PCA pump error

[BeckysMom1952]

Question: Our charge nurse set up a PCA pump with morphine for a new grad. Our policy states she has to set it up with another RN, but this manager just did it herself then had another nurse go in and check it. So, what happened was, she set it up so the patient got 25 mg of morphine in one hour (he survived with no obvious suffering). The charge nurse was not reprimanded, the floor manager decided to use it as an educational experience for the difficulty of the PCA pump. The MD wanted both nurses fired. So my question is, was this just a med error open to education? Or should something more have happened? Should the nurses have been fired?

Thanks for your input.

[BabyLady, BSN, RN]

I learned in my legal class that if you do not receive specific training regarding use of your facility's PCA machine and something goes wrong, you are liable. And, unfortunately, if you did receive education and something goes wrong, you still are liable because having had the training and accepting the opportunity to use the PCA indicates you should be competent in it's operation.

My legal class makes me very very paranoid now :chuckle

Does your facility offer training for it? I am curious to see if staff are routinely trained on PCA use.

You won't be allowed to operate a PCA pump in a facility without being trained on it...too much of a risk to the patient.

However, the facility policy was clear: Two RN's at the same time...one to set, one to check.

Doesn't get any clearer than that.

When you make the choice not to follow protocol and something goes wrong...that is the risk you take...that is why the MD thought both nurses should be fired...but to me, the 2nd nurse wasn't half as guilty as the first...what was the second one supposed to do...refuse to check it?

If I was the second nurse, I probably would have shut the PCA off and asked for the other nurse to program it and then I would check it.

However, we are also taught that pumps sometimes malfunction...not only are you responsible for making sure it's programmed right, but responsible for WATCHING to make sure it's dripping at the right rate.

Because that is what they did before they came up with them there PCA machines (in my best country accent).

[GraceNotes]

I'm a new grad & uncomfortable with PCAs. I was recently advised by an "experienced" nurse to request doctor's orders for a PCA pump when my patient's pain wasn't well-controlled by hourly PRN IV morphine orders. I just wasn't able to keep up due to high pt load/acuity assignment. I went through a few nurses, starting with the charge nurse, before finding one who knew how to set up the pump & repeated the scenario a couple of days later when it was time to d/c it.

We had a brief PCA lesson during orientation. I plan to let the manager know (without naming names) that the need for training beyond orientation exists.

The doctor, I think, feels that if a nurse is suggesting a treatment method she must be knowledgeable...

This is a good thread. Thanks to all previous posters for sharing your experiences.

[Philosophy]

]Where do you normally set up your PCA's if you are in an open unit like PACU?