Patient-controlled analgesia (PCA) refers to a process where patients can determine when and how much medication they receive. It offers advantages which are more effective analgesia and fewer side effects than traditional analgesia theoretically. However, medical errors can occur which may dangerous and even fatal unless PCA is used appropriately. It is important to understand the factors that threaten patient safety with the use of PCA pumps. The aim of this study was to investigate the safety of the PCA pumps and the medical errors with PCA for post-operative pain control at Jen-Ai hospital in the past eleven years.
It was a retrospective study; the patients who received PCA for post-operative pain control were enrolled to the study during the period from April 1(superscript st) 1995 to Sept. 30(superscript th) 2005. The causes and the types of side effects and complications induced by PCA as well as the safety of PCA were analyzed and evaluated.
During the study period, 11589 patients were enrolled to the study. The result showed that the common side effects induced by PCA contained inadequate analgesia, nausea and vomiting, drowsiness, dizziness. The incidence of serious complication, respiratory depression which needed naloxone to reverse the effect of narcotics, was 0.12% and no fatal cases attributed by PCA were noted in the study. The causes of these side effects could be divided by human-related factors and equipment-related factors. Most of the problems were caused by human-related factors. There was no mortality due to drug overdose which attributed by pump malfunction. It revealed that the PCA pump (Baxter AP Ⅱ) we employed was safe and reliable.
Although PCA has considerable potential to improve pain management for patients, but patients receiving opioids in this manner may also develop some complications and even life threatening events as conventional analgesia. Since errors can occur inevitably unless PCA is used appropriately. Some factors must be considered to reduce the risk of PCA when PCA used for pain control. We always pay attention to consider the following situations, it includes use single concentration of drug, simplify the analgesics, no PCA proxy, teach the patients and their family to use the PCA pump correctly, follow up the patient everyday during the period of PCA, increase the ability of nursing care by adequate staff and nurse training. We conclude that these are the effective ways to increase the safety of PCA and therefore no mortality attributed by PCA at our hospital in the past eleven years.
PCA之安全性，與很多因素有關，包括使用PCA的作業流程、醫護人員和病人或家屬對PCA的瞭解、術後的照護等都息息相關，能安全的使用PCA渡過11個年頭的經驗，我們認為與本院所使用PCA的特色有關，包括1)使用單一濃度(morphine 1mg/ml)止痛藥，2)止痛藥物單純化，3)醫師每天訪視病人，並調整藥量，4)使用單一PCA機種(Baxter APⅡ)，5)教導病人及家屬正確使用PCA幫浦，6)訓練本科護士熟識PCA幫浦，7)教育病房護士認識PCA，可能發生的併發症，何時應通知麻醉科人員及馬上處理，8)舉辦全院護士對疼痛認識的教育課程。雖然這些都是很簡單的方法，然而對防止錯誤事件的發生很有幫助。