The UC Irvine Medical Center is currently being investigated for a complaint that was made by the California Nurses Association regarding faulty Curlin patient-controlled analgesia (PCA) infusion pumps.
The pumps are programmed to release a certain amount of pain reliever, typically morphine or hydromorphine, over a certain amount of time. Patients are given some control over how much drug is released but nurses are able to program a maximum dose so patients cannot get too much of the drug at one time.
However, the problem at the UCI Medical Center was that the patients were receiving too much of the narcotics. Several of these patients were sent to the intensive care unit to be monitored, but no irreversible damage was done.
On July 10, the California Department of Public Health (CDPH) found nothing wrong with the pumps themselves, and on July 13, CDPH observed that the problem actually involved the improper training of nurses. This lead to an “immediate jeopardy warning,” which was released within 24-hours after the Medical Center released a plan that was approved for the training program for new nurses and re-training program for existing staff.
According to Ralph Montano from the California Department of Public Health Services, the medical center is still under an “ongoing investigation,” and therefore no information regarding their investigation can be disclosed. But Montano did say that when a hospital is being investigated, the federal government is notified and the hospital either fixes it or federal funding is dropped.
Because the center was out of compliance with the Medicare Conditions of Participation, it must now present its plan of correction which was developed involving corrections in performance improvement, nursing and pharmaceutical services.
According to the Centers for Medicaid and Medicare Services (CMS) report, the Medical Center is now monitoring the effectiveness of training the nurses in how to program the PCA pumps in order to correct their performance. They have also been tracking the data that was entered into the “incident reporting system” related to the drugs given to counter the narcotics, and have been looking at the data involved in improved health outcomes with PCA pumps.
The Medicare demands for nursing services will be met by the 170 nurse “super users” who will help train and assist nurses to use PCA pumps and will forbid registry nurses and nurses without documented training to use the pumps. Nurses will also be audited to ensure that their training is being updated, and patient assignments will be reviewed daily to ensure that patients in need of PCA pumps will be assigned to nurses who are properly trained to use them.
Pharmacists will now make all decisions regarding the pumps, including which ones to purchase. They will also randomly audit the pumps in nursing units to ensure proper use.
According to the CEO of the UC Irvine Medical Center, Terry A. Belmont, pharmacists are working hard to correct the problems addressed by the CMS report.
“The efforts of CMS and other regulatory agencies are important for quality assurance and we take their findings seriously,” Belmont said. “Though CMS found no patients that suffered irreparable injury, we must and will do better to keep those in our care safe.”
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