Capnography, Patient Stories, Patient-Controlled Analgesics, PCA

Physician-Patient Alliance for Health & Safety (PPAHS) Adds Voice to Physicians and Patient Advocates Warning Patient-Controlled Analgesia (PCA) Pain Pumps Need Better Monitoring

The Physician-Patient Alliance for Health & Safety (PPAHS), an advocacy group devoted to improving patient health and safety, added its voice to a growing number of physicians and patient advocates warning that patient-controlled analgesia (PCA) pain pumps need to be continuously electronically monitored with oximetry for oxygenation and capnography for adequacy of ventilation.

In a recent article, Everyday Health reports on one case involving a pain pump was that of 18-year old Amanda Abbiehl of Granger, Ind., who was looking forward to high school graduation when she came down with a throat infection so severe it landed her in the hospital. Her parents were relieved when a patient-controlled analgesia (PCA) pain pump delivering powerful opioids finally seemed to relieve their daughter’s blistering throat pain.

18-year old Amanda Abbiehl recently died in a PCA-related incident

The Everyday Health article interviewed Amanda’s parents, Brian and Cindy Abbiehl:

“She was feeling much, much better…” says Cindy Abbiehl. “So I kissed her goodnight, told her we loved her…”

Recounting the night in July 2010, Cindy breaks down sobbing. It was the last time she would see Amanda alive. A coroner’s report found the “probable cause of death” was a viral infection, and due to a legal settlement, Brian and Cindy Abbiehl cannot discuss specific details of Amanda’s medical treatment. But the Abbiehls believe the pain pump may have played a role in her death. In her honor, they have set up a foundation (promisetoamanda.org) to educate health care professionals and patients about the potential risks of PCA pumps, and to provide safety checklists for those using pain pumps.

Michael Wong, executive director of the PPAHS, says, “Continuous electronic monitoring with oximetry for oxygenation and capnography for the adequacy of ventilation that the Promise to Amanda Foundation is creating awareness of provides a much needed technological safety net for patients. Had Amanda been monitored with capnography, perhaps her caregivers would have been alerted in time and she would still be alive today.”

Patient controlled analgesia (PCA) pain pumps are commonly used medical devices that allow patients to self-administer pain medication with the push of a button. “PCA is an effective way and a desirable way to give patients pain medicine,” says Frank J. Overdyk, MD, an anesthesiologist at North Shore University Hospital. “Yet it needs some safety mechanisms.”

According to the FDA, between 2005 and 2009, more than 500 patient deaths and 56,000 adverse events have been linked to PCA pain pumps.

Dr. Overdyk, who has been an expert in a number of legal cases involving PCA pain pumps, advocates for continuous electronic monitoring of pain pumps through technologies such as capnography, which monitors CO2 levels and alerts medical staff when there is a potential problem. As. Dr. Overdyk explains, one of the reasons why this  issue “has not come to the forefront more is because it is difficult to pinpoint the opioid affect.”

Says Dr. Overdyk, “Patients are typically told don’t worry you can hit the buttons as many times as you like. Unfortunately, it is not as simple as that.”

The PPAHS recently released a safety checklist that reminds caregivers of the essential steps needed to be taken to initiate Patient-Controlled Analgesia (PCA) with a patient and to continue to assess that patient’s use of PCA.

This safety checklist targeting PCA can be viewed and downloaded for free at www.ppahs.org

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