{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:48:52Z","timestamp":1788284932549,"version":"build-2803163510"},"reference-count":52,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Intravenous smart pumps (IVSPs) use dose error reduction systems (DERS) to trigger alerts when an IV infusion is programmed outside the pump\u2019s drug library limits. Many IVSP alerts, however, are overridden, either by mistake, thereby potentially causing patient harm, or because they are clinically nonactionable. The purpose of this study was to describe the alert types and alert responses from IV infusions administered over 2 years in 107 US hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of alerts from more than 62 million IV infusions was conducted. The IVSP alerts and alert response types were described for all infusions, by medication class, and for the 30 medications with the most alerts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The alert-to-infusion ratio was 1 to 13.6 (0.074) for all infusions and 1 to 6.2 (0.160) for high-alert medications (HAMs). Dose alerts and duration alerts were the most common (45.6% and 34.6%, respectively). Most alerts (72.5%) were overridden (versus infusions being canceled or reprogrammed), with 74.9% of HAM infusion alerts being overridden. The override-to-reprogram ratio was 7.10 for all infusions and 8.99 for HAM infusions. The alert salience was 0.275 for all infusions and 0.251 for HAM infusions. Key medications with a high alert-to-infusion ratio, mostly dose alerts, and low alert salience were propofol, hydromorphone, oxytocin, midazolam, norepinephrine, and fentanyl.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study expands on the IVSP alert data published to date and highlights 3 key measures of alert override rates, including alert salience. Understanding the frequency and types of IVSP alerts and alert responses is critical for reducing unnecessary IVSP alerts and reducing alert fatigue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajhp\/zxag214","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:37:47Z","timestamp":1784029067000},"source":"Crossref","is-referenced-by-count":1,"title":["Targeting reduction of intravenous smart pump programming alerts: Insights from real-world use"],"prefix":"10.1093","author":[{"given":"Lori T","family":"Armistead","sequence":"first","affiliation":[{"name":"Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy , Chapel Hill, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan D","family":"Degnan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Purdue University College of Pharmacy , West Lafayette, IN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen K","family":"Giuliano","sequence":"additional","affiliation":[{"name":"Elaine Marieb Center for Nursing and Engineering Innovation, Elaine Marieb College of Nursing & Institute for Applied Life Sciences, University of Massachusetts Amherst , Amherst, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen F","family":"Eckel","sequence":"additional","affiliation":[{"name":"Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy , Chapel Hill, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026072313262695500_zxag214-B1","author":"World Health Organization"},{"issue":"1","key":"2026072313262695500_zxag214-B2","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1186\/s12916-020-01774-9","article-title":"Preventable medication harm across health care settings: a systematic review and meta-analysis","volume":"18","author":"Hodkinson","year":"2020","journal-title":"BMC Med"},{"issue":"10","key":"2026072313262695500_zxag214-B3","first-page":"651","article-title":"The medication-use process and the importance of mastering fundamentals","volume":"36","author":"Vogenberg","year":"2011","journal-title":"P T"},{"key":"2026072313262695500_zxag214-B4","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1136\/qshc.2004.011957","article-title":"Insights from the sharp end of intravenous medication errors: implications for infusion pump technology","volume":"14","author":"Husch","year":"2005","journal-title":"Qual Saf Health Care"},{"key":"2026072313262695500_zxag214-B5","first-page":"41","article-title":"Infusion pump adverse events: experience from medical device reports","volume":"20","author":"Brown","year":"1997","journal-title":"J Intraven Nurs"},{"key":"2026072313262695500_zxag214-B6","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1136\/bmjqs-2011-000089","article-title":"Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience","volume":"20","author":"Westbrook","year":"2011","journal-title":"BMJ Qual