Medication errors involving intravenous patient-controlled analgesia: results from the 2005–2015 MEDMARX database

Abstract

Background:The aim of this study was to determine the current magnitude and characteristics of intravenous patient-controlled analgesia (IV-PCA) errors, and to identify opportunities for improving the PCA modality.Methods:We conducted a descriptive analysis of IV-PCA medication errors submitted to the MEDMARX database. Events were restricted to those occurring in inpatient hospital settings between 1 January 2005 and 31 December 2015. IV-PCA errors were classified by error category, cause of error, error type, level of care rendered, and actions taken.Results:A total of 1948 IV-PCA errors were identified as potential errors (3.9%), nonharmful errors (89.5%), or harmful errors (6.7%) based on the National Coordinating Council for Medication Error Reporting and Prevention taxonomy for categorizing medication errors. Of these, 19.1% required a clinical intervention to address the deleterious effects of the error, indicating an underestimation of the risks associated with IV-PCA errors. The most frequent types of errors were improper dose/quantity (43.2%) and omission errors (19.9%). While human performance deficit was the leading cause of error (50.2%), other common causes included failure to follow procedure and protocol (42.2%) and improper use of the pump (22.7%). Although remedial actions were often taken to prevent error recurrence, actions were taken to rectify the systemic deficits that led to errors in only a minority of cases (11.8%).Conclusion:Preventable errors continue to pose unnecessary risks to patients receiving IV-PCA. Multimodal analgesic regimens and novel PCA systems that reduce human error are needed to prevent errors while preserving the advantages of PCA for the management of acute pain.

Comparing Patient-Controlled Analgesia Versus Non-PCA Hydromorphone Titration for Severe Cancer Pain: A Randomized Phase III Trial

“…Second, despite human and financial resources associated with PCA administration, including equipment cost and maintenance and management of complications, PCA reduces provider time and effort and may confer additional cost savings. [40][41][42] Cost benefits should be explored. Third, administration of opioid titration by a nurse having sole care of the patient, including availability every 15 minutes to reassess pain and/or titrate pain medication upward, may not be replicable in real practice.…”

Self-directed Learning (SDL) of Medication Safety Issues by Using a Dual Function (Educational & Supervisory) Checklist in Clinical Settings

“…The main format of the questionnaire was a "checklist" (an objective closed questionnaire) with dual educational and supervisory functions which designed as a tool for monitoring of drug events in hospitals and learn the facts simultaneously. The questions of checklist were classified in six categories including: demographic information of the patients, risk factors and facilitators (32 items), prescribing related questions (18 items), transcribing related questions (status of medical orders implementation by nurses) (3 items), rational medication use (RMU) (9 items), drugs reserving and storing indicators (17 items) and drug management indices (6 items) (14,15).…”

Kritische Ereignisse in der Akutschmerztherapie – eine Risikoanalyse von CIRS-Meldungen

“…An der Akutschmerztherapie sind als interdisziplinäres und interprofessionelles Tätigkeitsfeld zahlreiche Akteure beteiligt, sodass hier ein erhöhtes Risikoprofil vorliegt [25,28]. Der Einsatz von programmierbaren Pumpen, gemischten Medikamentenansätzen und oraler oder parenteraler (patientengesteuerter) Opioidapplikation birgt zusätzliche, potenzielle Risiken [1,17,19,27,33,34]. Das Thema systematischer Risikoanalysen und -steuerung wurde für den Bereich der Akutschmerztherapie bisher nur wenig betrachtet.…”