Physician-Patient Alliance for Health & Safety: Recently Proposed CMS Quality Measure Does Not Provide Enough Protection for Patients Using PCA

Physician-Patient Alliance for Health & Safety says CMS proposed quality measure does not provide enough protection for patients using patient-controlled analgesia (PCA) and is encouraging CMS to adopt continuous electronic monitoring with oximetry and capnography of all patients using PCA.

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strongly recommend that the proposed measure to monitor patients using PCA to include continuously electronically monitoring them with oximetry for oxygenation and capnography for adequacy of ventilation

Chicago, IL (PRWEB) January 25, 2013

Centers for Medicare & Medicaid Services (CMS) is now considering a new proposed quality measure (#3040) that calls for “appropriate monitoring of patients receiving PCA [patient-controlled analgesia .”

The importance of monitoring patients receiving opioids was recently emphasized by The Joint Commission in its Sentinel Event Alert No. 49, “Safe Use of Opioids in Hospitals", when it stated:

“While opioid use is generally safe for most patients, opioid analgesics may be associated with adverse effects, the most serious effect being respiratory depression, which is generally preceded by sedation.”

The CMS proposed quality measure provides that monitoring needs to be “documented” and the time between documentation must “not exceed 2.5 hours.” This means that a nurse or other caregiver must document the patient’s condition and do this in intervals of not greater than 2.5 hours.

Michael Wong, Executive Director for the Physician-Patient Alliance for Health & Safety (PPAHS) expresses concern with the CMS proposed quality measure as currently written, “Although the CMS proposed quality measure touches on a critical patient safety issue, the CMS measure only pays lip service to patient safety, as it goes against the recommendations of The Joint Commission, the Anesthesia Patient Safety Foundation, ISMP, and the Pennsylvania Patient Safety Authority. PPAHS encourages CMS to continuously electronically monitor with pulse oximetry for oxygenation and capnography for adequacy of ventilation of all patients using PCA."

Recommendations by the Anesthesia Patient Safety Foundation provide that these “spot checks” are not sufficient:
“Intermittent “spot checks” of oxygenation (pulse oximetry) and ventilation (nursing assessment) are not adequate for reliably recognizing clinically significant evolving drug-induced respiratory depression in the postoperative period.”

Dr. Frank Overdyk (executive director for research, North American Partners in Anesthesiology, and professor of anesthesiology at Hofstra North Shore-LIJ School of Medicine) explains the importance of PCA in managing pain, but also the need for continuous electronic monitoring of patients:

“Spot checks of SpO2, as are commonly taken on med/surg floors, need to be eliminated from patient monitoring practice because these single measurements may mislead a provider into thinking the the patient is fine when in fact they may be close to the precipice of unrecoverable respiratory depression.

“Entering a patient room and placing a pulse oximeter on their finger stimulates their consciousness and respiration sufficiently to falsely elevate their reading, particularly when they are receive supplemental oxygen. Once the provider leaves the room, this stimulus fades and the patient may lapse back into a dangerous level of respiratory narcosis.”

Moreover, as Matthew Grissinger (director, error reporting programs at ISMP) explains, “The CMS proposed quality measure regarding patient-controlled analgesia deals with a critical patient safety issue that hospitals need to urgently address. Errors with PCA occur and, unfortunately, sometimes with tragic consequences. However, for patients to be safe, we would strongly recommend that the proposed measure to monitor patients using PCA to include continuously electronically monitoring them with oximetry for oxygenation and capnography for adequacy of ventilation. In addition, standardization of PCA procedures would greatly reduce PCA errors and adverse events.”

For the complete article published on Patient Safety & Quality Healthcare, please see: http://www.psqh.com/news/psqh-blog/1509-does-cms-proposed-measure-for-pca-safety-go-far-enough.html

The Physician-Patient Alliance for Health & Safety is asking that those wanting to provide to CMS on its proposed quality measure can do so by emailing measureapplications(at)qualityforum(dot)org (subject line: CMS Proposed Quality Measure #3040).