Improving processes of care in patient-controlled analgesia: the impact of computerized order sets and acute pain service patient management.
BACKGROUND
In an effort to combat opioid induced side effects within the first 24 h of patient-controlled analgesia (PCA) induction, it has been recommended that care be provided by an Acute Pain Treatment Service (APS) and that computerized PCA order sets with patient monitoring requirements be implemented. To date, there are few published studies on the role of computerized order sets or APS in improving the quality and safety of pediatric PCA use. This retrospective analysis sought to determine if the implementation of computerized order sets would increase appropriate monitoring and problem recognition.


METHODS
Analysis included 536 patients prescribed PCA in one of three ways: an anesthesia order set with APS support (n = 285), a general PCA order set (n = 95), or no order set (n = 156). We analyzed the use of order sets by unit; the incidence of appropriate monitoring (> or =12 recordings within 24 h) of respiratory rate, oxygen saturation, and sedation level and the recognition of low respiration rate and low oxygen saturation between the types of PCA order.


RESULTS
We found a significant difference in type of PCA order used by unit. Appropriate documentation of respiratory rate and oxygen saturation occurred significantly more often if the order set with APS was used. Low respiration rate was also recognized significantly more frequently (P < or = 05) in the APS order set group.


CONCLUSIONS
These findings show that use of a computerized PCA order set with monitoring requirements and an APS can increase monitoring and documentation of important vital signs and increase identification of potential negative events.
Wrona
Sharon
S
Columbus Children's Hospital, Columbus, OH 43205, USA. wronas@chi.osu.edu
Chisolm
Deena J
DJ
Powers
Michael
M
Miler
Veronica
V
D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D016903:Drug Monitoring / Q000379:methods; D006801:Humans; D050316:Medical Order Entry Systems / Q000592:standards*; D009020:Morphine / Q000627:therapeutic use*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010100:Oxygen / Q000097:blood; D010146:Pain / Q000188:drug therapy*; D012129:Respiratory Function Tests; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D009020:Morphine; D010100:Oxygen