Monitoring of patient-controlled intravenous analgesia in different age groups

Objective: The monitoring of patients using intravenous self-controlled analgesia (PCA) on the general ward is the most important measure for detecting mishaps at an early stage, and avoiding fatal consequences. Children and elderly patients are particularly vulnerable to such events. The present study looks at the question whether the quality of PCA monitoring in our hospital depends on the period monitored and the age of the patient. Methods: The monitoring protocols of 217 consecutive patients (age group 1: < 18 years, AG II: 18-70 years; AG III: > 70 years) were blinded and analyzed retrospectively. The number of monitoring events or the completeness of the documented monitoring were evaluated for time period (TP) 1 (4 hours after onset of PCA), TP 11 (to 8 am the following day), and TP III (plus a further 40 hours), and AG I and AG III compared, using AG 11 as reference (Mann-Whitney-U-Test). Results: Monitoring was completely documented in 18%, 9%, and 36% of the cases for TP 1, 11, and 111, respectively. Monitoring in children was documented significantly more often than in AG 11 patients. The proportion of completely documented monitoring in children was twice that in AG 11 patients in all monitored periods. No significant difference was observed in the monitoring frequency of patients above the age of 70 as compared with AG II. Conclusions: PCA monitoring on general wards was unsatisfactory; the monitoring of children was significantly better than in adults.