IDENTIFICATION OF PATIENT-CONTROLLED ANALGESIA OVERDOSES IN HOSPITALIZED-PATIENTS - A COMPUTERIZED METHOD OF MONITORING ADVERSE EVENTS

OBJECTIVE: To describe and validate a computer-based quality assurance method that detects narcotic overdoses associated with patient-contro lled analgesia (PCA) use. SETTING: Two acute care teaching hospitals. PATIENTS: 4669 patients who received PCA. INTERVENTIONS: The following patient lists were obtained during a two-year period from both hospit al information systems: those who received PCA and (1) received naloxo ne, a narcotic antagonist, (2) were transferred to an intensive care u nit, (3) had a cardiac or respiratory arrest, or (4) died. Possible ov erdoses were defined as patients who appeared on the PCA list and one of the other lists. Charts were reviewed if the patient's name appeare d on the PCA and one of the other lists. Patients were judged to have experienced a narcotic overdose if there was an immediate improvement in blood pressure, respiratory rate, or mental status after the admini stration of naloxone. RESULTS: The search strategy identified 294 poss ible overdoses in 1499 patients who received PCA. Ten charts were unav ailable for review. An actual overdose occurred in 11 patients. The ac curacy of the new method was compared with that of the hospitals' pres ent reporting methods. Eleven overdoses were identified by the compute r search, but only 6 overdoses were identified in incident and adverse drug reaction reports. CONCLUSIONS: The systematic computer search id entified almost twice as many adverse incidents than were reported by the traditional hospital methods.