Patient-controlled pain med can increase risk of errors

Intravenous patient-controlled analgesia (PCA) allows patients to control their own pain medication, but a new study published in the December 2008 issue of The Joint Commission Journal on Quality and Patient Safety shows that errors related to this practice are four times more likely to result in patient harm than errors that occur with other medications.

The study of more than 9,500 PCA errors over five years showed that patient harm occurred in 6.5% of incidents, compared to 1.5% for general medication errors. The PCA errors examined also were more severe —harming patients and requiring clinical interventions in response to the error — than other types of medication errors. Most errors involved the wrong dosage or the wrong drug caused by human factors, equipment, or communication breakdowns. The PCA errors examined also were more severe — harming patients and requiring clinical interventions in response to the error — than other types of medication errors. Harm associated with PCA errors can include respiration suppression, inadequate pain relief, and patient death.

"PCA orders must be written, reviewed and then accurately programmed into sophisticated delivery devices for patients to be pain-free," said the study's lead author Rodney W. Hicks, PhD, MSN, MPA, endowed chair for patient safety, University Medical Center Health System, and professor, Anita Thigpen Perry School of Nursing, Texas Tech University Health Sciences Center, both in Lubbock, TX. "Such complexity makes PCA an error-prone process," he said. "Health care organizations should now plan to make the process safer."

Data for the study came from voluntary reports to the United States Pharmacopoeia's (USP) MEDMARX Program, and shows that more than 60% of the hospitals anonymously reporting medication errors through MEDMARX had at least one PCA error.

To reduce PCA errors, Hicks and the co-authors recommend three strategies:

• Use bar codes and an electronic medication administration record to reduce errors that involve the wrong medication. Independent double-checks of the PCA orders, the product, and the PCA device settings should be standard practice, the study advises.

• Ask pharmacists to design easily understood and standardized forms for PCA, and ensure that prescribers use only these standardized forms. These actions would address communication problems that lead to errors and bring regional standardization to the PCA process.

• Simplify the technical equipment used in PCA. The study shows that the PCA process is heavily dependent on the ability of caregivers to execute sequential tasks successfully, so easy-to-follow setup instructions for equipment could reduce errors.