'Just do something': Cancer patient implores Winnipeg health authority to upgrade outdated chemotherapy pumps
Hospitals in most other jurisdictions in the country have moved to 'smart' infusion pumps
Infusion pumps bring crucial cancer-fighting chemicals into the bloodstream and are used by hundreds of patients daily in Manitoba, but for various reasons, the province is lagging behind the rest of the country when it comes to adopting new "smart pump" technology.
CBC News has learned the Winnipeg Regional Health Authority (WRHA) had the chance to follow suit with the rest of country and upgrade to the more advanced pumps, but citing funding constraints and lack of readiness, opted to keep with the old pumps and sign a further 10-year contract for their use.
The news is another blow for Jennifer Zyla, a Winnipeg cancer patient who made headlines last month when she went public after documenting the use of infusion pumps in Winnipeg months after their safety checks had expired.
"Why? If there's something better, why?" she asked.
"There are budget concerns. I do know that," she said.
"But the other thing I do know is that these pumps are used 24/7, 365 in Manitoba. So right now, as we speak, there are people hooked up to these pumps — and not just [for] chemotherapy but other types of IV infusions."
CBC News reached out to hospitals and health authorities across the country and found that Winnipeg was one of only a handful of jurisdictions still using the Baxter Colleague — an infusion pump first purchased by the WRHA around 2005.
The Colleague was subject to a recall in 2010 in the United States after multiple reports of software and battery errors.
Health Canada did not follow suit, and instead worked with the company to address the defects.
CBC's survey also found hospitals in other regions, including Vancouver, Toronto, Ottawa and throughout Saskatchewan, have moved toward "smart pump" technology — the latest versions of infusion pumps, which experts say increase patient safety and remove elements of human error.
Older pumps 'error-prone'
The difference between smart pumps and the current general infuser used by the WRHA is the additional safeguards against unintentional human errors when dosing patients, said Joseph Cafazzo, the executive director of biomedical engineering at the University Health Network in Toronto.
"Smart pumps … are an evolution of that device, because in the past those devices, the conventional devices, tended to be error-prone," he said.
"There are a number of documented incidents over the years where they were misprogrammed — so either underdosing or unfortunately overdosing of a medication, which could cause harm."
Cafazzo says people should still feel completely safe using a general infuser such as the Colleague — which does have capabilities to connect to a drug library and sound an alarm if the wrong dose is administered.
But with the newer pumps, "there are improved safety features within it, as well as the simplification of the design, so that they are less error-prone for nurses, for patients, using those pumps for personal use," he said.
At the University Health Network, which encompasses the Princess Margaret Cancer Centre, Toronto General Hospital and Toronto Western Hospital, the switch over to smart pump technology was made five years ago, after the old contract for pumps expired.
Cafazzo said that any hospital or health authority is usually beholden to these contracts, which can often stretch 10 to 15 years.
"We happened to be in the renewal stage about five years ago," he said.
WRHA decided against smart pumps
However, so was the Winnipeg Regional Health Authority.
In 2011, it struck a working group to work with other Manitoba health authorities to replace pumps across the province. The WRHA's contract for pumps with Baxter was set to expire in 2013.
Options on the table included upgrading to Baxter's new smart pump model, or choosing between five other brands — including the BD Alaris smart pump, which is the model used by the University Health Network.
"No award" was chosen by the WRHA, meaning it would sign another 10-year contract to continue to use the Baxter Colleague.
"The conclusion was that complexity and expense of ensuring compatibility with the requirements of many different sites around the province with the proposals available at the time did not fit our needs — and ultimately would not be in the best interest of our patients," said Scott Sime, a spokesperson for the WRHA in a prepared statement.
With the new contract set to expire in 2023, Sime said the WRHA has struck another working group. The goal is to replace all infusion pumps in all of the province's health regions by the end of 2021.
The WRHA said it could not locate the budget allotted for the first request for proposals in 2011, and said the budget for the new replacement pumps has not been established.
'Get the updated equipment'
Zyla said she understands there are budget constraints for every government, but implores the government to move on from planning and get cancer patients the best care possible.
"Get the updated equipment, phase it in, start now. No more comments saying, 'It's a high priority, we're going to look at it, we're going to work on it. Somebody will research it,'" she said.
"You know enough of that. Just do something, even if you start small. Do something."
While Cafazzo said critical incidents of over- or underdosing are rare, and "the error rates, I believe, are dropping dramatically," the next generation of smart pumps further minimizes errors.
According to the CBC's database on medical device records, which records incidents reported to Health Canada about problems with devices, there were thousands of incidents that involved infusion pumps.
While some include small issues like damage to a pump, others are more serious — including a patient getting an overinfusion of fentanyl that resulted in the patient going into respiratory arrest.
Cafazzo says most critical incidents occur because of human error — which the latest smart pumps seek to eliminate. The latest version of smart pumps have Wi-Fi capability, which can access a master drug library and be connected directly to the patient's medical information.
"We're talking about thousands and thousands of patients around the world every day who are dependent on these types of technology and the properly administered medication — and at a specific dose and at a specific rate," he said.
"So it's hugely important, and unfortunately that human error often occurs, and so over time we've been trying to design these products to minimize those errors."
In Manitoba, according to the most recent publicly disclosed critical incident reports, the latest incident involving a pump happened because of an error programming the pump.
In 2016, a code blue — an emergency situation involving cardiac arrest — was called for a child after an error in programming an infusion pump. He was later resuscitated.
Baxter International, which manufactures the Colleague and a smart pump of its own called the Sigma Spectrum, said the Colleague is safe and effective "when used properly."
However, it pointed to the Spectrum as a system that includes software that "helps identify potential human programming errors."
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