Any expereince with patient controlled oral analgesic

[roey]

Hello everyone! I am new here and have enjoyed the postings- a lot of good info:). I was reading an article on how they are experimenting with patient controlled analgesic mostly after ortho surgeries like total knees. Instead of the nurse being paged and then administering the med, the patient is given one dose in sack and is to document their pain level and page the nurse after taking the med. The nurse documents and then refills the med. Has anyone had any expereince with this or heard of it being done? Thanks!

[roey]

Great info guys, thanks! I am glad to hear that some have heard of this system. So curious, those of you that have had experience where the patient is in controll of there oral pain med, would you prefer this system over nurse administration?

[beautifulb]

I'm sorry, I guess I didn't understand what you were saying about the "oral

PCA". It does sound very interesting. Hmm, I am going to look for some articles about that. Sorry about mis-reading your message and thanks for the info!

[epiphany]

Sounds like another scheme concocted by the hospital accountant to cut down on the need for nurses.

[RN4NICU, LPN, LVN]

I think it is a bad idea. There is really no guarantee that the patient would take the medication as directed, yet while the patient is in the hospital, the nurse is responsible for medication administration. Also, you have the JCAHO pain assessment requirements now. If the patient does not self-evaluate and document pain before and after (and not all patients are going to be compliant with that), all of a sudden you are falling outside JCAHO requirements - the nurse would probably get blamed for that too.

[JSRN81]

This is a totally new concept to me. How does one exercise the 5 (or 6, depending on where you are) Rights of medication adminstration with this? I have never heard of it, and I am supposing you use it in a certain patient population (one where you can be trusting of your patient), but how does one know the patient actually took the pill and didn't give it to their room mate or family member? Not that I'm questioning those who use this practice, but what are the legal aspects of this?

JS

[MsMouse]

As far as JC is concerned-if I remember correctly (I dont work at that hospital any more) the patient flowsheet was supposed to part of the permanent record and I was always told that if the patient wasn't following the guidelines for documentation to either go back to only nurse administered pain meds or

document in nurses notes that the patient wasnt documenting correctly. We also were supposed to document if the patient felt like their was was "well controlled" with each assessment. Maybe that is ok with JC? I was a new grad when introduced to this and just took it all in stride. Silly me! :)

Also, like I said before the patients had to sign a waiver/consent when they were started on this stating that they wouldnt give out the meds etc. As fasr as I know, they never had a problem with it. But it could be a case of good luck than good protocol as well. I personally liked the system, it decreased stress on the nursing staff, the patients were happier and had better pain control, less call lights going off (!!!), happier family members, and I think it also helped prepare patients for discharge, educating them about pain, pain control and the medications and appropriate administration. If a patient cant handle remembering only to take 1-2 Vicodin q4hrs prn or not to share meds with others while being supervised by the nursing staff, then can they really handle being given a whole bottle to take home independently? Of course, in hindsight, I WOULD probably have prefered to only have the patients in private rooms on the oral PCA so I wouldnt have to worry about sharing!

[RN4NICU, LPN, LVN]

Some people probably can't be trusted not to misuse their pain medication outside the hospital, but what they do once they are outside those doors is their own business and their own responsibility. But while they are in the hospital, we are responsible for them. That is the main problem I have with it. I am not so concerned about them sharing their pain medication with someone else as I am that they might not take them as directed - taking them too close together, hoarding doses and then taking too many, that kind of thing.

As far as JC is concerned, they really only started cracking down on the pain assessment guidelines within the past couple of years. I'm sure they've always looked at it, but it was one of their new patient safety goals for last year (or the year before...I don't really remember). They might think it is a great idea, I don't know. But I still do not think it is a good idea and wouldn't be comfortable with it.