurring each year across all routes and settings.1 While most are unlikely to cause harm, around 66 million are considered potentially clinically significant.1
Intravenous (IV) medicines present particular challenges because of the complexity of their preparation and administration.2 Within IV therapy, administration is a major area of risk, with a pooled estimate of 101 IV medication errors per 1,000 administrations and 32.1% of errors occurring during the administration process.2 These risks are often practical and workflow-dependent, including pump-programming and calculation errors, knowledge gaps and failures in double-checking procedures.2
The Care Quality Commission has identified medicines safety as a priority and a key focus of its regulatory work with NHS trusts. In this context, infusion safety should be approached as a governed, multidisciplinary safety programme rather than solely as a device-level initiative.3
Smart pumps can support safer IV administration by incorporating drug error reduction software (DERS), which helps identify programming outside locally defined parameters and intercept potential administration-related errors before they reach the patient.4,5 However, technology alone does not guarantee safer practice. Its effectiveness depends on maintaining an accurate and current drug library, consistent use of the safety software, appropriate governance and alignment with clinical workflows.5 As infusion systems become increasingly connected with wider digital systems, implementation should therefore be followed by ongoing monitoring, maintenance and optimisation.5
In July, eighteen pharmacists, medicines safety specialists and digital leaders from organisations across the UK met in Birmingham at B. Braun’s Medicines Safety Forum (MSF), to examine that gap directly: how to implement, stabilise and optimise smart infusion technology in increasingly complex digital environments.6
The discussion moved beyond the pumps almost immediately.6 Across organisations at different stages of digital maturity, pharmacists identified the same determining factors, governance, stakeholder engagement, protected time, staff adoption and ongoing optimisation.6
A clear message from the MSF was that smart infusion is not simply a technology deployment. It is a long-term clinical safety programme, and its success depends on the systems built around the device.6
During the opening exercise, pharmacists described their biggest drug library challenge in a single word. Two answers dominated: time and governance.6 Pharmacists spoke about maintaining libraries alongside a full existing workload, working in isolation, and the vulnerability created when the knowledge to run a library sits with one or two specialists.6
The post-event evaluation reinforced this. Respondents most often identified drug administration errors as their biggest medication safety challenge, while governance, connectivity and drug library management were repeatedly raised as areas for improvement.6 The feedback provided useful context: organisations wanted stronger governance, better connectivity and more support to translate learning into practice.6
Examples from the forum showed that pharmacy may lead drug library work, but sustainable adoption is stronger when nursing, digital, clinical engineering and senior teams are involved early and understand how their decisions affect bedside use.6
Table 1 summarises the key stakeholder groups that may need to be represented in smart infusion governance discussions and the likely contribution each group can make.
| Stakeholder | Interests, aims and contributions |
| Governance | Interested in reducing medicines-related harm and strengthening learning from incidents. May help set safety priorities, review alerts and incidents, agree escalation routes and support governance discussions. |
| Pharmacy | Interested in standardisation, assurance and safe medicines use. May support ownership arrangements, review cycles, pharmacy time and documented clinical approval for library changes. |
| Nursing | Interested in nursing workflow, staff confidence and safer bedside administration. May identify training needs, nominate champions, gather staff feedback and support adoption across clinical areas. |
| Digital | Interested in the fit with the digital roadmap, including EPR, ePMA, connectivity and data. May advise on dependencies, timelines, data access and integration issues. |
| Technical | Interested in safe deployment, fleet readiness, configuration and maintenance. May support device updates, version control, pump availability, training logistics and troubleshooting. |
Table 1. Stakeholder groups involved in smart infusion governance and implementation. The table outlines the likely interests, aims and contribution of each group when planning, implementing or optimising smart infusion safety programmes.
One organisation illustrated this point in practice. During testing in the intensive care unit (ICU), the team identified that dose-rate medicines would need to be programmed differently, requiring a change from established clinical practice.6 Rather than treating this as a technical problem, the organisation strengthened governance, reinstated clinical oversight groups, engaged senior stakeholders and introduced targeted training for the move from flow-rate to dose-rate prescribing, administration and titration.6
The B. Braun Clinical Therapy Specialist team worked alongside ICU staff to support the new workflows. The result was a successful multi-site implementation, positive clinical feedback and a drug library that functioned as intended.6 This aligns with published evidence that structured smart pump training can improve ICU adoption.7 Lehr et al. reported 100% drug library compliance across 6 ICUs following a structured implementation programme incorporating e-learning, simulation-based training, extensive planning and multidisciplinary collaboration, highlighting the importance of combining education with organisational support.7
Go-live was repeatedly described as the start of adoption rather than the end of implementation.6 This requires particular consideration in paediatric, neonatal and oncology services, where standardisation must account for specialty-specific clinical requirements, workflows and safety risks.8,9,10
One organisation described a comprehensive drug library achieving only 50% compliance six months after go-live.6 Renewed stakeholder engagement, direct nursing feedback and targeted support increased compliance to 86%, alongside an improvement in reported safety culture.6 This emphasis on nursing feedback is supported by Beaudart et al., whose survey of ICU nurses found that smart infusion safety technology was perceived as an important tool for reducing medication administration errors, with drug libraries identified as the most important infusion pump feature.11 These findings reinforce the importance of considering bedside users' experiences and wider organisational factors, alongside drug library configuration.
