Morphine PCA

[hubcaps]

I have a question about your hospital's policy on morphine or any other narcotic PCA. Are family member every allowed in your hospital to push the button?

I've always been taught that only the pt and the RN are allowed. I had an oncology pt, 4 y.o., who I caught the grandmother pushing the pca button. I told her that only the pt and the RN are allowed. The charge RN and I suspected that the gen peds RNs had allowed the family to use the PCA. The grandmother then threatened legal action and requested that everything that I told her be put in writing. I was not afraid of legal action because our hospital policy states that only pt's and RN or MDs are allowed to push the pca. This case was particularly bothersome because it was the only time I've requested not to take care of the pt any longer.

I was also surprised to find this statement on Cincinnati Children's Hospital:

"If the patient is very young, developmentally delayed, or unable to push the button, the Pain Service physician may permit the child's nurse or parents to push the button."

http://www.cincinnatichildrens.org/health/p/pca/

This may be okay for a palliative care situation, but not for a family that wants "everything done." What are your thoughts?

[One2gofst]

In my hospital only the patient is supposed to use the Pca. If the patient is unable to use a Pca another method of pain control should be used.

[NotReady4PrimeTime, RN]

Why on earth is a 4 year old being given a PCA? That's far too young. They aren't able to understand the concept or any of the nuances of PCA, like how it works, the lock-out and the goals of treatment. My hospital requires the Pediatric Acute Pain Service to assess the developmental status of the patient, write and amend the orders and if they have any qualms at all there is no PCA. The youngest I've seen on our unit with a PCA was 9.

[RLtinker, LPN]

What they teach us in school ( I am a nursing student) is that only the pt. can push the PCA button. I wonder if this peds rule is standard.

[loriangel14, RN]

I don't work in peds but my floor has a lot of palliative pts with pumps.RNs, PNs and family members are allowed to push the button.

[biancocm]

The hospital I work at only the patient or RN are allowed to push the button, we actually had a incidence on a floor at my hospital a few years ago when i was doing my clinicals here as a nursing student where the boyfriend was pressing the patient's PCA and the patient ended up dying of an overdose

[Queen Evita]

here in germany on palliative care we allowed the parents or other family members to push the button of the pca....i´m also sure that pt in this age understand

the concept of a pca....you even must explain it very child-friendly....

[merlee]

I insisted that my son have a PCA pump when he was 6 - 21 years ago! I figured if he could operate the VCR, he could push the button for the pump. I was correct. As for family members pushing the button under special circumstances, well, that's what the lock-out time period is for.

I find it hard to believe - not impossible - that someone could easily overdose. Those lockout periods are there for a reason.

[hubcaps]

Thanks everyone for the replies. Merlee I do believe that the lockout would keep this pt safe. Toddlers may be able to use a PCA, I am surprised that toddlers can use ipads and iphones. She has been on a lot of narcotics. However, I did not know her and did not know her tolerance. Here's a little bit more information that I had just remembered about the situation, it happened a while ago. She had originally had a epidural with a continuous infusion that was managed by pain service. I had called pain service multiple times and they given her multiple boluses and increased the infusions rate. Her pain was not controlled and the pain service was not comfortable increasing any further. The oncologist then switched her over to the morphine PCA. The intensivist thought she was developmentally able to use the PCA. Did I? I couldn't tell. She was in such a haze at that state, which was probably due to the weakness due to her illness, her pain and the narcotics. That was also why I thought it was inappropriate for family members to use the PCA. Janfrn, your hospital has a great policy. We need something like that. Our peds department tends to work independently from the rest of the hospital, so there's a lack of policies and lack of oversight.

[Double-Helix, BSN, RN]

The hospital I work at only the patient or RN are allowed to push the button, we actually had a incidence on a floor at my hospital a few years ago when i was doing my clinicals here as a nursing student where the boyfriend was pressing the patient's PCA and the patient ended up dying of an overdose

If this actually happened (and it sounds suspiciously like a hospital urban legend), then the problem was not that the boyfriend was pushing the PCA. The problem was that the parameters on the PC were clearly too high for the patient. Nobody should be able to overdose with an appropriately set PCA.

[caliotter3]

I was allowed to push the button for my daughter after she had surgery when she was 15. Have no idea what the policy was, but her nurse obviously had no problem in allowing me to do this. I would only do so with a little baby if I felt comfortable with the entire process. The grandmother in the OP sounds as if she was there looking for trouble.

[Double-Helix, BSN, RN]

We do allow family members to push the PCA button for children with physical and developmental delays. These parents are used to reading their child's cues and can tell when the child is uncomfortable much more effectively than the healthcare team. This is especially true when pain-scales cannot be utilized (such as with non-verbal, contracted patients).In these cases, allowing the parents to press the PCA provides better pain control for the patient and allows the parent a sense of control in their child's care.