In our February 21, 2012 Patient Safety Tip of the Week “Improving PCA Safety with Capnography” we mentioned that the Physician-Patient Alliance for Health & Safety (PPAHS) had a workgroup addressing PCA safety. On their website are some heart-wrenching stories about patients who died during PCA, likely as a result of inadequate monitoring. We said we look forward to seeing that checklist when it is ready. Well, the PPAHS has now released that checklist for PCA pump safety (PPAHS 2012). Their website not only has the link to the PCA Safety Checklist itself but also links to several columns and blogs regarding PCA safety, PCA hazards, monitoring, capnography, etc. These are excellent resources.
Another excellent resource on PCA safety is the San Diego Patient Safety Council and the San Diego Patient Safety Taskforce, which put together a tool kit for PCA safety. It is a comprehensive document that discusses assessment for PCA appropriateness, distinction between opioid naďve and opioid tolerant patients, PCA patient education, pain assessment, sedation assessment, respiratory assessment, monitoring, adjuvant therapies (eg. for treating side effects of opioid therapy such as constipation, nausea and vomiting, pruritis), multimodal pain management strategies, standardized order sets, and specific issues related to equipment and products.
In our May 17, 2011 Patient Safety Tip of the Week “Opioid-Induced Respiratory Depression – Again!” we encouraged hospitals to perform their own FMEA (Failure Mode and Effects Analysis) on the PCA process and provided links to two tools we use when doing FMEA’s of the PCA pump process: the PCA Pump Audit Tool and the PCA Pump Criteria. And we hope that you’ll go back and look at the string of recommendations we made in our September 6, 2011 Patient Safety Tip of the Week “More Tips on PCA Safety”. We think you will find them extremely helpful. And don’t forget that most of the issues pertaining to patients on PCA pumps apply also to patients receiving postoperative opioids by other routes.
Other Patient Safety Tips of the Week pertaining to opioid-induced respiratory depression and PCA safety:
PPAHS (Physician-Patient Alliance for Health & Safety)
PPAHS (Physician-Patient Alliance for Health & Safety). Physician-Patient Alliance for Health & Safety Announces New Expert Checklist for Facilitating Safety of Hospital-Based Intravenous Patient-Controlled Analgesia Pumps. July 17, 2012
PPAHS. PCA Safety Checklist.
San Diego Patient Safety Taskforce. Tool Kit: Patient Controlled Analgesia (PCA) Guidelines of Care for the Opioid Naďve Patient. Published: December 2008