hourly pain meds vs PCA

[Paige Turner RN]

It seems that recently on our medical floor MD's have been hesitant to order PCA for patients that appear to be or have a hx of "drug seeking." Instead they order 1 mg of either morphine or dilaudid every one hour. I work night shift and as usual the pt load is higher on nights than on days or eves. Pt 's become anxious and agitated when they are dependant on the nurse to provide their medication q 1 hour. In my opinion it would be better if the had a PCA.

Have any of you had this problem? I hate being the pain police and the idea that some pts are being denied adequate pain medication because they are in a certain age group or have a hx of drug seeking behaviors.

[Marie_LPN, RN, LPN, RN]

A couple of the surg docs at our facility order the pain med IV push just so the nurse HAS to go in the pt.'s room every hour. Sounds ridiculous, but this was the answer i got from the NM when i asked why a certain surgeon refused to order a PCA.

One surgeon orders IV push pain meds, because, "there's no guarentee that the pt. is the one pushing the button. Some of the family members take it upon themselves to hit that button every 10 minutes, whether the pt. is in pain or not."

[Paige Turner RN]

To me it doesn't matter who pushes the button. the lockout prevents too frequent doses. I think a PCA with a basal rate for overnight is the way to go. That way if the pt is sleeping they continue to get medication and don't wake up in pain.

[Ortho_RN]

To me it doesn't matter who pushes the button. the lockout prevents too frequent doses. I think a PCA with a basal rate for overnight is the way to go. That way if the pt is sleeping they continue to get medication and don't wake up in pain.

But it DOES matter who pushes the button.. You are right, you cannot get too many doses.. But if someone isn't hurting and have respirations of 12, and the family keeps giving the button a push, you can eventually have respirations of 8... We have had that happen, and end up Narcaning a patient.. I like PCA pumps.. But they CAN be abused..

[Paige Turner RN]

Ortho, I get your point. I wasn't thinking. I work night shift and there aren't alot of extra people in the room to push the button. On day shift there are more eyes to ensure no one is pushing the button thaat shouldn't be.

[IamRN]

But it DOES matter who pushes the button.. You are right, you cannot get too many doses.. But if someone isn't hurting and have respirations of 12, and the family keeps giving the button a push, you can eventually have respirations of 8... We have had that happen, and end up Narcaning a patient.. I like PCA pumps.. But they CAN be abused..

This was going to be my comment exactly! Unfortunately I have seen it happen...not my patient though! It was a fellow co-worker's patient. The patient had to be coded (respiratory arrest) and transferred to the ICU. It was discovered that the family were the ones pushing the button, even though they had been told not to! :angryfire