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PCA Safety Data Review After Clinical Decision Support and Smart Pump Technology Implementation

Prewitt, Judy DNP, RN*; Schneider, Susan PhD, RN; Horvath, Monica PhD§; Hammond, Julia PharmD, BCOP; Jackson, Jason PharmD; Ginsberg, Brian MB, BCH

doi: 10.1097/PTS.0b013e318281b866
Original Articles

Introduction Medication errors account for 20% of medical errors in the United States with the largest risk at prescribing and administration. Analgesics or opioids are frequently used medications that can be associated with patient harm when prescribed or administered improperly. In an effort to decrease medication errors, Duke University Hospital implemented clinical decision support via computer provider order entry (CPOE) and “smart pump” technology, 2/2008, with the goal to decrease patient-controlled analgesia (PCA) adverse events.

Methods This project evaluated PCA safety events, reviewing voluntary report system and adverse drug events via surveillance (ADE-S), on intermediate and step-down units preimplementation and postimplementation of clinical decision support via CPOE and PCA smart pumps for the prescribing and administration of opioids therapy in the adult patient requiring analgesia for acute pain.

Discussion Voluntary report system and ADE-S PCA events decreased based upon 1000 PCA days; ADE-S PCA events per 1000 PCA days decreased 22%, from 5.3 (pre) to 4.2 (post) (P = 0.09). Voluntary report system events decreased 72%, from 2.4/1000 PCA days (pre) to 0.66/1000 PCA days (post) and was statistically significant (P < 0.001). There was a difference in the ADE-S data for causality (P < 0.0001) with sleep apnea and renal insufficiency approaching significance. Voluntary report system safety event were statistically significant for obesity [body mass index (BMI) ≥30] and weight.

Conclusion This study demonstrated a decrease in PCA events between time periods in both the ADE-S and voluntary report system data, thus supporting the recommendation of clinical decision support via CPOE and PCA smart pump technology.

From the *Associate Chief Nursing Officer, and †Department of Pharmacy, Duke University Hospital; ‡Duke University School of Nursing; §Health Intelligence & Research Services, Duke Center for Health Informatics; and ¶Acute Pain Team, Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.

Correspondence: Judy Prewitt, DNP, RN, Duke University Hospital, Box 3545, Durham, NC 27710 (e-mail:

The authors disclose no conflict of interest.

© 2013 by Lippincott Williams & Wilkins