Anesthesiology

The researches find that the patient-controlled analgesia (PCA) is one of the most popular and effective methods for managing postoperative pain. Various types of continuous infusion pumps are available for the safe and accurate administration of analgesic drugs. Here we report the causes and clinical outcomes of device-related errors in PCA. Acute pain control is an important part of postoperative patient care, which is associate with promoting patient recovery; shortening hospital stay, and reducing medical costs. Patient-controlled analgesia (PCA) is one of the most popular modalities of acute postoperative pain management.

Patient-controlled analgesia

PCA is a method of analgesic administration in which an automatic infusion device controls the flow limit; thereby allowing patients to self-administer analgesics as per their requirement. PCA has proven its superiority over conventional nurse-controlled analgesia in decreasing postoperative pain. It has also been prove to improve patient satisfaction; preserve good pulmonary function, and shorten hospital stay. However, there is a high likelihood of medication errors; such as those in transcribing, prescribing, programming, dispensing, and monitoring, occurring at each stage. Occasionally, ≥2 combined errors can lead to complex errors in PCA.

 Most PCA involves opioid-based regimens. Therefore, errors in PCA are associated with a risk of opioid overdose and may cause serious adverse clinical outcomes. Therefore Many attempts to define and reduce PCA-associated medication errors have been made over a long period. But Resources on PCA-related medication errors have divided the errors into 2 main categories: human factor-related errors and device-related errors. PCA device-related errors account for 79% of the total errors in intravenous PCA, and human factor-related errors account for 6.5% of them. So far, studies have mostly focused on protection against human factor-related errors in PCA.

PCA-related medication

Several types of safety intervention programs, including those involving purchasing easier-to-use PCA pumps, using a standardized PCA protocol, educating nurses, and implementing an independent double-check system policy, have been established to prevent human factor-related errors in PCA. Paul et al  reported that these patient safety interventions considerably improve and stabilize the safety of PCA administration. Relatively less research has been direct toward PCA device-relate errors. However, there have been anecdotal case reports regarding PCA device malfunction associate with fatal morbidities that demand emergent resuscitation.

In this study, we assess the incidence of PCA device-relate errors according to the type of continuous infusion pump and describe the characteristics of these errors and their clinical outcomes.This retrospective study is approve by the Asan Medical Center Institutional Review Board. The requirement for written inform consent was waive by the institutional review board. Data are obtain from the electronic medical record database of the acute pain service (APS). The APS team comprises 3 nurses and staff anesthesiologists. Twice a day, APS nurses perform rounds of all postoperative patients using PCA devices and visit the patients during the daytime on weekdays.