In addition, standardization of PCA procedures would greatly reduce PCA errors and adverse events. However, for patients to be safe, we would strongly recommend that the proposed measure to monitor patients using PCA include continuously electronically monitoring them with oximetry for oxygenation and capnography for adequacy of ventilation. Errors with PCA occur and, unfortunately, sometimes with tragic consequences. The CMS proposed quality measure regarding patient-controlled analgesia deals with a critical patient safety issue that hospitals need to urgently address. As Matthew Grissinger (director, error reporting programs at ISMP) said about the measure: These health experts had criticized last year’s CMS proposed quality measure #3040, as it went against the recommendations of The Joint Commission, the Anesthesia Patient Safety Foundation, Institute for Safe Medication Practices (ISMP), and the Pennsylvania Patient Safety Authority. That proposed quality measure (#3040) provided that monitoring needs to be “documented” and the time between documentation must “not exceed 2.5 hours.” This meant that a nurse or other caregiver must document the patient’s condition and do this in intervals not greater than 2.5 hours.

Last year, CMS proposed a quality measure that many health experts think did not go far enough in protecting patients. This guidance recommends “at a minimum” that hospitals “have adequate provisions for immediate post-operative care, to emphasize the need for post-operative monitoring of patients receiving IV opioid medications, regardless of where they are in the hospital.” Ĭlinicians and hospital executives trying to understand this new guidance may wonder what CMS means by “monitoring.” Does it mean intermittent monitoring?

Hospital patients on IV opioids may be placed in units where vital signs and other monitoring typically is not performed as frequently as in post-anesthesia recovery or intensive care units, increasing the risk that patients may develop respiratory compromise that is not immediately recognized and treated.

Opioid-induced respiratory depression has resulted in patient deaths that might have been prevented with appropriate risk assessment for adverse events as well as frequent monitoring of the patient ’s respiration rate, oxygen and sedation levels. In its guidance, “ Requirements for Hospital Medication Administration, Particularly Intravenous (IV) Medications and Post-Operative Care of Patients Receiving IV Opioids,” CMS explains the reason behind the issue for this guidance:Įach year, serious adverse events, including fatalities, associated with the use of IV opioid medications occur in hospitals.

New guidance from the Centers for Medicare & Medicaid Services (CMS) recommends monitoring of patients receiving opioids.

Cms monitoring address