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題名 | 使用病患自控式止痛之安全性:病例報告=Safety Issues with Patient-Controlled Analgesia: A Case Report |
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作者 | 張明松; 鍾漢軍; 盧聞天; Chang, Ming-sung; Chung, Han-chium; Lu, Wen-tian; |
期刊 | Medical Journal of South Taiwan |
出版日期 | 20091200 |
卷期 | 5:2 2009.12[民98.12] |
頁次 | 頁105-110 |
分類號 | 416.5 |
語文 | chi |
關鍵詞 | 病患自控式止痛; 安全性; Patient-controlled analgesia; Safety; |
中文摘要 | 住院病患接受手術治療者,術後疼痛一直是困擾病人的原因。病患自控式止痛(PCA)因能有效降低術後疼痛且使用者滿意度高而被廣泛用於術後止痛。由於PCA使用的藥物Morphine如果不慎過量將會引起呼吸抑制的致死性副作用,所以PCA的安全性一直是一個重要議題。本文病例即因一連串錯誤造成病患使用PCA中,短時間注入過量Morphine而發生呼吸抑制,所幸即時處理而未發生任何後遺症。雖然PCA本身有許多安全設定,但是因為涉及人為操作,所以仍會因操作不當而影響病人安全。綜合檢討與PCA安全相關的課題包括了適當的病人選擇;代理人操作問題;機器本身的問題及人為錯誤問題。同時,對一個能提供PCA做術後止痛的醫院,為了能預防錯誤及提高PCA的安全性,美國安全用藥協會ISMP作了廣泛性的建議,包括在開處方時;配藥時;啟動PCA時及使用PCA中等等。唯有整個術後止痛團隊的醫師、護士、藥師及病患或其家屬都能遵照指示,才能確保PCA真正的安全。 |
英文摘要 | One of the main frustrations facing patients admitted for surgery is undoubtedly postoperative pain. Because of its effectiveness in lowering postoperative pain as well as its high user satisfaction, Patient-Controlled Analgesia (PCA) has been widely used as a method of postoperative pain control. However, safety concerns surrounding PCA has been a controversial issue because serious side effects of morphine overdose may lead to respiratory depression, sometimes even death. The case discussed in this paper is an example of a series of mistakes that lead to the patient under PCA injecting an overdose of morphine, which caused respiratory depression, thankfully with no further complications due to timely intervention. Although PCA itself includes many safety measures, it still involves the manual operation and can be a threat to patient safety if used inappropriately. A synthesis of safety-related issues surrounding PCA includes an improper patient selection, PCA by proxy, mechanical issues such as pump problems, and human errors. Furthermore, to increase safety and prevent errors, the Institute for Safe Medication Practices (ISMP) has released guidelines with regard to each step in the PCA process: prescribing and dispensing the medication, initiating PCA, and items for attention when using PCA. In the end, only when the entire postoperative group including doctors, nurses, pharmacists, as well as the patient and family followed orders and guidelines precisely, can the safety of PCA be assured. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。