Intravenous (IV) smart pumps are among the most widely used medical devices in hospitals, yet they remain a significant source of medication errors. Researchers at the University of Massachusetts Amherst have now demonstrated that eye-tracking technology can provide unprecedented insights into how nurses interact with these devices, revealing usability issues that conventional testing methods often miss.
The study is the first known to use eye-tracking technology to evaluate IV smart pumps. By recording exactly where users look while programming infusion devices, the researchers were able to identify moments of hesitation, confusion and error, offering valuable information that could ultimately improve device design and patient safety.
Looking through nurses' eyes
The study builds on more than a decade of research into IV smart pump safety led by Professor of Nursing Karen Giuliano and Professor of Engineering Frank Sup, co-directors of the Elaine Marieb Center for Nursing and Engineering Innovation (EMCNEI) at UMass Amherst. Since launching the research programme in 2012, the team has published more than 30 peer-reviewed studies examining IV medication administration, including programming errors, alarm fatigue, workflow interruptions and the usability of infusion pumps under real-world clinical conditions.
The latest study focused on understanding how users visually interact with infusion pumps during programming. Thirty-one undergraduate nursing students wore Tobii Pro Glasses 2 eye trackers while completing medication administration tasks using four different IV smart pumps in the university's IV Smart Pump Laboratory.
The wearable eye trackers recorded participants' gaze direction and fixation times, allowing researchers to synchronise eye movements with every programming step. This provided detailed insight into where participants focused their attention, where they hesitated and which interface elements contributed to programming errors. According to the researchers, traditional usability testing can identify whether a user makes a mistake, but eye tracking reveals why that mistake occurs.
Interface design matters
The comparison of four commercially available infusion pumps revealed significant differences in both programming time and overall ease of use. The newest touchscreen-based system consistently outperformed older devices that remain widely deployed in hospitals. Participants completed identical programming tasks more quickly and with fewer difficulties, suggesting that interface design has a direct impact on clinical performance.
The researchers note that IV medication administration errors are associated with more serious patient consequences than any other medication delivery route. Given that an estimated 1.7 billion IV infusions are administered annually across the U.S. healthcare system alone, even small improvements in device usability could have substantial implications for patient safety. The eye-tracking approach itself originated from an interdisciplinary collaboration with mechanical and industrial engineering researchers who previously used the same technology to study how drivers interact with vehicle dashboards and safety systems.
Safer device development
The investigators believe eye-tracking technology could become an important tool for evaluating medical device usability before products reach routine clinical practice. By identifying interface elements that consistently confuse users, manufacturers can redesign systems to reduce cognitive workload and minimise the likelihood of programming errors. The research programme has already expanded beyond nursing students. A national follow-up study involving experienced critical care nurses from hospitals across the United States has been completed, using the same eye-tracking methodology to examine how clinical expertise influences interaction with IV smart pumps.
Ultimately, the researchers hope their findings will support manufacturers, healthcare organisations and regulators in developing safer infusion technologies. As hospitals continue to invest in digital medical devices, understanding not only what users do, but also how they think and where they focus their attention, may become an increasingly important component of patient safety and human-centred medical device design.
