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Author ORCID Identifier


Campus-Only Access for Five (5) Years

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Karen K Giuliano

Second Advisor

Joohyun Chung

Third Advisor

Juan M. Jiménez

Subject Categories

Critical Care Nursing | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Other Nursing | Perioperative, Operating Room and Surgical Nursing


The use of large volume intravenous smart pumps (IVSP) is widespread in the United States to deliver life-critical medications to acutely ill patients with about 90% of hospitalized patients receiving at least one IV medication, most of which are infused via an IVSP. The most popular IVSP technology was designed decades ago with minimal innovation since, although newer technology is available there has been little shift in the market use. The devices using outdated technology represent about 85% of the IVSP currently in use and require many manual setup requirements, high cognitive task load and have many failure points, all of which put patients at risk. Chapter One of this dissertation will introduce these technologies and demonstrate the need for improved understanding to drive innovation and improve patient safety.

In Chapter Two a systematic literature review of IVSP flow rate accuracy is presented, which explores the flow rate accuracy and associated IV medication error rates for the most commonly used IVSP in US acute care medicine. Also included in this chapter are 4 manuscripts previously authored by the PhD candidate that serve to demonstrate the clinical implications of this program of research. All 4 manuscripts build on the argument that there are many considerations and decisions that clinicians must make at the bedside when using these devices.

The methods and decision-making considerations for flow rate accuracy laboratory measurement are discussed in Chapter Three. This includes a discussion of the importance of clinical relevance to this research in addition to considerations that must be made to ensure a robust and controlled study.

In Chapter Four, results are reported from all studies conducted within this program of research involving the doctoral candidate. All these studies are important for the overall program of research because they are exploring variables that can impact IVSP safety and accuracy.

Chapter Five summarizes findings within this program of research with contextual discussion related to clinical and policy implications. This program of research thus far has demonstrated a need to improve patient safety through innovation that prioritizes usability and accurate flow under realistic clinical conditions.


Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Available for download on Saturday, May 13, 2023