As parents of a teenage daughter, our worst fears were that our daughter would become pregnant, take drugs, or drink and drive. Never did we imagine that our daughter would go into a hospital with an infection, be hooked to a patient-controlled analgesia (PCA) pump to manage her pain, and never come out alive; but this is exactly what happened.
Our 18-year old daughter, Amanda, was admitted to a local hospital on Thursday, July 15, of 2010. She was dehydrated, had lost at least 10 pounds, and had a virus that was causing a great deal of pain in her mouth and throat. Our family physician’s plan was to rehydrate her and put her on antibiotics for both viral and bacterial infection. This was to help jump start her system and hopefully she would be back home with us in a couple days.
The rest of Thursday was a rough day for Amanda. The morphine that the hospital staff was giving her was not getting rid of the pain. Moreover, Amanda’s tonsils and uvula were extremely swollen. She was still not interested in eating; even drinking hurt. To help manage her pain, Amanda was put on a PCA pump that allowed her to control the pain medication used (hydromorphone).
The next morning Amanda was found unresponsive and died.
Amanda was on a general care floor and was not on any kind of electronic monitoring that might have alerted staff to her deteriorating condition.
Would capnography monitoring have alerted Amanda’s nurses that she was experiencing respiratory depression that night?
We have come to understand that continuous monitoring is not standard protocol outside of operating rooms. We encourage all healthcare facilities to monitor with oximetry and capnography to eliminate the possibility of respiratory depression as a cause of death.
Hospitals like St. Francis in Indianapolis, Indiana, have been using continuous monitoring with Capnography and Pulse Oximetry for the last five years. They have not experienced any PCA related events during this time – that’s amazing!
My wife and I realize that we cannot get our daughter back, but we can raise awareness regarding respiratory depression. We have started A Promise to Amanda Foundation. With the help of The University of Notre Dame Graphic Arts Design Class, we have launched this website in her honor and to remind patients, their families, and their healthcare providers to always monitor PCA use with oximetry and capnography.
Losing our daughter has been and will always be the worst thing that could happen to us. The sunshine came into the room when Amanda walked in. She was very LOVED by all who knew her. Amanda was a diverse young lady who saw no color in people. She could spend the night at a friend’s house who lived in a million dollar home and the next day spend the night with a friend whose parents could barely make ends meet and still have the time of her life. There had never been a more diverse group of people attending Amanda’s funeral. The church was full beyond capacity and standing room. Our daughter was not perfect, but she was simply our Amanda, our only daughter!
We hope and pray that no one will ever have to feel the emptiness that we have in our hearts. Our 24-year-old son, Andrew, is now an only child and that breaks our hearts for him. Your sibling relationship is the longest relationship you will ever have and that was taken from him. We as a family have to find a new norm. A new norm? That is a work in progress and probably always will be.
We have started our efforts locally, here in South Bend, Indiana, but intend to contact hospitals nationwide, as well as non-hospital settings that provide anesthesia such as Oral surgeons, Plastic surgeons, Podiatrists, Bariatric Surgery Centers, and Ambulatory Surgery Centers.
We intend on getting this information out to the general public and where the decision makers can use it to make the proper decisions in hopes of saving lives. Everyone needs to know the disastrous consequences of respiratory depression.
It should not be a question if drug induced respiratory depression was the cause of death. It simply should be mandatory to continuously electronically monitor all patients by using both Capnography and Pulse Oximetry, every time a patient is placed on a PCA pump, every time a patient is sedated, every time a patient requires general anesthetic, every time a patient is given a powerful sedative, like morphine or hydromorphine.
In honor of our daughter we intend to make this our life long mission.