What made your jaw drop

[DextersDisciple]

Pt had moderate sedation and was brought to recovery drowsy but arousable. PCA started but no other drugs administered by nursing. Pt begins snoring and becomes completely unaroausable. Friend at bedside asked how frequently the pt was pressing PCA button. Friend was indeed pressing the button for the patient q6mins.

Pt received over 7mg Dilaudid and had to be reversed.

What's something that made your jaw drop?

[Have Nurse, ADN, RN]

Why in the heck was the PCA even set to administer that much in that short of a time span?! This is a hospital error and should be reported!

This really has not so much to do with a family member pressing the button, and all to do with the PCA being programmed incorrectly. The point of the PCA is to allow the patient to safely administer narcotics to themselves, which means the healthcare team has to regulate how much the device can give before it locks out. That clearly was not done in this case.

Annie

I must respectfully disagree. Many patients are sensitive to low doses and with family members worried about their loved one waking up in pain, they think (erroneously of course,) that they are doing them a favor. On our floor, we ALWAYS gave education to visitors NOT to touch the PCA and why it can be dangerous for the patient. They leave it alone, once they understand.

[Orion81RN]

I am going to tell you why we use so many narcotics, particularly Dilaudid. HCAP scores. The biggest downturn in scores is "pain isn't adequately controlled" Adequately to patients means "NO PAIN". So since reimbursements depends on scores and surveys, then if you aren't bringing out the big guns on pain control then you aren't getting paid. Thanks Joint Commission for making pain a vital sign. Patients will tell you that their pain is a 10, right before they respiratory arrest. I have worked PACU for 15 years! Patients aren't educated enough on what to expect from pain after a surgery. If doctors tell patients that they are going to have pain after surgery, if it is an elected surgery, they won't have it. We are a give me society and a no pain society. I will tell you this, the new laws that they have enacted in Tennessee about narcotic dispensing should be a crack down on all this pill mill crap. If you ask for a 2nd pain pill prescription after the original supply given after surgery, then you have to enroll in a pain clinic contract. All patients getting more than a 3 day supply of narcotics have to sign a contract with the facility that they are aware of the side affects and potential problems and that they don't have multiple narcotic prescriptions already. The doctors can look in a data base prior to giving a narcotic prescription to see if the patient has had a recent prescription. If they have, hopefully they won't give another. It is a big problem and everyone suffers. Boy do I have a book of stories that would cover this topic.

"Patient satisfaction paying us, epic fail." "And if you think pain's a vital sign, then you can go and rott in hell!"

Zpac 4 LIFE! lol

Sigh...so messed up

[jodispamodi]

Why in the heck was the PCA even set to administer that much in that short of a time span?! This is a hospital error and should be reported!

This really has not so much to do with a family member pressing the button, and all to do with the PCA being programmed incorrectly. The point of the PCA is to allow the patient to safely administer narcotics to themselves, which means the healthcare team has to regulate how much the device can give before it locks out. That clearly was not done in this case.

Annie

Totally agree, what was the lockout dose on the PCA?

[DextersDisciple, BSN, RN]

Totally agree, what was the lockout dose on the PCA?

Please read my comment listed shortly below hers. I'm disappointed that this thread has turned into an argument over PCAs and not a fun discussion of our bizarre nursing encounters :/