Patient-controlled analgesic (PCA) infusion pumps allow patients to give themselves pain relieving medication within certain limits as prescribed by a doctor or other licensed professional. PCA therapy is used for patients after an operation, obstetric patients, terminally ill patients and patients who have a serious injury. PCA pumps deliver medication through a needle (e.g.,intravenously) and allow patients to give themselves the medication by the push of a button. Many of the of the reports showed confusion about the medication order. The U.S. Food and Drug Administration’s Manufacturer and User Device Experience (MAUDE) database shows that PCA-related events are three times more likely to result in injury or death than events involving general purpose-infusion pumps.
Other healthcare leaders also have strongly advocated for process simplification and standardization, including the Institute for Safe Medication Practice as published in their most recent safety improvement recommendations (summarized):
• Assess vulnerability to serious errors. Medication safety teams should review current practices around the use of custom concentrations.
• Limit concentrations. When possible, a single, standard concentration for each PCA drug should be used. If more than one concentration is deemed necessary by the organization, the number of standard concentrations should be limited to two at the most. Additionally, the use of custom concentrations should be minimized and, when possible, restricted to selected patient care areas.
• Distinguish custom concentrations. When a custom concentration is necessary, the container label should be very distinctive and should not look like the standard PCA syringe/bag label. Auxiliary labels (e.g., “High-Potency”) and a different color pharmacy label with specific instructions for programming the pump should be used for custom concentrations.
• Clarify the label. ISMP usually recommends presenting the total drug concentration in the bag/syringe first, followed by the amount of drug per mL below this within the same background or border on the product label. Depending on the PCA pump vendor, the user may be prompted to enter the concentration in a mg/mL strength. In these cases, it would be safer to express the concentration with the amount of drug per mL listed first, and then the total amount of drug/total volume in the syringe/bag.
• Match the MAR to the label. The concentration on the Medication Administration Record (MAR) should be listed the same as the PCA label.
• Employ an independent double-check. The narcotics used for PCA are high-alert medications; thus, an independent double-check of the product and pump programming should be considered. When replacing an empty syringe/bag, the empty container should be compared to the new container to verify the concentration is the same.
• Use barcoding technology. Some infusion pumps incorporate barcoding technology. Scanning the barcode on the PCA bag would help ensure the correct concentration is entered during PCA programming.
• Use smart pumps. PCA pumps with Dose Error Reduction System (DERS) should be used whenever possible. Because the significance of a low concentration alert during pump programming is not fully appreciated, low concentration limits should always be set as hard limits. Additionally, clinical advisories should be in place to reinforce caution when using custom concentrations.