Description of Event or Problem · 1
OUR CERNER EHR IMPLEMENTATION REQUIRES (FORCED FIELD) A DEMAND DOSE LOCKOUT, A ONE-HOUR LIMIT AND A 4-HR LIMIT ON OUR PCA ORDERS. OUR PCA PUMP (HOSPIRA LIFECARE PCA) DOES NOT ALLOW PROGRAMMING OF BOTH, THE 1 HR AND THE 4 HR LIMITS (ONE OR THE OTHER IS ALLOWED). THIS PUTS US IN A POSITION OF HAVING TO CARRY OUT A PHYSICIAN ORDER THAT WE CANNOT CARRY OUT USING THE TECHNOLOGY WE CURRENTLY HAVE. ON A BOARDER SCALE, IF A PHYSICIAN ORDERS A DEMAND DOSE LOCKOUT (6-10 MIN) AND A 4 HR MG LIMIT FOR A PARTICULAR PT, THERE IS A RISK OF THE PT FRONT - LOADING ALL ALLOWED DEMAND DOSES TO THE FRONT END OF THE 4 HR WINDOW. THIS HAS THE RISK OF PHARMACOLOGICAL OVERSEDATION EARLY IN THE WINDOW, AND INADEQUATE PAIN CONTROL IN LATER PART OF 4 HR WINDOW. WE THINK IT IS GOOD TO HAVE BOTH, A 1 HR WINDOW AND A 4 HR LIMIT PROGRAMMABLE. WE THINK THAT BOTH 1 HR AND 4 HR LIMITS SHOULD HAVE MAXIMUMS WHICH ARE LESS THAN SIMPLE MULTIPLES OF THE Q6-10MINS DEMAND DOSE. WE FEEL THAT THE PCA PUMP SHOULD HAVE THE ABILITY TO LIMIT THE DOSES ON ALL THREE PARAMETERS. DEMAND DOSE LOCKOUT, 1 HR MAXIMUM AND 4 HOURS MAXIMUM. WHERE DID THE ERROR OCCUR: HOSPITAL. REPORTER'S RECOMMENDATIONS: WE THINK IT IS GOOD TO HAVE BOTH, A 1 HR WINDOW AND A 4 HR LIMIT PROGRAMMABLE. WE THINK THAT BOTH 1 HR AND 4 HR LIMITS SHOULD HAVE MAXIMUMS WHICH ARE LESS THAN SIMPLE MULTIPLES OF THE Q6-10MINS DEMAND DOSE. WE FEEL THAT THE PCA PUMP SHOULD HAVE THE ABILITY TO LIMIT THE DOSES ON ALL THREE PARAMETERS. DEMAND DOSE LOCKOUT, 1 HR MAXIMUM AND 4 HOURS MAXIMUM. (B)(6).