Monitoring Liability and Costs, Patient-Controlled Analgesics, PCA, Post-Operative Monitoring

What are the costs of implementing patient safety?

by Michael Wong

St. Joseph’s/Candler Health System (SJCHS) found out that the “costs” over a 5-year period of implementing a patient safety initiative was the prevention of at least 471 adverse events, a return on investment of $1.87 million, an internal rate of return of 81%.

Here’s the problem that SJCHS was trying to solve — Patient controlled analgesia (PCA) pumps give patients the power to control when pain medication (as prescribed by their doctor) is delivered to them by computerized pumps connected directly to the patients’ intravenous line (IV). Typically, PCA pumps are used by patients recovering from surgery, but of course any patient coping with pain may be provided a PCA pump.

Monitoring with pulse oximetry and capnography could enhance patient safety

Unfortunately, as the researchers relate in their study, “Intravenous Infusion Safety Technology: Return on Investment”, the use of PCA is “associated with significant hazards” to patients. Data gathered by MEDMARX and United States Pharmacoppeia from 1998 to 2005 indicate that patient harm increases more than 3.5 times when PCA is used. Moreover, according to the FDA, in 2004, the use of PCA was associated with 106 adverse events (including 22 deaths) and large-volume pumps were associated with 390 adverse events (including 17 deaths).

Consequently, SJCHS replaced its existing traditional IV pumps with “smart” IV safety systems. These smart IV safety systems contain drug libraries, best practices, and alerts that are designed to help prevent IV medication errors.  In addition, these smart systems included pulse oximetry (which monitors the oxygenation of the patient’s hemoglobin) and capnography (which measures the concentration of carbon dioxide exhaled by the patient). Shown below, averted error rates: risk of harm per 1,000 patient-days:

As the researchers concluded, “Implementation of these smart systems reduced high-risk medication errors and PCA-related undesired outcomes and provided an impressive 5-year ROI of $1,866,973 and an IRR of 81%”:

The question is no longer, “Can we afford to implement IV safety systems?” The real question is, “Can we afford not to?”

What do you think? (For more statistics and another study on how monitoring technology can improve patient health and safety, please see Postoperative Patient-Controlled Analgesics.)

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