Many medical devices that are currently on the market are sub-optimal for human use, thus contributing to medical errors. This places significant responsibility for device selection on purchasers. This paper describes a retrospective analysis of decision making processes for infusion pump selection in three large hospitals and focuses on patient safety. Through a series of detailed interviews and a study of relevant documentation we characterized the nature of the decision-making, patterns of communication, and the roles of different participants. Findings suggest that success of the process is related to effective communication among participants with different expertise and adequate device usability assessment during the process. The paper discusses how information technology could provide support to distributed institutional decision making.