Saf"},{"issue":"8","key":"2026072313262695500_zxag214-B7","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1097\/01.NAJ.0000767808.75464.c3","article-title":"Secondary medication administration and IV smart pump setup","volume":"121","author":"Giuliano","year":"2021","journal-title":"Am J Nurs"},{"issue":"6","key":"2026072313262695500_zxag214-B8","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1097\/01.NAJ.0000938716.49846.e8","article-title":"Smart use of smart infusion pumps","volume":"123","author":"Aschenbrenner","year":"2023","journal-title":"Am J Nurs"},{"key":"2026072313262695500_zxag214-B9","author":"Institute for Safe Medication Practices"},{"issue":"3","key":"2026072313262695500_zxag214-B10","doi-asserted-by":"publisher","first-page":"e36007","DOI":"10.7759\/cureus.36007","article-title":"The impact of smart pump technology in the healthcare system: a scope review","volume":"15","author":"Alamer","year":"2023","journal-title":"Cureus"},{"key":"2026072313262695500_zxag214-B11","author":"AAMI Foundation"},{"key":"2026072313262695500_zxag214-B12","author":"Joint Commission"},{"issue":"3","key":"2026072313262695500_zxag214-B13","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1097\/01.NURSE.0000512888.75246.88","article-title":"Are smart pumps smart enough?","volume":"47","author":"Giuliano","year":"2017","journal-title":"Nursing"},{"issue":"2","key":"2026072313262695500_zxag214-B14","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1097\/NR9.0000000000000028","article-title":"Development of smart infusion pumps: state of the art and future perspectives","volume":"2","author":"Xu","year":"2023","journal-title":"Interdiscip Nurs Res"},{"key":"2026072313262695500_zxag214-B15","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1093\/ajhp\/zxab120","article-title":"ASHP national survey of pharmacy practice in hospital settings: dispensing and administration\u20142020","volume":"78","author":"Pedersen","year":"2021","journal-title":"Am J Health-Syst Pharm"},{"key":"2026072313262695500_zxag214-B16","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.cnc.2018.02.004","article-title":"Intravenous smart pumps: usability issues, intravenous medication administration error, and patient safety","volume":"30","author":"Giuliano","year":"2018","journal-title":"Crit Care Nurs Clin N Am"},{"key":"2026072313262695500_zxag214-B17","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1055\/s-0041-1730031","article-title":"Quantifying the impact of infusion alerts and alarms on nursing workflows: a retrospective analysis","volume":"12","author":"Yu","year":"2021","journal-title":"Appl Clin Inform"},{"key":"2026072313262695500_zxag214-B18","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1016\/j.sapharm.2019.02.007","article-title":"High-alert medication administration and intravenous smart pumps: a descriptive analysis of clinical practice","volume":"15","author":"Marwitz","year":"2019","journal-title":"Res Social Adm Pharm"},{"key":"2026072313262695500_zxag214-B19","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1186\/s12911-019-0945-2","article-title":"Smart pumps improve medication safety but increase alert burden in neonatal care","volume":"19","author":"Melton","year":"2019","journal-title":"BMC Med Inform Decis Mak"},{"key":"2026072313262695500_zxag214-B20","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1310\/hpj5002-113","article-title":"Optimizing smart pump technology by increasing critical safety alerts and reducing clinically insignificant alerts","volume":"50","author":"Mansfield","year":"2015","journal-title":"Hosp Pharm"},{"key":"2026072313262695500_zxag214-B21","doi-asserted-by":"publisher","first-page":"317","DOI":"10.2146\/ajhp140424","article-title":"Comparative analytics of infusion pump data across multiple hospital systems","volume":"72","author":"Catlin","year":"2015","journal-title":"Am J Health-Syst Pharm"},{"issue":"8","key":"2026072313262695500_zxag214-B22","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1002\/phar.2153","article-title":"Strategies for managing smart pump alarms and alert fatigue: a narrative review","volume":"38","author":"Shah","year":"2018","journal-title":"Pharmacotherapy"},{"issue":"6","key":"2026072313262695500_zxag214-B23","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1097\/PTS.0000000000000374","article-title":"Intravenous administration errors intercepted by smart infusion technology in an adult intensive care unit","volume":"17","author":"Ibarra-Perez","year":"2021","journal-title":"J Patient Saf"},{"key":"2026072313262695500_zxag214-B24","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxaf297","article-title":"Utilizing a real-world data set to assess titration practices for high-alert medications delivered via continuous