Patient-controlled analgesia (PCA) uses high-tech pumps with pain medication syringes. They are connected to a patient’s intravenous line or epidural catheter. PCAs deliver small, constant flows of medication. Additional doses are self-administered. The patient simply presses a button. They are also set so that patients can control when they receive medication. They do not have to receive constant flows. Before PCAs, pain was eased by ordering recurrent doses of narcotics. Patients frequently protested the number of doses required. PCA gives patients a sense of control.
Danger Seen with Patient Controlled Analgesia Actually Controversial
The broader concept of PCA is not restricted to a single class of analgesics or single route or mode of administration. It is likely that the future direction of PCA will be the evolution and refinement of alternative routes and drugs (other than opioids) for analgesic delivery. Whereas IV-PCA has a well-established safety track record as a method of opioid delivery, I challenge the PCA device industry and health care providers to work together to enhance the safety of PCA devices and PCA delivery to eliminate the harmful and even fatal mishaps that continue to occur. (Jeffrey A. Grass, MD, MMM Department of Anesthesiology, Western Pennsylvania Hospital and Allegheny General Hospital, Pittsburgh, Pennsylvania)
While PCA may be the safest mode of opioid delivery it is true that regardless of the route of administration, respiratory depression may still occur. To help prevent such incidents from happening, it should be remembered that some of the most significant strides in medicine and surgery are directly attributable to anesthesiology’s advances in patient monitoring. (Pat Iyer, MSN, RN, LNCC, President, avoidmedicalerrors.com)
Error-reduction strategies for PCA therapy should include a balanced approach of practice-related, system-related, product-related, and device-related efforts. By embracing proven prevention strategies, healthcare facilities can help reduce the risks associated with this technology and improve patient safety. (H.T.M. Ritter III, BA, CBET, CCE Senior Patient Safety Analyst Pennsylvania Patient Safety Authority)
Reasons Respiratory Depression is Seen After Using a PCA
Surgical patients are ordered PCA pumps. It is used when they are awake and feel pain. The button is not pressed if patients are feeling sleepy. It should also not be pressed by staff or family members trying to “help” the patient. This is called PCA By Proxy. An alert patient is more likely to take part in therapy. This will conceivably shorten their recovery time. Once the acute pain from surgery is controlled, they are converted to oral medications.
PCA pumps have built-in safety features. The total dose of medication the patient self-administers is within safe limits. Patient safety is an area of important concern with PCA. Grave errors sometimes occur when using them. Serious unintended consequences such as over-sedation, and respiratory depression occur.
Contributing factors include improper patient selection, inadequate monitoring, pump programming errors, PCA by proxy, patients’ self-administration of home medications while receiving PCA, and inadequate health care provider instruction about medications administered via PCA and their dosing and lockout periods. Adverse events due to one of these issues are avoidable. It is reduced with guidance for providers, patients, and family members.
Do you have a case where a plaintiff suffered respiratory depression while using a PCA? The medical records tell the story. Professional and thorough examination of the medical records and health related literature is vital to a positive lawsuit conclusion.
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