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Patient Controlled Analgesics in California Hospitals: Are They Safe?

Patient-controlled analgesic (PCA) infusion pumps allow patients to self-administer opioid analgesics within the limits prescribed by a physician or other health professional. They are frequently used to treat postoperative, obstetric, terminally ill, and trauma patients.

As San Diego malpractice attorneys, we are increasingly concerned about the number of medical errors associated with PCA use in hospitals in California and across the country. Since PCA pumps are used with potent opioids, even small errors can lead to serious patient harm. In fact, according to data from the Food and Drug Administration, PCA-related errors are three times as likely to result in injury or death when compared to device errors involving general-purpose infusion pumps.

Below are some of the most common medical errors associated with PCA infusion pumps:

Improper Patient Selection

Since PCA therapy requires the patient to deliver the dose, candidates for PCA should have the mental alertness and cognitive ability to manage their pain and communicate their pain level to health care professionals. However, the benefits of PCA have led some healthcare providers to extend its use to less-than-ideal candidates (e.g., young children, confused elderly patients), often at the expense of patient safety.

Prescription Errors

The PCA order itself can also lead to errors. For instance, reports indicate that prescribers have made mistakes in converting oral opioid doses to the IV route. In other cases, one opioid has been prescribed, but the dose has been for a different drug.

Even with correct PCA orders, clinicians have been known to make mistakes in communicating the orders, sometimes leading to serious harm to patients. In some cases, concurrent orders for other opioids while PCA is in use have resulted in opioid toxicity. Problems also have occurred when patients are started on PCA therapy but have a documented allergy to the ordered medication.

Drug Product Mix-Ups

Some opioids used for PCA have similar names and packaging, which has led to drug selection errors. This often occurs when health professionals fail to verify that the drug is correct before administering it to the patient.

For instance, errors have occurred when prefilled vials of meperidine and morphine have been packaged in similar-looking boxes. In addition, morphine is available in prefilled vials in two concentrations, but the packaging may not allow quick differentiation of the strengths, which can also lead to errors.

PCA by Proxy

Finally, reports also indicate that PCA pump patients have received dangerous and even lethal amounts of opioids when family members or clinicians activated the pump’s delivery request button on the patient’s behalf (i.e., PCA by proxy).

Source: Pennsylvania Patient Safety Authority

If you or someone you care about has suffered serious harm due to a medication error or other serious medical mistake, you may be entitled to compensation. For more information, please contact a San Diego medical malpractice attorney at the Law Offices of Robert Vaage for a free consultation.