We generally start PCA's if it is a floor patient waiting on a room and we have used all that our docs have ordered. Then we get an order that we may use surgeons post-op orders for pain control. "May start PCA in PACU" We always start femoral infusions and epidurals in pacu.
We just started doing the PCA's in PACU about 2 months ago. Prior to that we had no means to refrigerate them (we don't have pyxis). It's not so bad because you can get it done quickly when there are so many other RN's right in the room to set it up with you. At first we were afraid that it would be too time consuming, but, all in all it's OK. The nurses on the floor really appreciate it.
Any place that I have worked PACU, the PACU RNs start the PCA or at least set it up and send it to the floor with the patient. That way all the floor nurse has to do is turn the PCA on, make sure it is programed properly and start the paper work. Epidurals are also started in the PACU but that is because we have to verify that neurovascular status has returned to the limbs before the epidural can be started.
We start PCA's in PACU, also. If we send the patient to the floor without it, they have to call the IV team to start the PCA and it is not in the best interest of the patient or the nurse. It's quick and easy during "regular" hours but takes longer for the pharmacy to get it to us on nights.
We start them in the PACU immediately upon arrival if the patient is stable and in pain(or even a hint of pain), then we use the normal anesthesia post op orders to augment and get them comfortable. Those IV meds don't last long. If I tried to transport the patient after giving those measly anesthesia IV doses they would be in pain by the time we arrived to their rooms. With the PCA we can have them press the button in the elevator(or we do it for them if they give us permission...they always do). We order a supply of PCA pumps from Central the night before using the next days schedule to anticipate how many we might need. We also "assign" the pump to the patient(using Doctors name i.e: Dr. G#1, Dr G#2 etc..) to facilitate the process as we have to sign the pump out in a log for Central daily.
It seems like more work but it saves a LOT of time. If the doc doesn't order a PCA then we simply remove the name (we use post its) from the pump and it can be assigned to another who needs one.