Hospitals That Monitor
Hospitals that monitor PCA with integrated capnography have not only been able to reduce or eliminate adverse events related to PCA use, but have been able to achieve significant cost savings and return on investment.
Our goal should be to reduce all harm, understanding that we may not know how to today. When a patient dies from respiratory depression, the toll on the patient’s family, friends, and community are enormous. The cost of adverse events goes beyond the costs associated with a medial malpractice claim.
Frank Federico, RPh, Executive Director, Institute for Healthcare Improvement
The question is no longer, “Can we afford to implement IV safety systems?” The real question is, “Can we afford not to?”
“The strongest fix for PCA pumps is a forcing function, such as an integrated end tidal CO2 monitor that will pause the pump if a possible over infusion occurred.”
“Using this technology could prevent more than 60 percent of adverse events related to PCA pumps.”
The following hospitals are illustrative case studies:Bryanne Patail, biomedical engineer U.S. Department of Veterans Affairs, National Center for Patient Safety
Since using “smart” PCA pumps with integrated capnography, St Joseph/Candler Hospitals has been “error-free”. In addition, SJ/C calculates that:
- $4 million — estimated potential expenses averted (not including potential litigation costs)
- $2.5 million — 5-year return on investment
A few years ago, as Tammy Haslar, RN (Oncology Advanced Practice Nurse at St Francis Hospital) recently described to a class at University of Notre Dame, St Francis was in the process of replacing its IV pumps with “smart” IV PCA pumps. Research into best practice literature and guidelines lead them to purchase “smart” pumps with integrated capnography.
Although monitoring all patients using PCA can be seen as ‘extra-work’, our facility decided that we could not make the ethical decision of saying which patients should or should not be monitored and our facility made the decision that all patients with PCA would be monitored with capnography.
Prior to implementing capnography monitoring in 2010, 12.5% of moderate-to-severe patients progressed to Code Blue. After implementing end-tidal CO2 monitoring, that rate fell to 4.3% and then 0% in 2011.
Dr. Mark Wencel and Debra Fox, RN at Wesley Medical Center concluded, “End-tidal CO2 monitoring is an effective method for early detection of respiratory depression in patients receiving PCA and intermittent intravenous opioid pain management.”
KGH is the “first facility in Canada to implement continuous bedside capnography monitoring for postoperative patients with a history of OSA who are discharged from the recovery room to patient care wards.”
This retrospective study showed the number of blood gas measurements declined from 13,171 to 8,070, resulting in a total cost savings of almost $1 million over a 6-month period.