Continuous Respiratory Monitoring and a "Smart" Infusion System Improve Safety of Patient-Controlled Analgesia in the Postoperative Period
Maddox, R. R.; Oglesby, H.; Williams, C.K.; Fields, M.; & Danello, S. (2006). American Journal of Health-System Pharmacy 63, 157-164.
http://www.ajhp.org/content/63/2/157.citation
Abstract
Effective pain management is essential to patient satisfaction, quality of care, and institutional compliance with Joint Commission standards. Patient-controlled analgesia (PCA) is a widely used, effective method of opioid administration for postoperative pain management. However, PCA therapy is also associated with serious risks.
The Anesthesia Patient Safety Foundation notes that the significant, underappreciated risk of serious injury from PCA in the postoperative period includes a low, unpredictable incidence of life threatening, opioid-induced respiratory depression (RD) in young, healthy patients. A recent study using continuous noninvasive monitoring of both oxygenation and ventilation found that the incidence of RD based on bradypnea was many orders of magnitude greater than the 1 to 2 percent widely reported in the literature. MEDMARXSM and U.S. Pharmacopeia (USP) data show that when PCA pumps are involved, the chance for patient harm increases more than 3.5 times.
The Joint Commission has noted that health care professionals’ concern about opioid-related RD is one of the barriers to adequate pain management. Improving the safety of PCA is thus a major factor in improving both medication safety and the quality of postoperative care.