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Canadian Journal of Anesthesia 50:854-855 (2003)
© Canadian Anesthesiologists' Society, 2003

Correspondence

Programming errors from patient-controlled analgesia

Wolfgang Lederer, MD MSc and Arnulf Benzer, MD DEAA

Innsbruck, Austria

To the Editor:

Vicente et al. recommend hospital-operating procedures to minimize programming errors associated with patient-controlled analgesia (PCA) and to enhance their detection before patients are harmed.1 Most of the preventable incidents in anesthesia, however, involve human error.2 Anesthesiologists are frequently exposed to stress, operating under difficult and sometimes critical conditions including emergency situations.3,4 This requests a high ability to work under pressure. Stress is well known to occupy thought processes and decrease alertness. Drugs and alcohol (and hangover) can impair judgment, even in minor doses. Physical and mental strain, lack of sleep and immobility may cause lasting degradation of performance. Even minor illness can affect alertness. In addition, coordination and vision may be impaired by medication. Fatigue favours the acceptance of unwarranted risks. Emotional upset, including anger, depression, and anxiety decreases alertness, alters critical self-assessment and enhances risk-behaviour. Personal fitness and good health are important factors that influence situational awareness and performance. As generally in anesthesiology distraction means danger to the patient, all personnel involved in the use/programming of PCA pumps are strongly advised to avoid the following four situations:

- S tress;
- A lcohol (drugs);
- F atigue;
- E motional upset.

References

1 Vicente KJ, Kada-Bekhaled K, Hillel G, Cassano A, Orser BA. Programming errors contribute to death from patient-controlled analgesia: case report and estimate of probability. Can J Anesth 2003; 50: 328–32.[Abstract/Free Full Text]

2 Cooper JB, Newbower RS, Long CD, McPeek B. Preventable anesthesia mishaps: a study of human factors. Qual Saf Health Care 2002; 11: 277–82.[Abstract/Free Full Text]

3 Coomber S, Todd C, Park G, Baxter P, Firth-Cozens J, Shore S. Stress in UK intensive care unit doctors. Br J Anaesth 2002; 89: 873–81.[Abstract/Free Full Text]

4 Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V. Occupational stress and burnout in anaesthesia. Br J Anaesth 2003; 90: 333–7.[Abstract/Free Full Text]


Related articles in CJA:

REPLY
Kim J. Vicente, Karima Kada-Bekhaled, Gillian Hillel, Andrea Cassano, and Beverley A. Orser
CJA 2003 50: 856-857. [Full Text]  



eLetters:

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Programming Errors From Patient-Controlled Analgesia
Monakshi Sawhney
CJA Online, 3 Nov 2003 [Full text]
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