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Using Video to Describe the Patient-Controlled Analgesia Pump Programming Process: A Qualitative Study.

Milisa Manojlovich1, Katie Barwig, Jember Bekele

  • 1School of Nursing, University of Michigan, Ann Arbor (Drs Manojlovich and Ali Charania); Von Voigtlander Women's Hospital (Dr Bradshaw), and Surgical Services and PM&R, Pain Service (Ms Lundy), University of Michigan Health, Ann Arbor (Mss Barwig, Bekele, and Streelman).

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Summary

Nurses face challenges programming patient-controlled analgesia (PCA) pumps, leading to errors. Video reflexive ethnography revealed workflow issues and programming uncertainties, prompting process changes.

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Area of Science:

  • Nursing Practice
  • Medical Device Usability
  • Patient Safety

Background:

  • Patient-controlled analgesia (PCA) pumps are critical for postoperative pain management.
  • Variations in PCA pump programming by nurses can result in medication errors.

Purpose of the Study:

  • To identify and describe the similarities and differences in how surgical nurses program PCA pumps.
  • To analyze the impact of PCA pump design on nursing workflow.

Main Methods:

  • A qualitative study employing video reflexive ethnography (VRE) was conducted.
  • Nurses were filmed programming PCA pumps; videos were analyzed by nursing leaders.

Main Results:

  • Nurses frequently ignored or silenced alarms and exhibited uncertainty in programming sequences.
  • Multiple interpretations of syringe loading and a misalignment between PCA pump design and nursing workflow were observed.
  • Video reflexive ethnography effectively visualized common programming challenges.

Conclusions:

  • VRE is a valuable tool for identifying challenges in PCA pump programming.
  • Nursing leaders are initiating process changes based on the study's findings to improve patient safety.