just a little thought

  1. I see people at the place I work charting, "patient encouraged to use PCA pump". Is that OK, does it sort of sound like the nurse is taking the Patient out of PCA? Would it not be better to say that, "reinforced teaching about use of PCA" or something along that line. Like I said it is just a little thing. Sounds like I am nit picking does it not?
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  2. 12 Comments

  3. by   TazziRN
    Not sure. I don't do PCAs since I'm in ER, but "encouraged" sounds okay to me. On the other hand, "reinforced teaching" sounds okay too. Perhaps the first way would sound better if it said "Pt encouraged to use PCA pump for breakthrough pain"?
  4. by   RNHawaii34
    hmmmm...maybe the nurse should reword it before charting it, sounds like the patient needs to press the pca button for pain medication....the pump is the machine that controls the amount of the pain medication. " reinforce teaching...." sounds much, much better.
  5. by   ragingmomster
    I will chart that pca teaching was completed, reinforcement needed because I am the one setting them up immediately after surgery.

    If I have a pt who isn't using it appropriately I will chart that I encouraged them to use the pca and for a particular reason, ie; "to increase mobility", " to increase TCDB functions".

    I also try to document why the pt tells me she is not using the pca enough and what I taught about that specific subject.
  6. by   Tweety
    I think think "teaching" is a better word than "encouraged". JACHO is big on teaching, and the idea behind is PCA is that it's patient controlled. I agree with the above poster that some elaboration is needed if you're encouraging the patient to use it.


    "Encouraged" could be used in the context if the patient's pain isn't well controlled, but yet they are not using their pca appropriately. "Encouraged to quit whining about pain when they have PCA at their disposal that they haven't pushed in two hours" would be a perfectly accepted note.

    j/k....
  7. by   VickyRN
    I agree - use the word "teach" or "reinforce teaching." And always remember, when you teach something to the patient, you must always chart (if truthful, that is) that patient "verbalized understanding" or "returned demonstrated." Otherwise, your teaching effort is not considered valid. The "verbalized understanding" part helps validate the learning on the part of the patient.
  8. by   SouthernLPN2RN
    Quote from oramar
    I see people at the place I work charting, "patient encouraged to use PCA pump". Is that OK, does it sort of sound like the nurse is taking the Patient out of PCA? Would it not be better to say that, "reinforced teaching about use of PCA" or something along that line. Like I said it is just a little thing. Sounds like I am nit picking does it not?
    I would put "Pt encouraged to use PCA as needed for pain".
  9. by   BrnEyedGirl
    "encouraged to quit whining about pain when they have pca at their disposal that they haven't pushed in two hours" would be a perfectly accepted note."
    :yeahthat:
    also,.."pt family strongly encouraged not to press pca button, after pt found w/resper of 6, o2 sats 75%, and responsive only to painful stimuli ie sternal rub" don't think she's hurting much
  10. by   HappyNurse2005
    I have put "pt encouraged to use PCA prn".
  11. by   RNfromMN
    I agree with the "teaching reinforced" and then documenting pt's response to teaching...worst case scenario:

    Pt gets addicted to pain med, sues facility (and/or you) and all the documentation brought into court basically says that pt was repeatedly reinforced use of PCA machine...As a lay jury person, "PCA use reinforced" does sound...what's the word I'm looking for? Basically, it could sound like the hospital staff contributed to a pt's addiction to a narcotic by "reinforcing" the use of PCA, rather then spending any time with the pt, exploring other methods of pain relief, etc. I know this is an extreme scenario, but that's how we're taught to look at things in school.

    Also, I would think a pain assessment with documentation should be recorded every time someone documents whatever they did with a pt that has a PCA machine. You know what I mean? "Pt c/o pain, 10/10, all p.m. PCA use reinforced..." would even sound better than just, "PCA use reinforced." Thoughts?
  12. by   Antikigirl
    I say encouraged all the time, since that is exactly what I am doing! I will document if I re-taught them the uses of the PCA (we have a teaching flow sheet and areas to mark with date and time for teaching and re-teaching...I fill that out with call lights with patients all the time..LOL...you know the ones..."NURSE NURSE" at the top of their lungs...ummm hi ya..little button here!"..LOL!

    Naaaaa I encourage the incentive spirometer and cough and deep breath all the time and chart "encouraged IS and CDB"...

    Remember...do document all you do, but make it short and sweet if you can...if your nursing notes are too long...then MD's (if they even look) and other RN's may glaze over it and not hit the points...trust me, I use to document pages! LOL! I would rather them get the points...and use terms that will help me in CYA PRN. It is a fine balance, and takes practice.
  13. by   wannabemw
    Pt Instructed, reinforced; both of these have worked for me
  14. by   CarVsTree
    If they're not using PCA and still c/o pain, I find out why (i.e. very sleepy than wake up in 9/10 pain) hit button, fall asleep, wake up 9/10 pain and so it goes on.

    For these pt's I try to get them off PCA and on percs. I will chart encouraged only when I find out if encouraging will help.

    Does any of what I wrote make sense?

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