Please take PCA's seriously

[URO-RN]

I make it a habit of checking PCA (patient controlled analgesia) and doc that i did so on pain flow chart often.

I discovered 4 count em' 4 patients with respirations of 2 to 4 this week! Narcan given to all....one of them was almost a sentinel event!

anyone else had this happen to them in one week?:uhoh21:

[SmilingBluEyes]

I forgot: we also have to document in our computerized MAR q4 hours the usage/history of each PCA used until it's d/c'd. With the procedures in place where I work, it's rare for there to be any complications in PCA usage. But like JoAnn pointed out, it' s up to US to really be vigilant for out patients' safety. The two nurse checks help. Sat monitors help. PCA history documentation helps. But the watchful eyes of a nurse can't be replaced by any of the above.

[URO-RN]

I guess the moral of the story is check and check often. Use your sat monitors, anyone w/ a pca and a basal infusion (continous rate : amount of drug adm continously per hour;can be a solo mode or in combination with pca mode) need to be assessed.

good tips and advice everyone.

[URO-RN]

Here are some definitions:

Loading dose: A bolus dose delivered during set up or whenever a supplemental booster dose is needed.

4 hour dose limit: A physician value that limits the total amount of drug that can be delivered in any 4 hour period. When the SUM of all doses in any "rolling" 4 hour period equals or exceeds the 4 hour dose limit, the patient's requests for additional demand doses will be unsuccessful.

Demand dose (pca dose, pca injected) amount of med the pt will receive each time a dose is self adm.

Unmet demands (pca demands) pt pushes the button but no dose is delivered. this is the result of the pt pushing th4e button during the lockout period.

Lockout period: timing determined by the md that allows the pt to access the drug at certain time intervals, e.g. q 10 min. Usual range of time is 6 to 10 min, based on the physiological response time of the drug.

Continous rate ( BASAL INFUSION) Amount of drug administered continously per hour; can be a solo mode or in combo w/ pca mode. ( MY LEAST FAVORITE).

[SmilingBluEyes]

We almost NEVER use a basal rate with any of our PCA's. For just the reasons you state.

[rnmi2004]

I think having a basal rate cancels out the "patient controlled" part of the acronym. It sounds great in theory, but I'm more comfortable with demand-only PCA orders.

[pricklypear]

We often have basal rates. I personally think they control pain better than PC only. But only if ordered appropriately according to the individual patient's needs and physiological status. I have not seen a pt oversedated by a basal rate in a long time. I have had so many experiences where the pt has finally gotten the pain under control, only to fall asleep, and wake up in the same pain all over again. It defeats the purpose.

The times I have seen oversedation is when family is pressing the button for the patient. We had a case where we had to confiscate the button from the pt's room because we couldn't convince the family that they were causing more harm. I was so irritated by those people.