Nurses pushing a PCA pump for a patient?

[rn undisclosed name]

Is this ever an ok thing to do? When I received report this am the nurse told me that he and all the nurses have been pushing the pca pump whenever the patient seemed like he was in pain. We don't usually get post surgical patients and this was my first patient with a PCA pump but I definitely remember from school that not all patients are appropriate for a PCA pump. Luckily the doc rounded early this am and he d/c'd the pca pump because he agreed with me. Now I think it was laziness on the nurses part so they wouldn't have to go to the med room and draw up morphine. I did let my manager know. I also disconnected the pca pump and removed it from the patients room cause I just didn't feel comfortable with the situation.

On the one hand I could see the convenience of it cause the nurse is already in there while the patient seems uncomfortably but really anyone could press that pump while they're in there and I know there's a lockout on the pump.

I spoke with some surgical nurses about this and they didn't seem to think it was that much of a problem. In my mind I know I did the right thing but having the doc d/c the pump and getting an order for morphine IVP. What does everyone else do?

[joprasklpn]

called patient controlled for a reason.

[gt4everpn, BSN, RN]

great that you spoke to the m.d about this, the whole idea of pca is that the patient has authority of their pain control, what the point of pca if the nurses are making decisions as to when the patient needs it, not everyone is suited for pca. i remember when my mother was in the hosp, she had pca, i wouldnt have liked it if the nurses were deciding when she gets her pain medicine! good job at fixing this one!

[WSU_Ally_RN, BSN, RN]

No one is to push that button but the patient! That's why it's called PATIENT controlled analgesia! I do agree, it may be easier for the nurse to just push the button, but if they are thinking the patient is in pain, they should be encouraging the patient to push it, to educate the patient on how to use it and why to use it. If the patient is unable to use the PCA themselves, then they should have never been placed on it in the first place.

[EmmaG, RN]

I've reminded a patient they have the button to push, but it's up to them to do so. However in my experience, the visitors/families are a bigger problem. They'll often watch the clock and push the button (or awaken the patient and tell them to push it).

[student1000]

RN undisclosed name wrote: [Nurses pushing a PCA pump for a patient]Is this ever an ok thing to do? When I received report this am the nurse told me that he and all the nurses have been pushing the pca pump whenever the patient seemed like he was in pain. We don't usually get post surgical patients and this was my first patient with a PCA pump but I definitely remember from school that not all patients are appropriate for a PCA pump. Luckily the doc rounded early this am and he d/c'd the pca pump because he agreed with me. Now I think it was laziness on the nurses part so they wouldn't have to go to the med room and draw up morphine. I did let my manager know. I also disconnected the pca pump and removed it from the patients room cause I just didn't feel comfortable with the situation.

rn undisclosed name you are correct that ONLY the patient is supposed to press the PCA pump as you learned in school (as others have already noted here). Was this patient alert and oriented? The only way a PCA pump can really work is if the patient understands that in order to get pain medicine he/she needs to push the button. PCA pumps are wonderful especially since the patient doesn't have to wait for the nurse to get the medicine every time they need pain control but it isn't appropriate in all situations or for all patients. Good for you for advocating for the patient.

I had a patient today who wouldn't have been appropriate for a PCA pump because she couldn't even rate her pain on a scale of 1-10 but she could tell us if she was in pain.

[EmmaG, RN]

I had a patient today who wouldn't have been appropriate for a PCA pump because she couldn't even rate her pain on a scale of 1-10 but she could tell us if she was in pain.

I fail to see how that would make her inappropriate for a PCA pump.

I think the 1-10 scale is (for the most part) worthless.

[Mulan]

Now I think it was laziness on the nurses part so they wouldn't have to go to the med room and draw up morphine.

What is the logic in this statement?

The nurses didn't order the PCA pump, obviously.

[suzanne4, RN]

If a patient is unable to be aware that they are in pain or not able to understand the use of the button, then they should not have pain meds that they are in control of. It is one thing if it is being used to give them a basal rate, but if they are the sole provider of their pain meds and they are not getting a basal rate, then they should not have the PCA hooked up to their IV.

It it called Patient Controlled for a reason, and there are tags now on every single maching that I see where ever I am that the patient only is to provide their meds. And is common sense if you have a patient that has two broken arms but they can still tell you to push the button for them, that is in the grey area but acceptable.

The only recorded overdoses meds via the PCA pump have been when others have been pushing the button for them and usually a family member; and this has resulted in respiratory arrests. There is no reasont that the nurse cannot get the dose from the narcotics box, or Pyxis when needed and administer it. It is actually even less paperwork with not using the PCA in most cases.

If not a basal rate or continuous dose, then it should not be used. You need to make the judgement of what you want to do but just because others before you have thought that it was just fine, does not mean that it is.

I always get the order dc's when the patient is unable to use it as it was designed to be used.

[breastisbest14]

In a local hospital a pt OD'd while on a PCA pump. The family was pushing the button for their elderly family member when they thought she was in pain.

We have strict policy AGAINST RNs or family pushing the PATIENT controlled machine.

[EmmaG, RN]

We have strict policy AGAINST RNs or family pushing the PATIENT controlled machine.

That's been policy everywhere I've worked. Problem is convincing the family that they aren't the exception to the rule.

[Tait, MSN, RN]

My general rule of thumb is promote and educate when it comes to a PCA. I will often explain to my patients that they will wake up in mild pain after falling asleep, they should then take the time to count off two doses (lockout is q12 minutes, but I tell them just go every 15) then nod back off. I never push the button, am very clear with aids not to push it (yes I had one who used to do it) and strictly enforce family not to touch.

I think you did the right thing talking to the doc and alerting him the patient wasn't doing well with the pump.

I believe that is what the first nurse who realized the patient wasn't managing well should have done.

Now the only point I am unclear on is when you removed the pump from the room, was that pre order or post. I will save any further comment until clarified.

Taitter :)