So, working in ICU, I never had anyone on a PCA pump w/ demand dosing since most of my patients are not with it enough to use the button so we just have them on continuous infusions. So I finally had one patient who was a&o X3 and I could not control their pain with the measly 1mg Dilaudid Q 2 hrs order I had. I finally persuaded the MD to order a PCA pump for this patient, and the order set I got was this:
Loading dose: 1mg
Continuous dose: 0.5mg/hr
Demand dose: 0.25mg
Lockout interval: 10 minutes**
4 hr limit: 4 mg. **
This order really annoys me! I don't understand why you would have a 10 min interval for the demand dose because if the patient actually uses it Q 10 min, they hit that 4 hr limit in the 1st hour, and then the pump wont deliver anything else, not even the continuous, until those 4 hours are up? Realistically, this patient could only press the button once every 30 minutes in order to not reach that 4hr limit too soon.
My patients pain was severe and he pressed it as frequently as possible and then the pump ended up locking out so he was getting NOTHING!
Am I missing something? I just want to know if this is a standard way to order PCA dosing.
The MD wouldn't change the order, so I just told the patient that if he wanted it to last he would have to press it no more than every 30 minutes
Dec 6, '11
by Ashley_RN, BSN
[0.2mg each dose/7min interval /3mg lockout in 4 hours] is our typical Dilaudid PCA orders; however, everyone is individualized. What is the pain for? Any option for bolus doses?
I second the pain specialist, if available. They are wonderful & creative as the poster above stated. If Dilaudid isnt working, what about a changing the med in the PCA? Fentanyl? Morphine? Although in my experience (which isnt saying much, Ive just passed my year
), I'm usually switching from Fentanyl to Dilaudid for better pain control. Does his meds need to be IV? Can he be changed over to something longer acting, ex. Oxycontin with breakthrough PRN? What's his HCT & renal situation, can Toradol be of some additional help if IV is the only way?
I absolutely feel terrible for patients in pain; has your MD SEEN the patient? When I'm working with a "stingy on the pain meds" doc, I tell them to get their butts in to see the patient so THEY can be the ones to explain why they will not order anything further. Sometimes after seeing the pain on the poor patient's face, they come around
Last edit by Ashley_RN on Dec 6, '11