1. The effectiveness of interventions in preventing medication errors in patient controlled analgesia among post-surgical patients: A systematic review
Ms Irene Mayo1, Dr Lucylynn Lizarondo2, Dr Murray Stokan3
1 MClinSc Candidate, The Joanna Briggs Institute, Faculty of Health Science, The University of Adelaide, SA 5005.
2 The Joanna Briggs Institute, Faculty of Health Science, The University of Adelaide, SA 5005.
3 Anaesthetics Department, Westmead Private Hospital, NSW 2145.
Background
Patient controlled analgesia (PCA) is recognised as a common and effective method of pain management in the post-operative period across the world1,3,4,5. It often involves the administration of an intravenous opioid, a high-risk medication, where the patient is able to self-administer a dose of analgesia within specific safety parameters.
PCAs are simple for the patients to use, but it takes trained healthcare professionals to setup and troubleshoot specific parameters for administration which involve a number of steps. Additionally, healthcare professionals must be trained in monitoring patients who are on PCAs for adverse events. This monitoring also entails trained staff to monitor patients with PCAs and the use of specific monitoring equipment to prevent adverse drug events particularly respiratory depression6.
Despite various safety interventions in place, several studies have highlighted PCA related medication errors remain to be an area of concern1,3,6. When seen as a process, PCAs have many areas where errors can occur: from poor patient selection, incorrect pump setup to poor patient monitoring. Therefore, it is important that healthcare professionals are aware of the best safety strategies to implement whilst caring for patients with PCAs to avoid adverse patient outcomes.
Acknowledgments
The author would like to acknowledge the following individuals for contributing their ideas and support for conducting this project: Dr Cindy Leigh
Objective
The objective of this systematic review is to identify, evaluate and synthesise the evidence for the efficacy interventions in preventing medication errors among post-surgical patients receiving PCA.
Methods
Type of participants:
This review will consider studies that include healthcare professionals responsible for prescribing, dispensing or administering medications, in charge of care of post-surgical patients using patient controlled analgesia.
Type of interventions:
Interventions will be classified according to the 2011 EPOC taxonomy2 of interventions aimed at achieving practice change. This taxonomy includes: delivery arrangements, governance arrangements and implementation strategies. Interventions grouped within the same taxonomy will be compared with one another.
Type of outcomes:
Proportion of patients with a PCA medication error
Incidence of PCA medication errors
Proportion of patients with serious adverse drug events from PCAs
Mortality
Morbidity
Search strategy
The search strategy will involve a three step process. An initial limited search of PubMed and CINAHL will be undertaken followed by analysis of keywords contained in the titles and abstracts, and of the index terms used to describe the article. A second search with all identified key words will be undertaken across PubMed, CINAHL, ProQuest, PsychINFO, Scopus, Cochrane Central Trials Register, Embase and Web of Science. Studies published in English and which meet the inclusion criteria will be considered.
Types of studies
Experimental and observation – analytic studies will be included in this systematic review.
Data Collection
Data will be extracted from papers included in the review using the standardised data extraction tool from JBI-MAStARI and they will be pooled in statistical meta-analysis using the same tool.
References
Clinical Excellence Commission (2013). Clinical focus report based on analysis of clinical incident reports in NSW health facilities. Retrieved from
Cochrane Effective Practice and Organisation of Care Group. (2011). Updated taxonomy of interventions. Retrieved from:
Hicks, R. W., Sikirica, V., Nelson, W., Schein, J. R. & Cousins, D. D. (2008). Medication errors involving patient-controlled analgesia. American Society of Health-System Pharmacists, Inc. 65, DOI: /ajhp070194
Ohashi, K., Dalleur, O., Dykes, P. C., Bates, D. W. (2014). Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug Safety, 37, DOI: /s
Paul, J. E., Bertram, B., Antoni, K., Kampf, M., Kitowski, T. Morgan, A., Cheng, J., Thabane, L. (2010). Impact of a comprehensive safety initiative on patient-controlled analgesia errors. Anesthesiology, 113(5), Retrieved from:
Schein, J. R., Hicks, R. W., Nelson, W. W., Sikirica, V. & Doyle, J. D. (2009). Patient-controlled analgesia-related medication errors in the postoperative period: causes and prevention. Drug Safety 32(7),