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]

Just a sort of aside, but if folks aside from the patient are pushing e button it is no longer a PCA, by definition.

[imaginations]

There are two major children's hospitals in my city. I worked at the largest one last year (it's also one of the biggest children's hospitals in the country) where they had an 'NCA' policy (or, 'nurse controlled analgesia) for patients who were not, for whatever reason, able to operate a PCA. These were prescribed and monitored by the pain service and parents did not push the button, the nurse did.

At my current hospital, the other children's hospital in this city, if a child is not able to use a PCA as assessed by the pain team other methods of pain control are sought, generally an infusion.

[mama_d, BSN, RN]

Not sure how this would apply to your population, but when we have patients on PCAs that are unable to use them (generally EOL oncology patients), the nurse (never anyone else per policy) titrates to the Ramsey scale. If we're pushing the button regularly, basal rate gets increased.