Checklist Reminds Caregivers of Essential Steps

The Physician-Patient Alliance for Health & Safety (PPAHS), an advocacy group devoted to improving patient health and safety, has announced the release of a concise checklist that reminds caregivers of the essential steps needed to be taken to initiate Patient-Controlled Analgesia (PCA) with a patient and to continue to assess that patient’s use of PCA.

The checklist was developed in conjunction with renowned medical experts, including intensive care specialist and a leader in medical checklist development Peter J. Pronovost, MD, PhD, FCCM, Professor, Departments of Anesthesiology/Critical Care Medicine and Surgery, The Johns Hopkins University School of Medicine and Medical Director, Center for Innovation in Quality Patient; and Atul Gawande, MD, Professor in the Department of Health Policy and Management at the Harvard School of Public Health, who is a surgeon at Brigham and Women’s Hospital Professor of Surgery at Harvard Medical School and author of The Checklist Manifesto.

This safety checklist targeting PCA can be viewed and downloaded free at www.ppahs.org

“Every patient in a hospital has a responsibility to work with their healthcare provider to ensure their own safety,” said Michael Wong, executive director of the Physician-Patient Alliance for Health & Safety. “That is why, with the support of noted experts, we have developed a checklist of safety procedures for healthcare providers and patients using IV PCAs.  It is through the active collaboration of physicians, nurses and patients themselves that true patient safety be achieved.”

More than 56,000 adverse events and 700 patient deaths were linked to PCA pumps in reports to the Food and Drug Administration (FDA) between 2005 and 2009. One out of 378 post-surgical patients are harmed or die from errors related to the patient-controlled pumps that help relieve pain after surgical procedures, such as knee or abdominal surgery.

While research being conducted for alternatives to current PCA pumps is encouraging, for the sake of patient safety, healthcare providers should not maintain the status quo and wait for future developments.  Today’s patients and their family members should ask healthcare professionals:

• How the pump works and for a demonstration of warning signs
• Whether the patient’s oxygen levels are being monitored
• Whether the patient is being monitored for adequacy of ventilation
• If the patient’s weight, medical conditions and other medications are being taken into account

“Hospital protocols should call for two professionals to confirm pump settings, and continuous electronically monitoring of all their patients using PCA pumps with pulse oximetry and/or capnography, along with other measures to ensure the safety of patients. A number of centers now use capnography only to monitor ventilation in PCA patients. They have overcome the hurdles of early adoption and alarm fatigue with capnography and are showing excellent results. They have chosen to do this since they recognize the propensity for patients to be placed on supplemental oxygen and in that setting, the pulse oximeter may issue a delayed warning of critical respiratory depression,” commented Frank Overdyk, MD, Executive Director for Research, North American Partners in Anesthesiology, and Professor of Anesthesiology at Hofstra University School of Medicine, who was instrumental in the development of the Checklist. “The technology and know-how exist to reduce PCA-related incidents and deaths, and more advanced technology is being developed for the future.”

About PPAHS
The Physician-Patient Alliance for Health & Safety (PPAHS) is an advocacy group devoted to improving patient health and safety.  PPAHS, whose members include physicians, patients, individuals, and organizations, was inspired by Howard Snitzer, who survived 96 minutes without a heartbeat.  Snitzer’s resuscitation by volunteer paramedics and Dr. Roger White at the Mayo Clinic is a truly remarkable story.

PPAHS Executive Director Michael Wong is a graduate of Johns Hopkins University and is currently on the editorial board of the Journal of Patient Compliance, a peer-reviewed journal devoted to improving patient adherence.  Wong is passionate about improving patient safety and health outcomes through technology like capnography, a type of patient monitoring. For more information and to download the PCA safety checklist, visit www.ppahs.org.