To the Editor
In an earlier publication we described the experience with patient-controlled analgesia (PCA) by proxy at our institution (1999–2003).1 The objective of this study was to determine the impact of these earlier findings on the institutional use of PCA by proxy between 2004 and 2010. The IRB was informed of this retrospective research evaluating preexisting data captured during the quality improvement process.
Similar to our initial publication, the patient population comprised pediatric oncology inpatients; data were collected on 791 days (average 2.2 days per week). Every patient receiving PCA in the previous 24 hours had their medical record notes examined for any indications of respiratory or neurological complications. The definitions used for complications were the same as those in the original publication. PCA by proxy allowed the use by a clinician or a family member; the standard PCA was operated only by the patient. The drugs, doses, equipment, and procedures used for standard PCA and PCA by proxy are identical.
Of the 1537 records reviewed from patients receiving PCA during the 7389 PCA days, 7296 (98.7%) were complication free. This rate is comparable to that in our initial study reporting 4902 complication-free PCA days (98.6%). The use of PCA by proxy as a proportion of all PCA usage increased from 11.6% (1999–2003) to 49.7% (2004–2010). The complication rates in the proxy group were consistently low and similar to those in our earlier study (Table 1).
In conclusion, we report a 4-fold increase in the use of PCA by proxy as a proportion of all PCA usage with maintenance of the same low rate of complications. Institutional policies include the requirement to provide parent teaching before instituting a PCA by proxy and mandatory annual competencies for all prescribers and nurses including content for patient selection for proxy PCA.
Doralina L. Anghelescu, MD
Roland N. Kaddoum, MD
Linda L. Oakes, MSN, RN-C, CCNS
Kelley B. Windsor, MSN, RN-C, PCNS-BC
Lane G. Faughnan, RN
Division of Anesthesia
St. Jude Children's Research Hospital
Laura L. Burgoyne, BM, BS
Department of Children's Anesthesia
Women's and Children's Hospital
Adelaide, SA Australia
1. Anghelescu DL, Burgoyne LL, Oakes LL, Wallace DA. The safety of patient-controlled analgesia by proxy in pediatric oncology patients. Anesth Analg 2005;101:1623–7