"Children's Health Ireland (CHI) developed a paediatric 'smart-pump' drug library using standardised concentrations" Howlett et al (2023).

Paediatric smart-pump IV drug library


Background: Standard concentration infusions and ‘smart-pumps’ are recognised as best practice in the paediatric setting. Implementation rates in European hospitals remain low. Children’s Health Ireland (CHI) developed a paediatric ‘smart-pump’ drug library using standardised concentrations. At time of development, other Irish hospitals continued to use traditional pumps and weight-based paediatric infusions.

Aim: To expand best paediatric infusion practices by nationalising use of the CHI drug library.

Setting: Tertiary paediatric, maternity and general acute hospitals, and associated transport services in Ireland.

Development: The CHI drug library was first developed for paediatric intensive care and then adapted over a 10-year period for use in emergency departments, general paediatric wards, neonatal units, adult intensive care and transport services. The original library (42 drug lines, 1 ‘care-unit’) was substantially expanded (223 drug lines, 6 ‘care-units’). A neonatal sub-library was created.

Implementation: Executive support, dedicated resources and governance structures were secured. Implementation and training packages were developed. Implementation has occurred across CHI, in paediatric and neonatal transport services, 58% (n = 11) of neonatal units, and 23% (n = 6) of paediatric sites.

Evaluation: A before and after study demonstrated significant reductions in infusion prescribing errors (29.0% versus 8.4%, p < 0.001). Direct observation of infusions (n = 1023) found high compliance rates (98.9%) and low programming errors (1.6%). 100% of nurses (n = 132) surveyed 9 months after general ward implementation considered the drug library had enhanced patient safety.

Conclusion: Strategic planning and collaboration can standardise infusion practices. The CHI drug library has been approved as a National Standard of Care, with implementation continuing.


Howlett MM, Sutton S, McGrath EL, Breatnach CV. Implementation of a national system for best practice delivery of paediatric infusions. Int J Clin Pharm. 2023 Nov 16. doi: 10.1007/s11096-023-01652-3. Epub ahead of print. PMID: 37971685.