P atient-controlled pain medications are popular for post-surgical recovery, theoretically enabling people to get what they need when they need it, without having to wait for a nurse... though perhaps that's not so great. A recent study found flaws in the delivery of patient-controlled pain medications that amounted to greater likelihood of medical error. The study examined more than 9,500 errors that occurred with PCA over a five-year period and found that patients were harmed in 6.5% of those cases -- a major difference compared with the 1.5% rate associated with other medication errors.

Perhaps surprisingly, the problems didn’t typically result from patients overdosing themselves. Medical errors, including malfunctioning PCA equipment, incorrectly programmed doses (giving 10 mg/mL instead of 1 mg/mL per dose, for example) or incorrect medications, caused the most problems, with human error responsible for about 70% of them.

WHAT CAN PATIENTS DO?

To see what a concerned patient (or family member) could do to prevent these problems, I contacted the study’s lead author, Rodney W. Hicks, PhD, RN, FNP-BC, the UMC Health System Endowed Chair for Patient Safety and professor, School of Nursing, Texas Tech University Health Sciences Center in Lubbock, Texas.

Here are some suggestions:

Before your surgery and also for the immediate post-surgical time when you’re too foggy to think clearly, have a trusted family member with you to ask for information on the dosing and medications. After you are feeling more alert and aware, take responsibility for this yourself. Know what medication is prescribed and in what dosage and double-check that what you are getting is correct.

Your "trusted person" should be aware of any medication allergies you might have and should remind caregivers of them before medication is administered. "When we start these analgesia pumps on patients, the patients are usually coming out of surgery and that means they’re asleep," Dr. Hicks explains. "So if I don’t know that the person is allergic to morphine and I start them on a morphine pump… that’s trouble." He noted that in this study, the absence of allergy information was an issue. "Part of the problem is where allergies are documented. Sometimes the nurse uses one sheet, the OR staff another and the MD another."

Also important -- the person with you during recovery should be reminded never to push the button delivering the medication for you. Dr. Hicks said there were some instances of "errors related to PCA by proxy." "That means that someone else, likely a family member, pushed the button to administer more pain medication when the patient didn’t really need it," he explained. "Let’s say you’re a patient and you’re asleep, and a family member in the room is concerned that you’re going to experience pain so he pushes the button for you -- that can slow your breathing down so you can’t keep your blood oxygen levels up. It’s never intentional, but it happens." The solution: Don’t push the button for someone else.

The future will likely bring some changes in how PCA pumps are set up (perhaps with a simpler user interface and a bar-code-scanning system to ensure that the proper drugs are delivered) and how the medications are prescribed in an effort to eliminate those errors. For now, be careful -- even when you think you are in charge.