Groups that are ill-suited for PCA pumps

Hello again! In my first blog post, I identified several groups of individuals that were ill-suited mentally or medically for PCA pumps. Studies by the Institute for Safe Medical Practices have revealed that harmful errors were more likely to impact patients in these specific groups (Vicente, Kada-Bekhaled, Hillel, et al.). The patients who frequently cannot handle the responsibility of PCA pumps include infants, confused/obstinate patients, and substance abusers (D’Arcy). Patients who cannot medically handle the PCA pumps include asthmatic patients, obese patients, patients on other specific medications, and patients with sleep apnea. In this post, I am going to explain why each of these patient groups should not be prescribed PCA pumps and identify the risks that could face them if they were improperly prescribed one.

Using a PCA pump requires a patient to be capable of following directions, mentally aware, and responsible. For this reason, children under the age of seven and patients who suffer from confusion or disorientation should not be given PCA pumps. Some physicians may even choose to avoid prescribing these pumps for overly obstinate patients who have a poor ability to follow directions (Moe and Maloney). Substance abusers and addicts, other groups of patients that typically suffer from irresponsibility, can have many adverse reactions to the opioids in PCA pumps if their condition is not known to their healthcare provider. Even though these patients are typically assumed to be incapable of safely "self-medicating," clinical trials have found PCA pumps to be “useful for pain relief in this population” if the pump is programmed to allow for modified dosages (usually higher to account for patients developing a tolerance for opioids) and if nurses are alerted to watch over these patients closely (Prince). Substance abusers and other mentally impaired patients can all benefit from the technology of PCA pumps, as long as their healthcare provider correctly modifies the pump's programming to account for the patient's condition. For this reason, it is essential that physicians use established and common psychiatric examinations such as the Mental Status Exam (MSE) to determine the mental awareness and capabilities of all patients prior to PCA pump prescription (Goldberg).

Beyond being mentally incapable of handling a PCA pump, many patients have pre-existing conditions or conflicting drug prescriptions that could make a PCA pump dangerous. The Center for Medicare and Medicaid, a large government medical database and research facility, has found several case studies of chronic sleep apnea causing respiratory depression (essentially a deep sleep that leads into death) in patients treated with PCA pump opioids. Patients who take other drugs (either legal or illegal) can be exposed to dangerous effects if the medication they take reacts with PCA opioids. A detailed medical history can allow the physician to screen out and plan alternate pain management strategies for patients who take these conflicting drugs (Prince).

Most of the groups that commonly suffer complications from PCA pumps can be easily screened out. This can give physicians time to either modify the pump’s programming or design an alternative pain management strategy to protect the patient. With these modifications, PCA pumps are still the most effective and safe method for postoperative pain management.

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