Disclosing a PCA programming error that slowed a patient's breathing
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Mr. James Whitfield is a 64-year-old man, 88 kg, who had a total hip replacement under general anesthesia this morning and is staying in the hospital. In recovery you started a hydromorphone PCA (a pain pump he controls with a button), ordered as 0.2 mg per press with no continuous infusion. The syringe supplied was five times more concentrated than the standard one, and when you programmed the pump you selected the standard concentration without checking it against the syringe label. Each press therefore gave five times the intended dose. Two hours later his nurse found him very drowsy, breathing 6 times a minute, with a low oxygen level. She stopped the pump; he needed brief assisted breathing by mask and a dose of naloxone, and then recovered fully. He is now awake, comfortable on oral pain medicine, and on continuous oxygen and breathing monitoring overnight. His wife is at the bedside. Both know only that he "had a reaction to the pain medicine."
Your task: explain to Mr. Whitfield what happened and answer his questions.