How often do surgeons order a basal rate for PCA?

[nursenatalie]

We recently had a situation in which a patient was ordered to have a basal of 3mg morphine after a lap appy! This surgeon has increasingly ordered basal rates on his surgical patients and in this situation the patient became oversedated within 24 hours. I dont only fault the surgeon for the order but believe that the oversedation resulted primarily from a lack of monitoring by the nurse. Just wondering if your surgeons often ordered basal rates or simply demand?

[NurseDixie]

I had a pt last night in with sickle cell crisis, she was getting PCA morphine with basal rate of 2mg per hour, plus .5 q 30 minutes as needed. She also got 3 tylenol q 4 hours prn. This did not help her pain that much. She was my first pt with sickle cell crisis. Her temp went up to 102, her arms and legs were aching. She had an IV going at 200/hr. I really felt sorry for her.

[Lysa]

by basil rate, do you mean bolus? Usually the patient gets a bolus in the RR then when they come to the unit their PCA is usually set for 1-2mg of morphine q 5-6min depending on the anethetist. However, a PCA is never used for a lap chole or lap appy. On our unit they are mostly used for major abd. surgeries or orthos.

[RN-PA, RN]

by basil rate, do you mean bolus? Usually the patient gets a bolus in the RR then when they come to the unit their PCA is usually set for 1-2mg of morphine q 5-6min depending on the anethetist. However, a PCA is never used for a lap chole or lap appy. On our unit they are mostly used for major abd. surgeries or orthos.

Basal rate means continuous rate ordered along with the PCA "demand" rate.