Together, the forum experience and Beaudart et al. reinforce the importance of listening to bedside users when implementing infusion technology. The forum provided a further practical lesson: low adoption does not have to become permanent, but it is unlikely to correct itself.6 Measuring adoption allowed the organisation to identify the problem, understand where support was needed and respond.6
Data analytics was not explored in depth during the forum, but pharmacists did identify it as an area they would value more focus on in future sessions.6 The opportunity is clear: infusion data could help teams understand library use, compliance, alerts and variation in practice, provided there is support to interpret what the data is showing.
For teams already using smart pumps, the question is therefore not simply whether data is available, but whether it is being reviewed, understood and acted on. A useful starting point is to ask where variation is occurring, whether alerts are prompting learning, and whether library changes are being linked back to clinical workflow and staff feedback.
The forum also highlighted that support requirements change over time.6 Teams preparing to implement may need help with planning and engagement, while established users may benefit from support with library maintenance, integration, optimisation and learning from peers.6
To support that conversation, B. Braun has developed an Infusion Medicines Safety Maturity Model: a five-stage framework covering governance, library design, connectivity, analytics and clinical adoption. It is intended as a practical self-assessment, helping teams identify where the next realistic improvement may sit. The need for that kind of structured reflection was clear in the forum discussion.6
Pharmacists described limited time, isolated working conditions and difficulty securing engagement beyond pharmacy or medicines safety workstreams.6 Several also recognised that the expertise needed to sustain these programmes often sits across multiple disciplines, not with one team alone.6
B. Braun’s support services bring together clinical, digital, technical and medicines safety expertise to support organisations throughout the lifecycle of a smart infusion programme, from implementation planning and drug library development through to optimisation and scheduled ‘Health Checks’ (review meetings). By combining infusion data with an understanding of governance, clinical workflows and drug library management, B. Braun facilitates organisations to identify opportunities to improve adoption, strengthen compliance and support safer patient care.
The value of this combined support can be seen in practice. In one organisation, baseline drug library compliance with Space pumps was 64%, using a broad definition of compliance as any use of the drug library, whether an IV medication monograph or rate-only entry was selected.12 Following a hospital-wide upgrade to fully connected Spaceplus pumps, supported by DoseTrac analytics, compliance increased to 88%.12 While the data alone cannot determine the reasons for this improvement, the uplift indicates stronger adoption in routine clinical practice and is consistent with the role of effective implementation, staff training and actionable analytics in supporting behavioural change.
Feedback from live B. Braun accounts adds further context: across completed responses, 92% of respondents rated the clinical education provided as “Excellent”, with training described as clear, practical and responsive to local practice.13 Together, these findings suggest that connected technology releases more value when it is paired with clinical education, implementation support and data-led optimisation.
Taken together, the discussions pointed to a practical set of priorities for organisations implementing or optimising smart infusion, DERS or ePMA integration programmes: 6
Feedback from the survey showed that pharmacists valued the forum highly, with many highlighting how enjoyable, inclusive and interactive the day had been.6 Networking and hearing from other organisations were consistently described as some of the most valuable aspects, while sharing experience with other users was the single most cited takeaway.6 Every respondent identified a practical opportunity to strengthen medicines safety in their own organisation.6
Pharmacists asked for future forums to be more collaboratively led, with practical examples of governance in action and shared problem-solving supported by peers and B. Braun.6 The next forum is planned for Feb 2027. If you would like to be involved, or to propose a session, get in touch with us via the contact form below.
The Infusion Medicines Safety Maturity Model and self-assessment are available on request. If you would like to complete the self-assessment, please get in touch. It takes around 45 minutes with a multidisciplinary group and can be completed without supplier involvement.
If it would help to talk through your results, discuss library governance, or look at what your own infusion data is telling you, contact the B. Braun Medicines Safety Team through the contact form below.