Implementing Resilience Engineering for Safety Management in Patient-Controlled Analgesia

To apply the functional resonance analysis method (FRAM) and resilience engineering (RE) to identify sources of functional variability and systemic risk in the administration process of patient-controlled analgesia (PCA).

A qualitative case study conducted in a regional branch of a university-affiliated medical center in Taiwan.

Three focus group interviews were conducted with eight anesthesia nurse specialists (ANSs) who had more than four years of experience in PCA care. Functional mapping using the FRAM identified five main functional groups and 19 associated tasks. Functional variability and task coupling were analyzed based on participant narratives.

Performance variability was observed across all stages of the PCA administration process. Critical risks emerged from tightly coupled steps, particularly under conditions of high workload, shift handovers, and limited staffing. Functional resonance led to delays, configuration errors, and increased reliance on informal coping strategies. Recommended interventions included improved monitoring, early warning mechanisms, structured near-miss learning, and targeted training.

The FRAM effectively captured real-world variability in PCA workflows and revealed latent risks not evident in formal protocols. RE provided a framework for developing adaptive strategies to improve safety.

Integrating the FRAM into routine practice may enhance medication safety by making variability visible and supporting system-level redesign. Targeted staff training and workflow reorganization may reduce task interruptions and improve PCA delivery in high-demand environments.