infusions with smart infusion pumps","author":"Nery","journal-title":"Am J Health-Syst Pharm"},{"issue":"1","key":"2026072313262695500_zxag214-B25","doi-asserted-by":"publisher","first-page":"46","DOI":"10.4258\/hir.2016.22.1.46","article-title":"Clinical alarms in intensive care units: perceived obstacles of alarm management and alarm fatigue in nurses","volume":"22","author":"Cho","year":"2016","journal-title":"Healthc Inform Res"},{"key":"2026072313262695500_zxag214-B26","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0000000000001427","article-title":"Evaluating quality and safety during the administration of IV infusions during real-world IV smart pump use","author":"Vital","journal-title":"J Patient Saf"},{"issue":"6","key":"2026072313262695500_zxag214-B27","doi-asserted-by":"publisher","first-page":"433","DOI":"10.2345\/0899-8205-52.6.433","article-title":"Frequency and duration of infusion pump alarms: establishing national benchmarks","volume":"52","author":"Vitoux","year":"2018","journal-title":"Biomed Instrum Technol"},{"issue":"5","key":"2026072313262695500_zxag214-B28","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1097\/NAN.0000000000000295","article-title":"Perceptions of infusion pump alarms: insights gained from critical care nurses","volume":"41","author":"Vitoux","year":"2018","journal-title":"J Infus Nurs"},{"issue":"8, suppl","key":"2026072313262695500_zxag214-B29","doi-asserted-by":"publisher","first-page":"4","DOI":"10.7205\/MILMED-D-13-00505","article-title":"The mixed blessings of smart infusion devices and health care IT","volume":"179","author":"Nemeth","year":"2014","journal-title":"Mil Med"},{"key":"2026072313262695500_zxag214-B30","author":"BD"},{"key":"2026072313262695500_zxag214-B31","author":"Top 10 health technology hazards list released for 2011"},{"key":"2026072313262695500_zxag214-B32","author":"Becker\u2019s Healthcare"},{"key":"2026072313262695500_zxag214-B33","author":"ECRI Institute"},{"key":"2026072313262695500_zxag214-B34","author":"ECRI Institute"},{"key":"2026072313262695500_zxag214-B35","author":"ECRI Institute"},{"key":"2026072313262695500_zxag214-B36","author":"ECRI Institute"},{"key":"2026072313262695500_zxag214-B37","author":"ECRI Institute"},{"key":"2026072313262695500_zxag214-B38","author":"ECRI Institute"},{"key":"2026072313262695500_zxag214-B39","author":"ECRI Institute"},{"key":"2026072313262695500_zxag214-B40","author":"ECRI Institute"},{"key":"2026072313262695500_zxag214-B41","author":"ECRI"},{"key":"2026072313262695500_zxag214-B42","author":"ECRI"},{"key":"2026072313262695500_zxag214-B43","author":"ECRI"},{"key":"2026072313262695500_zxag214-B44","author":"ECRI"},{"key":"2026072313262695500_zxag214-B45","author":"ECRI"},{"key":"2026072313262695500_zxag214-B46","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxaf233","article-title":"Evaluating IV smart pump infusions and alarms in health systems across the United States","author":"Armistead","journal-title":"Am J Health-Syst Pharm"},{"key":"2026072313262695500_zxag214-B47","article-title":"Exploring the impact of medication type and infusion duration on IV smart pump alarms","author":"Armistead","journal-title":"Am J Health-Syst Pharm"},{"issue":"15","key":"2026072313262695500_zxag214-B48","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1093\/ajhp\/zxaa164","article-title":"Impact of interoperability of smart infusion pumps and an electronic medical record in critical care","volume":"77","author":"Joseph","year":"2020","journal-title":"Am J Health-Syst Pharm"},{"issue":"1","key":"2026072313262695500_zxag214-B49","doi-asserted-by":"publisher","first-page":"e30","DOI":"10.1093\/ajhp\/zxad245","article-title":"Data-based program management of system-wide IV smart pump integration","volume":"81","author":"Giuliano","year":"2024","journal-title":"Am J Health-Syst Pharm"},{"key":"2026072313262695500_zxag214-B50","author":"BD"},{"key":"2026072313262695500_zxag214-B51","volume-title":"AHFS Drug Information","author":"American Society of Health-System Pharmacists","year":"2025","edition":"2025 ed"},{"key":"2026072313262695500_zxag214-B52","author":"Institute for Safe Medication Practices"}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxag214\/68873324\/zxag214.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxag214\/68873324\/zxag214.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:26:32Z","timestamp":1784827592000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article\/doi\/10.1093\/ajhp\/zxag214\/8734703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":52,"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxag214","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"article-number":"zxag214"}}