Patient-controlled analgesic (PCA) infusion pumps allow patients to give themselves pain relieving medication within certain limits as prescribed by a doctor or other licensed professional. PCA therapy is used for patients after an operation, obstetric patients, terminally ill patients and patients who have a serious injury. PCA pumps deliver medication through a needle (e.g.,intravenously) and allow patients to give themselves the medication by the push of a button. However, the Pennsylvania Patient Safety Authority has received about 4,500 event reports associated with PCA pumps. Many of the of the reports showed confusion about the medication order. The U.S. Food and Drug Administration’s Manufacturer and User Device Experience (MAUDE) database shows that PCA-related events are three times more likely to result in injury or death than events involving general purpose-infusion pumps.
Pennsylvania Patient Safety Authority Analysis
Pennsylvania Patient Safety Authority analysts researched the MAUDE database (as of January 31, 2011) for events involving PCA pumps and general-purpose pumps. Authority analysts found that out of 4,230 reports of events using PCA pumps, 826 (19.5%) resulted in injury or death. Of the 48,961 reports of events using general-purpose pumps, 3,240 (6.6%) resulted in injury or death. The difference in the number of injuries and deaths associated with these two different types of pumps may be due to the high-risk medications used with PCA pumps.
What You as a Patient or Caregiver Can Do to Avoid PCA Pump Medication Errors
Since the patient must deliver each dose of medication to him/herself from the PCA pump, it is important that the patient is mentally alert and able to understand how the PCA pump should work. The PCA pump patient should also be able to communicate their pain level to their caregiver. Therefore, children and confused older patients are not ideal candidates for the PCA pump.
Oversedation has also occurred in patients using the PCA pump who have health problems prior to their hospital stay. For example, obese patients, asthma patients, patients with sleep apnea or patients taking prescription drugs that may increase the effect of stronger pain relieving medications are questionable candidates for using the PCA pump.
Patient caregivers should be aware of any changes in the patient that do not seem right. For example, if the patient is still experiencing pain after dosing, have a healthcare worker double check pump programming.
If you are a caregiver, do not push the button for your patient. It increases the risk of the patient overdosing if more than one person is administering the medication.
Make sure you as a patient are able to understand what is expected of you if you are put on a PCA pump. If you are a caregiver, make sure the patient understands what is expected when using a PCA pump. This PCA pump education should be done before the operation or hospital stay.
For more information about the data and research on PCA pumps go the Authority’s website at www.patientsafetyauthority.org, click on “Patient Safety Advisories,” then the September 2011 article “Making Patient-Controlled Analgesia Safer for Patients.”