When a patient received high amounts of a narcotic due to their patient-controlled analgesia (PCA) pump being reprogrammed for an ordered increase, Nikki Verkleeren, PharmD, and the Pharmacy team at AHN-Forbes became passionate about addressing this safety risk. Their efforts turned into a network-level project with multiple facets that ultimately led to not only a new and improved and standardized PCA order set, but also a standardized drug library, standardized epidural orders, and a networkwide equipment upgrade.

Steps involved in this very lengthy process involved a PCA order set redesign including the following components: review of ISMP recommendations and data analysis, design of orders to limit need for higher concentration/admixed bags to lessen the chance for medication errors, and extensive work with the information technology department to define the build and validate on numerous occasions. In addition, Verkleeren and her team updated and personally built the PCA library, employing double checks by Pharmacy and incorporating recommendations from the epidural library reviews. The extensive work with the library was duplicated for pediatric populations as well.

Education was systemwide, with Verkleeren working with a physician advisory group to ensure provider education was adequate and order set wording was clear from a physician standpoint. She and the team reworked verbiage on high-dose PCAs to ensure the practice was feasible at all hospitals, even if palliative care is not available, and worked with all disciplines on education regarding this important safety measure. Verkleeren coordinated with the vendor and the installation of software and was the point person for the overall network go-live.  

The work and leadership required to carry this project through while Verkleeren conducted her normal day-to-day responsibilities was immense, but patients are safer across the entire system for it.

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