Case Study: Munson Medical Improves Patient Safety With Wireless Monitoring

Patient-controlled analgesia (PCA) is widely used to administer pain-control medication. But as the Anesthesia Patient Safety Foundation (APSF) reports, the available evidence suggests a significant and underappreciated risk of serious injury from PCA in the post-operative period, including a low but unpredictable incidence of respiratory events in young healthy patients. The most serious PCA-related adverse event is oversedation, which can lead to respiratory depression, increased lengths of stay, emergency interventions, ICU admissions and even preventable deaths.

Today's nursing shortage and busy work environments often preclude continuous, direct patient observation by general-care nursing staff. Pulse oximetry is often used to monitor the respiratory status of patients receiving PCA therapy, either continuously or on a "spot check" basis. However, early indicators of respiratory depression (changes in respiration rate, levels of EtCO2 and apneic events) are detected by capnography, not pulse oximetry. In a study of EtCO2 monitoring during procedural sedation, capnography captured 100 percent of those patients with respiratory depression, while pulse oximetry captured only 33 percent.8

Individual patient response to opioids varies greatly, and patient status can change quickly. The APSF advocates continuous monitoring of oxygenation and ventilation in patients receiving PCA. Reliable alerting methods (audible alarms, central stations, pagers) are required.