PCA question

[msjellybean]

We didn't get a very complete introduction to PCA.

If you have an order for Fentanyl PCA 10/10/250, that interprets at 10mcg no more than every 10 minutes with a 4 hour max of 250mcg?

Is that right?

[iluvivt, BSN, RN]

Technically this is an incomplete order. The MD needs to write out the drug,dosage strength.lockout interval and any prn doses. Usually this is accomplished by a specific order set (order sheet on paper or computer). Are they doing this or just writing the order as you did? If they are writing the order as you did they need some education and nursing should not accept it that way.

[ChristineN, BSN, RN]

I agree with the above poster that it's an incomplete order. Also, you don't normally have 4 hr lockouts, that's too long. Normally it's "can get 15mcg Q10min" Meaning, as long as they are hitting the button in 10 min intervals, they can get as much as they need. Also, your order, is confusing, but I don't think it addresses continuous doses, or clinican boluses. Even if your pt isn't ordered any, that, ideally, should be spelled out.

[chare]

PCA pumps can either deliver a continuous low dose basal administration rate, an intermittent PRN dose, or a combination of both. A proper PCA order at my facility must include the following:

Medication and concentration

Administration mode

Basal dose (if applicable)

PCA bolus dose

PCA bolus dose frequency

4 hour lockout

The purpose of placing a patient on a PCA pump is to allow them to control their analgesia administration by reducing delays associated with the traditional method of the nurse administering PRN bolus doses. To be effective the patient must be able to understand the concept and depress the administration button when needed. If the patient can not do this then they are not a candidate for PCA. I have never worked in a facility where it was considered appropriate for the nurse to depress the administration button for the patient.

As for the 4 hour lockout, this has been common practice in every facility that I have worked in and is usually set for the total dose that the patient can receive in a 4 hour period. Most practitioners see this as an additional safeguard to help prevent a “runaway” pump.

Regardless of the introduction you recieved during orientation, your facility should have policy or procedure detailing the use of the PCA pump, and possibly a standard order sheet/form for PCA use as well.

[msjellybean]

It's a scenario for a skills exam. It's the only info I have. I would assume I can get more information if needed, when the skills exam time comes.