Quote from IngyRN
I never have pt w/PCA. Can somebody please explain settings/terms. IE lockout, basal, etc. thanks so much
We get PCA's quite often on my floor (for hospice and sickle cell pts).
Often a pt can use the PCA in 3 ways (any combination of the three ways could be ordered for a pt): Continuous (gets a set amount of the narcotic, all the time, I'm assuming this is also what you mean by basal), Demand(pt gets a pre-set amount only when pt hits the button), and Clinician Bolus (pt can get narcotic when RN administers through PCA, often this amount is larger than Demand). Often I see pt's on Demand, so they can control pain themselves as well as Bolus, for breakthrough pain relief.
A lockout is needed in the order for both Demand and Clinician Boluses. If the doctor does not want a lockout, he needs to specify such in the order. Often you'll see it ordered something like "Demand 1mg, Lockout 6 min, Bolus 5mg, Lockout 1hr" When you review your PCA at the start of your shift, it should tell you how many mls are left in the PCA, as well as the amount of continuous (even if 0), amount of Demand, Demand lockout.
When you go in and review the PCA, it should tell you how times the pt is pressing the button per hour. It will tell you how many times the button is pressed, as well as how many of those times the pt actually got a dose (ie pressed button 10 times, got meds 4). On my floor, we chart how many times the button was pushed as well as doses given. This is charted in ml, so you have to know the concentration of your PCA to figure out the mg/ml. We also chart when we change the PCA CADD (the narcs), as well as when we give boluses. We change the CADD every 24hrs, but some facilities might be different.