Opioid Safety, Respiratory Compromise

The Path to a Safer PCA Pump: Improving Patient Safety with Integrated Capnography

By Timothy L.V. Wong (college intern with A Promise to Amanda Foundation, a non-profit working to ensure – “Monitor ALL PCA patients using Capnography – It Saves Lives”)

Patient Controlled Analgesia is the most common and effective form of pain treatment because it offers consistent and continuous pain relief. However, faults in current PCA technology are putting patients at risk everyday. Read More

Opioid Safety, Respiratory Compromise

Case Study in How to Eliminate Adverse Events, Improve Patient Safety, and Reduce Healthcare Costs

St. Joseph’s/Candler Hospitals reduced opioid-related events with patient-controlled analgesia (PCA) pumps. The hospitals are “error-free” since using “smart” PCA pumps with integrated capnography.

by Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

St. Joseph’s/Candler Hospitals (SJ/C) in Savannah, Georgia, are two of the oldest continuously operating hospitals in the US. About 10 years ago, SJ/C had three opioid-related events with patient-controlled analgesia (PCA) with serious outcomes over a two-year period.

Fortunately, none of these adverse events resulted in deaths, says Carolyn Williams, RPh, Medication Safety Specialist at SJ/C.

Since using “smart” PCA pumps with integrated capnography, SJ/C has been “error-free”. Read More

Opioid Safety, Respiratory Compromise

Hospitals Need to Address PCA Pump Patient Safety: Q&A with ISMP & Pennsylvania Patient Safety Authority

by Michael Wong

Pain control in hospitals using patient-controlled analgesia (PCA) need to be made safer. In this interview with Michael Wong of the Physician-Patient Alliance for Health & Safety (PPAHS), Tim Ritter (Senior Patient Safety Analyst at the Pennsylvania Patient Safety Authority) and Matthew Grissinger (Director, Error Reporting Programs at ISMP) discuss PCA pumps and why reliance on periodic checks by caregivers and pulse oximetry can only catch an adverse event, but not prevent an adverse event from occurring. For patient safety, PPAHS encourages continuous electronic monitoring, including the use of both capnography and pulse oximetry, of all patients using patient-controlled analgesia (PCA). Read More

Opioid Safety, Patient Stories, Respiratory Compromise

State Trooper’s Life Saved by Nurse: Why Hospitals Need a Monitoring Technological Safety Net

Retired Michigan State Police Officer, Matt Whitman, tells his story of how his life was miraculously saved by a nurse and why hospitals need a monitoring technological safety net to not rely upon miraculous interventions. 

by Matt Whitman (Retired Michigan State Police Officer, Law Enforcement Teacher, Van Buren Technology Center)

Former State Trooper Matt Whitman – “to all hospitals that care about their patients’ safety and welfare — Electronically monitor ALL your patients, not just the ones at high risk.”

Amanda Abbiehl and I share a similar story. Both of us were on patient-controlled analgesia (PCA) pumps to manage our pain.

However, the difference is that, by the grace of God, an observant nurse who just happened to walk by my room when I stopped breathing, called a “Code Blue”, and that ultimately saved my life. I would have been just another statistic if it wasn’t for that nurse. Unfortunately, Amanda was not so lucky. Read More

Opioid Safety, Patient Stories, Respiratory Compromise

Notre Dame class project: improving patient safety through monitoring

by Michael Wong

18-year old Amanda Abbiehl tragically died in 2010 at Saint Joseph Regional Medical Center (SJRMC).

The cause — a PCA (patient-controlled analgesia) pump error. Read More

Opioid Safety, Respiratory Compromise

Reducing Errors With Patient-Controlled Analgesia Pumps: Q&A With Bryanne Patail of the National Center for Patient Safety

In this interview, Bryanne Patail, biomedical engineer at the U.S. Department of Veterans Affairs, National Center for Patient Safety, discusses patient-controlled analgesia (PCA) pumps and what the Veterans Health Administration has done to reduce errors and improve patient safety.

by Michael Wong

Bryanne Patail, biomedical engineer at the U.S. Department of Veterans Affairs, National Center for Patient Safety, discusses patient-controlled analgesia (PCA) pumps and what the Veterans Health Administration has done to reduce errors and improve patient safety. This interview was conducted with Michael Wong of the Physician-Patient Alliance for Health & Safety. Read More

Opioid Safety, Patient Stories, Respiratory Compromise

Monitoring can prevent errors with patient-controlled analgesia

by Laura Batz Townsend

My Mom, Louise Batz, died from a preventable medical error after recovering knee surgery. Mom went into the hospital for knee replacement surgery.

This was not emergency surgery. She had planned the surgery so she would have enough time to heal and be ready to welcome the arrival of her fourth grandchild. Read More

Opioid Safety, Respiratory Compromise

PCA use – forgetting history (and monitoring) jeopardizes patient safety: An interview with Dr Jason McKeown

Although there are many benefits to the use of PCA, continuous electronic monitoring has greatly improved patient safety.

by Michael Wong

Patient-controlled analgesia (PCA) allows patients to “control” the amount of pain medication they receive. Although there are many benefits to the use of PCA, I discussed with Dr. Jason McKeown (Associate Professor, Medical Director – Inpatient Pain Service, University of Alabama School of Medicine), who is a member of the Anesthesia History Association and was the recipient of the Bullough Prize at the International Symposium on the History of Anesthesia in Cambridge, UK, in 2005, about the history of PCA and role of technology in ensuring patient safety when using PCA. Read More