Adverse events involving intravenous patient-controlled analgesia

Hankin, Cheryl S.; Schein, Jeff; Clark, John A.; Panchal, Sunil J.

doi:10.2146/ajhp060220

Cited by 55 publications

(46 citation statements)

References 49 publications

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“…This early study took place before the 1990 change in Federal Reporting Guidelines that requires reporting of incidents involving 'device malfunctions and serious injuries or deaths' to FDA. A later study [12] found that nearly 80% of the 2009 reported incidents in 2002 and 2003 were blamed on device malfunctions and that nearly 65% of these suspected device malfunctions were confirmed by the device manufacturers. The human factors of pump interface design are an important means of reducing use errors [19,20].…”

Section: Pca Hazardsmentioning

confidence: 99%

Prototyping closed loop physiologic control with the medical device coordination framework

King

Arney

Lee

et al. 2010

Proceedings of the 2010 ICSE Workshop on Software Engineering in Health Care

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Medical devices historically have been monolithic units -developed, validated, and approved by regulatory authorities as standalone entities. Despite the fact that modern medical devices increasingly incorporate connectivity mechanisms that enable device data to be streamed to electronic health records and displays that aggregate data from multiple devices, connectivity is not being leveraged to allow an integrated collection of devices to work together as a single system to automate clinical work flows. This is due, in part, to current regulatory policies which prohibit such interactions due to safety concerns. In previous work, we proposed an open source middleware framework and an accompanying model-based development environment that could be used to quickly implement medical device coordination applications -enabling a "systems of systems" paradigm for medical devices. Such a paradigm shows great promise for supporting many applications that increase both the safety and effectiveness of medical care as well as the efficiency of clinical workflows. In this paper, we report on our experience using our Medical Device Coordination Framework (MDCF) to carry out a rapid prototyping of one such application -a multi-device medical system that uses closed loop physiologic control to a affect better patient outcomes for Patient Controlled Anelgesic (PCA) pumps. ABSTRACTMedical devices historically have been monolithic units -developed, validated, and approved by regulatory authorities as standalone entities. Despite the fact that modern medical devices increasingly incorporate connectivity mechanisms that enable device data to be streamed to electronic health records and displays that aggregate data from multiple devices, connectivity is not being leveraged to allow an integrated collection of devices to work together as a single system to automate clinical work flows. This is due, in part, to current regulatory policies which prohibit such interactions due to safety concerns.In previous work, we proposed an open source middleware framework and an accompanying model-based development environment that could be used to quickly implement medical device coordination applications -enabling a "systems of systems" paradigm for medical devices. Such a paradigm shows great promise for supporting many applications that increase both the safety and effectiveness of medical care as well as the efficiency of clinical workflows. In this paper, we report on our experience using our Medical Device Coordination Framework (MDCF) to carry out a rapid prototyping of one such application -a multi-device medical system that uses closed loop physiologic control to a affect better patient outcomes for Patient Controlled Anelgesic (PCA) pumps.

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Section: Pca Hazardsmentioning

confidence: 99%

Prototyping closed loop physiologic control with the medical device coordination framework

King

Arney

Lee

et al. 2010

Proceedings of the 2010 ICSE Workshop on Software Engineering in Health Care

View full text Add to dashboard Cite

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“…Errors may occur in the drug administration, usually by programming failures on infusion pump [24] and they may result in inadequate pain control, heavy sedation, respiratory depression, and, eventually, death of the patient [25]. Currently, many infusion pumps feature smart devices that are equipped with an integrated software library on dosing regimens of diferent drugs, thus avoiding underdosing or overdosing.…”

Section: Intravenous Pca (Iv-pca)mentioning

confidence: 99%

Patient-Controlled Analgesia (PCA) in Acute Pain: Pharmacological and Clinical Aspects

Fernandes¹,

Hernandes²,

Almeida³

et al. 2017

Pain Relief - From Analgesics to Alternative Therapies

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Moderate or severe pain are important sources of complications as well as morbidity and mortality in the postoperative period after surgical procedures. Patient-controlled analgesia (PCA) is an efective strategy for postoperative analgesia, since it may provide suitable analgesic dose just after system activation, with reduced periods of pain and an increase in patients' satisfaction. Although intravenous and epidural routes are the typical approaches used for PCA, regional patient-controlled analgesia has been shown to be an efective alternative providing a higher standard of analgesia with lower incidence of adverse efects. New devices and routes of PCA administration (transdermal, sublingual, inhalation, and oral routes) have shown to be promising alternatives in clinical studies. Nowadays, there is still no consensus regarding which is the best route or drug used since clinical eicacy/safety depends on the complex comprehension of the drugs pharmacokinetic proile through different routes of administration. Additionally, pharmacoeconomic studies are needed to evaluate the cost-efectiveness of these approaches.

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“…30 In addition, patients tended to prefer IV PCA, 30,31 which may result in greater patient satisfaction. [30][31][32][33] Although IV PCA provides no apparent decrease in cost or length of hospital stay, it does reduce demand on the nursing staff, who are required for delivery of IV or IM PRN analgesics. This reduced administration by the nursing staff may indeed have a cost benefit.…”

Section: Opioidsmentioning

confidence: 99%