OR nurses don't deal with PCAs

Specialties Operating Room

Published

  1. How comfortable are you with programing a PCA pump?

    • Very comfortable (do it all the time)
    • 0
      Pretty comfortable (wouldn't mind a refresher educational session)
    • 0
      Comfortable enough
    • Comfortable because of the double checking
    • Uncomfortable (dread seeing patients with them)

11 members have participated

Hey guys!

I posted a few days ago casting a wide net for responses on PCAs so with your helpful answers and an assessment of my own I now have to ask:

-As an OR nurse how often do you program a PCA?

-How often do you document what is occurring with an in-patient's PCA throughout surgery?

-How often does the anesthesiologist have you double check their programing?

-Did you have training on PCA pumps when you began in the OR or were you expected to carry over previous knowledge you had on PCAs?

In my unit we have a hard-copy paper Analgesia Flow Sheet that should be in the chart of every patient with a PCA however there has been an issue with this. If the patient is In-patient then the PCA is often times disconnected with no documentation as to what happened, if the PCA is hooked-up in the OR the flow sheet is not placed in the chart for PACU to reference.

I'm very excited about this project and will hit the ground running on Tuesday with it so thanks in advance for your responses :)

MereSanity

412 Posts

Specializes in Operating room..

PCA's are turned OFF for surgery. Anesthesia takes care of pain management (not using a PCA). PCA's are then turned back on in PACU.

NurseStelri

39 Posts

Specializes in Med Surg.

Thanks for your response MereSanity! I know that PCAs are unneeded in surgery so where do you guys document that they are turned off?

MereSanity

412 Posts

Specializes in Operating room..

I make a nurses note on the MAR.

scrubnurselife

37 Posts

First, I think it would really benefit your research to understand the roles of the CRNA vs the OR circulator. The CRNA is in charge of managing the patient's meds, IV's, vitals, etc. The role of an OR nurse is very different than other specialties of nursing. Here's how it's done in the facilities I've worked as far as meds and their charting. If a patient has come to the OR with a PCA still attached for some reason, the CRNA or anesthesiologist are the ones who disconnect it and document it. Anesthesia keeps documentation of meds given during the procedure. The OR circulator documents, in the surgical chart, meds on the surgical field that are given, such as local, antibiotic irrigation, hemostatics, topicals, etc, etc. Also an IM injection if given by the circulator. I have never charted on a MAR, so that must vary at different facilities. I have also never programmed or set up a PCA, or a pump for that matter, as I've only ever been in the OR. I had not even started IV's on patients since nursing school, until I recently started doing peds OR. Of course this will vary by facility and policies, but I haven't seen a huge difference in this process between working in a Level 1 in one state, and a small hospital in another state.

Anyway, it sounds like you need to talk to your facility's anesthesia staff regarding documentation and process.

MereSanity

412 Posts

Specializes in Operating room..

We aren't required to note it in the MAR (more of a nurses note than an actual MAR entry). I just do it to cover my butt. (PCA discontinued prior to transport to OR by "Dr. so and so". Sure, they can document it too but I'm covering my butt. Whoever restarts it can then document that (which I'm assuming would not be until they leave PACU). They are getting so weird about this stuff today.

NurseStelri

39 Posts

Specializes in Med Surg.

Great idea, I will discuss this with our anesthesia staff. I'll start observing and doing a chart review this coming week and I'll keep you all posted on what I find because it does sound like there is a slight grey area in the documentation of PCAs. But like you said MereSanity the most I've seen is a nurses note because our computer program does not have a PCA section. Scrubnurselife thanks for your suggestions I now have a clearer path to my observation/research!

Editorial Team / Admin

Rose_Queen, BSN, MSN, RN

6 Articles; 11,658 Posts

Specializes in OR, Nursing Professional Development.

Because facility policy dictates that all meds are discontinued by having surgery, our PCAs are turned off and wasted in preop. PACU is responsible for setting up PCAs if they are ordered once the patient is alert enough to use it.

TraumaORnurse

76 Posts

In my facility, PCAs are discontinued by the floor nurse prior to coming to the OR so we don't ever see them.

MereSanity

412 Posts

Specializes in Operating room..

If only all floor nurses would do that life would be a beautiful thing!

ORoxyO

267 Posts

In my facility, PCAs are discontinued by the floor nurse prior to coming to the OR so we don't ever see them.

Same here

NurseStelri

39 Posts

Specializes in Med Surg.

This is a great idea! I agree with meresanity; I am going to look into suggesting this in my program!

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