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National survey reveals gaps in opioid PCA pump practices

October 31, 2013
by Pamela Tabar, Editor-in-Chief
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A new survey released this week on hospital practices for monitoring patients who use a manually controlled infusion pump to administer their own pain medications may hold lessons for long-term and hospice care as well. The survey, released by the Physician-Patient Alliance for Health and Safety (PPAHS), is the first national effort to study the risk factors involved in the hospital use of patient-controlled analgesia (PCA) pumps and the impact of proper monitoring of patient vitals during pump use.

Although the PPAHS study focused on PCA use in hospitals, the results provide plenty of lessons for long-term and hospice care. About 15 percent of hospitals surveyed did not consider advancing age to be an additional risk factor for pump-related adverse events, the report found. Low body weight and obesity are two other factors that are often overlooked as risk factors.

Within the hospital setting, the report finds:

  • 70 percent of adverse events are due to errors in pump settings or medication installation.
  • 3 out of every 20 hospitals are not following the recommended patient monitoring guidelines using either pulse oximetry or capnography.
  • hospitals that use electronic “smart pumps” for patient monitoring are almost three times less likely to have adverse events.
  • An overwhelming 95 percent of hospitals expressed concern over “alarm fatigue,”  wishing the PCA pumps had tools that would present all assessment data in a single resource for nurses.

Allowing residents to self-manage pain through the use of PCA pumps has long been viewed as a way to reduce the risk of overdoses. The Joint Commission now recommends the use of PCA pumps to help reduce oversedation and other adverse events, but stresses that the diligent monitoring of PCA users is crucial to maintaining their proper medication doseage.

“The assessments are particularly important when the dose has been increased or another type of opioid is administered. In addition to monitoring respiration and sedation, pulse oximetry can be used to monitor oxygenation, and capnography can be used to monitor ventilation,” notes the Joint Commission report. “Staff should be educated not to rely on pulse oximetry alone because pulse oximetry can suggest adequate oxygen saturation in patients who are actively experiencing respiratory depression, especially when supplemental oxygen is being used—thus the value of using capnography to monitor ventilation.”

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