title: PCA safety data review after clinical decision support and smart pump technology implementation.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Duke University Hospital, Durham, North Carolina 27710, USA. prewi004@mc.duke.edu
authors.forename: Judy
authors.initials: J
authors.lastname: Prewitt
authors.forename: Susan
authors.initials: S
authors.lastname: Schneider
authors.forename: Monica
authors.initials: M
authors.lastname: Horvath
authors.forename: Julia
authors.initials: J
authors.lastname: Hammond
authors.forename: Jason
authors.initials: J
authors.lastname: Jackson
authors.forename: Brian
authors.initials: B
authors.lastname: Ginsberg
mesh_terms: D059787:Acute Pain / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000295:instrumentation*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D020000:Decision Support Systems, Clinical; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D061214:Patient Safety; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid