Another use for the forced air warmer.

Plus II Infusion Pump is unique in several important respects. First, according to Abbott, by 2000, this device was the market leader, was used around the world, and accounted for about 75% of all PCA use in the U.S., being used in nearly 4,000 hospitals there.3,4 Furthermore, in 2001, ECRI (formerly the Emergency Care Research Institute, www.ecri.org) stated "this pump has a significant safety problem".5 In late 2002, ECRI continued to receive reports of deaths from programming errors with this pump.6 These deaths were not included in our epidemiological analysis. Second, "the Abbott PCA pumps are the only pumps that ECRI is aware of that can default to a low concentration setting".6 As we explained in our article, this design feature has important safety implications. For example, accepting an initially displayed concentration value of 0.1 mg·mL–1 could lead to an over-infusion of analgesic when a more concentrated drug preparation is used (e.g., 1 mg·mL–1 or 5 mg·mL–1). In contrast, accepting the initially displayed concentration value of 0.0 mg·mL–1, as provided by other PCA pumps described by Dr. Chan, presumably does not lead to any infusion — a fail-safe design feature. In retrospect, given that no study of this type had ever been conducted, analyzing the market leader that has unique design features linked with patient safety seems worthwhile. We agree with Dr. Chan that human factors analyses of other PCA pumps should be conducted and we encourage him and others to do so. If objective scientific evidence eventually confirms Dr. Chan’s opinion that all PCA pumps are equally error-prone, then the threat to patient safety of PCA use is even greater than anticipated; the total number of deaths from concentration programming errors alone could be greater than our initial upper estimate of 667.1 This would make the application of human factors engineering design principles to protect public health even more urgent.