[roey]

Hello everyone! I am new here and have enjoyed the postings- a lot of good info. I was reading an article on how they are experimenting with patient controlled analgesic mostly after ortho surgeries like total knees. Instead of the nurse being paged and then administering the med, the patient is given one dose in sack and is to document their pain level and page the nurse after taking the med. The nurse documents and then refills the med. Has anyone had any expereince with this or heard of it being done? Thanks!

[CarVsTree]

Never heard of it and don't see how that is any different than a patient ringing for a dose of pain medicine. If it is every 4h prn, then you wouldn't be able to give them the pill before that time anyway. Otherwise, the patient would be at risk of overdosing. In addition, you wouldn't be able to do it with any controlled substance. So what would it be a motrin in a sack? Sounds prepostorous.

[beautifulb]

I am surprised that you havn't heard of it. I have used it in several hospitals. One down south and the others here in New England. We mainly use it for ortho's. It will deliver a dose of medication, for instance Morphine, every determined number of minutes when the pt. hits the "button". An example would be Morphine 1mg every 6min for a maximum total dose of 8mg per hour. It works really well and helps the patient to gain better control of their pain.

[SFCardiacRN]

The only patient controlled ORAL analgesic I'm aware of is the call light!

[NephroBSN]

Originally Posted by roey

Hello everyone! I am new here and have enjoyed the postings- a lot of good info. I was reading an article on how they are experimenting with patient controlled analgesic mostly after ortho surgeries like total knees. Instead of the nurse being paged and then administering the med, the patient is given one dose in sack and is to document their pain level and page the nurse after taking the med. The nurse documents and then refills the med. Has anyone had any expereince with this or heard of it being done? Thanks!

What sack are you talking about and is this oral or IV medication?

[KiKi05]

I work on a orthopedic surgery and oncology flood at my hosp. and we use a lot of PCA pumps. Most all of our ortho surgeries come back with a PCA pump from surgery and use them until the second post-op day. They are usually morpine but sometimes dilaudid, they are IV. They work great but you have to monitor your patients very closely as far as respirations ect...also a lot of our patients will be come slightly confused towards evenings.

[roey]

Thank you all for the responses. I know that this sounds strange, it did to me as well, but I read that there were clinical trials being done in the nursing journal Nursing 2004 and a clinical trial done in Toronto in July 2005. In the trials they were actually using Vicoden! The Vicoden was placed in a wrist pouch and in both articles found the patient controlled group obtained their pain goal better and faster than with the nurse controlled group. I was just interested in this and was wondering if anyone had encountered or heard of anything actually being practiced. Thank you again.

[RGN1]

We used Patient controlled analgesia in our UK hospital for all major orthopaedic and breast surgery (mastectomy & axilla clearance mainly). We call it PCA for short & it's usually 30mg morphine + 30mls water for injections in a 50 ml syringe which is in a pump. The pump is usually set to 1-2mg bolus with a 5-10 minute lock out. it works fantastically and patients get very good pain control. Usually they are in a peripheral vein but in my last hospital they did have some set to go into the epidural catheter but I don't know the drug concentrations for that. They have the pump for an average 24 - 36 hours before reverting to oral analgesia. It really is a great system.

[RGN1]

I forgot to add that it does mean you have to do hourly resps though and chart all the uses etc from the history on the machine.

[MsMouse]

I used this at a hospital I used to work at. It was a ortho unt and the protocol was strict. Patients had to sign a consent form to do it. Basically they were given a wrist pouch and were given 2-3 tablets of Percocet, Vicodin, or whatever po pain med they were wirtten for. They then had a flowsheet that they were supposed to write in the time and number of pills they took pain medication and pain scale when they took the med and 1 hour after they took it. The idea was that when the pouch was empty or only had one pill left, the patient would tell the nurse and she would come and refill it. There was a set limit of how many pills a patient could have with them (typically 1-2 doses), you had to document on the MAR when and how many pills you gave to the patient and upon discharge you had to recount and take back any unsued meds. It worked really well b/c the patients typically never had to wait for pain meds (unless their pouch was empty) and it was less work for the nurses. It was a lot less stressful when you knew someone was just calling for a "refill" than in urgent need of a pain med, even if it you were just giving them one dose. Also, it was the nurses responsibilty to make sure that only the patients who wouldnt abuse the system were on it. IE, the confused 90 year old wouldnt be allowed to use it or the the drug seeking patients. As far as I know, we never had any problems with it like patients ODing, selling the drugs or sharing them. I think there have been studies about it as well.