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?
Specializes in Med/Surge, Psych, LTC, Home Health.
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.
I second that! I actually dread having patients with PCA's. Lots of extra documenting, and when their syringes run out I have to call the pharmacy and have them bring me a new one; I can't get them out of the Omnicell where I work.
For various reasons, I have pushed the PCA for my patient. I never thought to justify my actions but if that person is in discomfort and can't reach it or whatever, just push the darn button. Your not going to overdose them. The pump is set for a reason. The medication they are getting sort of over rides any judgement they may have.
Pain is pain. We are not working for the FDA. Get that patient comfortable. In my opinion it is the same as medicating them for breakthrough pain with a PRN. I document and have never had a bad outcome.
As for family members, teaching is everything and those first post op hours are a blur no matter how much education you provide. They never remember. But that patient will remember that they didn't have to feel so much discomfort and grope for the PCA button/call light/TV conrtol/bed control/IV pump ( I could go on and on, FC, SL?) just give them a hand when they are in discomfort .
Specializes in Postpartum, antepartum, newborn nsy.
i'm surprised to hear of patients who've gone into resper arrest or distress because family was pressing the button. whether it's a family member or the patient, there is still a lockout for that very reason and the lockout dose is set by the doctor who surely sets it within safe parameters. just because the button gets pushed does not mean the patient receives a dose.
remember that md's, crnas ect can make dosing errors, that the rn who set the pump can set it wrong, that every patient responds differently to medications in general. underlying conditions can also cause meds to work in different ways. narcotic pain meds depress the resp system. if the pt's family is pushing the pca button @ every available time, it could lead to resp arrest in some cases. in our facility vitals are done q2 on pts with pca pumps along with o2 sats d/t to a pt who was found to have a resp rate of 8 after the family had been pushing the button for the patient. pca machines are not always as safe as they seem, there is room for error!
You did the right thing. This is a diff situation. But it is suppose to be for the Patient to decide if they need the med or not. Not at the nurse's choice. If a patient is in severe pain. He/she Will push the button. We were stressed in nursing school.-NEVER push the button for the patient.
I agree w/ the other responses. In my facility No one except the patient is to press the button, staff nor family are to press the button. You made decision.
As a Palliative care nurse we are taught to educate the patient and their family about the bolous button. If the patient can't push it the family can. If they are not comfortable with that I would have no problem bolousing them. This would be with a continous drip of course.
NurseCard, ADN
2,850 Posts
I second that! I actually dread having patients with PCA's. Lots of extra documenting, and when their syringes run out I have to call the pharmacy and have them bring me a new one; I can't get them out of the Omnicell where I work.