City-wide medication use process standardization and implementation of intravenous patient-controlled analgesia consensus recommendations at an academic medical center

Introduction: Indianapolis Coalition for Patient Safety, Inc. (ICPS) identified practice variation across participating health-systems related to intravenous Patient-Controlled Analgesia (PCA) in 2018. No evidence-based published recommendations were available to provide optimization for the medication use process during this evaluation, leading to development of an ad hoc interdisciplinary group to address gaps.Objectives: Primary objectives were to operationalize safe use of PCA and evaluate implementation of ICPS PCA consensus recommendations at an academic medical center by assessing PCA prescribing patterns following policy and electronic health record (EHR) changes. Secondary objectives focused on markers of adoption changes and employee engagement.Methods: ICPS formed an interdisciplinary, diverse group of content experts representing six health-systems to review current PCA processes. Significant variations were identified, and a gap-analysis was completed to develop consensus recommendations. To evaluate implementation of these recommendations, a retrospective pre-/post-analysis was completed of patients at a safety-net, academic medical center from March 2021 to July 2022 who received an order for PCA. Prescribing patterns and electronic documentation were analyzed.Results: The ICPS PCA Safety Summit developed 45 consensus recommendations addressing the following PCA medication use processes: ordering, patient assessment, administration, EHR design, documentation tools, smart pump drug library settings, policies, adverse event monitoring, and education. Evaluation included a total of 155 patients. The ordered total number of morphine milligram equivalent (MME) potentially available per day to a patient from PCA, electronic documentation of opioid tolerance, and PCA smart infusion pump review all significantly improved post-implementation.Conclusion: City-wide standardization and development of PCA consensus guidelines filled a gap in practice to provide direction and optimization for the medication use process surrounding these high-alert medications. Organizational results following implementation provide evidence that using new EHR order sets and incorporating opioid tolerance resulted in more intentional PCA prescribing and more thorough electronic nursing documentation.