The Physician-Patient Alliance for Health & Safety has released the results of its first national survey of patient-controlled analgesia practices. Patient controlled analgesia is known to result in harm when safety practices are inconsistent.
Survey respondents included more than 160 health professionals from across 40 states, including physicians, nurses and pharmacists. Some findings from the survey include:
1. Eight-one percent of hospitals use smart pumps for all PCA patients.
2. Only 10 percent of hospitals performed double-checks on patient identity, analgesic dosage, programming of smart pump and attachment of lines to patients.
3, Double-checks were most likely for settings, drug selection and dosage and patient identity, with double-checks for these three items occurring more than 90 percent of the time. Dosage adjustments, patient allergy checks and line connection checks were less common, occurring between approximately 69 and 77 percent of the time.
4. Possible risk factors for harm or death for patients with PCA include potential sedative effects from mixing drugs (94.6 percent), pre-existing conditions (92.2 percent), advanced age (84.9 percent), being opioid naïve (81.3 percent), being obese (69.9 percent) or being underweight (63.3 percent).
5. Despite these percentages, 15 percent of hospitals did not consider advanced age as a risk factor, 20 percent of hospitals did not assess opioid naïveté, and 30 percent of hospitals did not consider obesity as a risk factor for harm or death from PCA.
6. When it came to adverse events, 65 percent of respondents said continuous electrical monitoring of PCA reduced adverse events, costs and expenses. Thirty-five percent said it was too early to tell.
7. Ninety-five percent of hospitals surveyed are worried about the effects of alarm fatigue. While 34 percent thought the problem is extremely difficult to solve, 61 percent did not think the problem is insurmountable.