Is going part-way for patient safety good enough?

This is the question that I have been asking myself ever since the Physician-Patient Alliance for Health & Safety posted an article encouraging Centers for Medicare & Medicaid Services (CMS) to include continuous electronic monitoring of patients using patient-controlled analgesia (PCA) pumps.

“Patient Controlled Analgesia (PCA) pumps” says Pat Iyer, president of www.avoidmedicalerrors.com, “were developed to address the problem of undermedication. They are used to permit the patient to self-administer small doses of narcotics (usually Morphine, Dilaudid, Demerol, or Fentanyl) into the blood or spinal fluid at frequent intervals. PCA pumps are commonly used after surgery to provide a more effective method of pain control than periodic injections of narcotics. This method of pain control has been found to result in less pain and earlier discharge from the hospital.” So, for the most part, use of PCA is safe and recommended.

However, unfortunately PCA is not always safe. A tragic example is that of Amanda Abbiehl, an 18-year old college bound high school student. As her parents, Brian and Cindy Abbiehl explain,“Our 18-year old daughter, Amanda, died when connected with to a patient-controlled analgesia pump. Had she been monitored for adequacy of ventilation with capnography and oxygenation with pulse oximetry perhaps one of her nurses might have noticed her declining state and she would still be alive today.” For more on Amanda’s story, please visit http://promisetoamanda.org

CMS recently released the quality measures it is considering for adoption through rulemaking for the Medicare program. One of the measures under consideration (proposed quality measure #3040) calls for “appropriate monitoring of patients receiving PCA [patient-controlled analgesia]”.

CMS defines “quality measures” as

“tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient-centered, equitable, and timely care.”

More specifically, CMS is proposing that for “All patient admissions with initiation of an opioid via an IV PCA device that is active for more than 2.5 continuous hours” that these patients be monitored for “respiratory rate, sedation score and pulse oximetry”.

Patient safety will be improved by monitoring patients. However, the CMS proposed quality measure in requiring monitoring for “respiratory rate, sedation score and pulse oximetry” does not go far enough.

To make sure that there are no other Amandas, whether that be someone’s sister, father, grandmother, friend, or neighbor, it is essential to include continuous electronic monitoring for the adequacy of ventilation with capnography and oxygenation with pulse oximetry, as recommended by the Anesthesia Patient Safety Foundation.  This would ensure that there is an electronic safety net for all patients using patient-controlled analgesia pumps, so that they can receive there prescribed pain medication without the risk of adverse event.

Please contact CMS to express your support for proposed measure #3040 to adequately monitor patients using PCA:

  • Email: measureapplications@qualityforum.org
  • Subject line: CMS Proposed Quality Measure #3040
  • Message suggestion: “Please adopt measure #3040 to ensure the safety of patients using patient-controlled analgesia by ensuring that all patients are continuously electronically monitored for ventilation with capnography and oxygenation with oximetry, as recommended by the Anesthesia Patient Safety Foundation.”

Or, send a message to PPAHS for them to forward to CMS by clicking here.

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