What is your policy on PCA pumps?

[sunnyskies9]

A surgery resident placed an order to start a Dilaudid PCA on a post-op pt about 1000. A few of the other orders placed were clear the pump q4h; monitor resp, sedation and pain q1h for the first 12h, q2h for the second 12h and q4h after 24 hr. Also, bp is monitored q4h like normal. I always make sure I chart everything with PCA's. I gave report to the night nurse at 7p, and she seemed very frustrated that I did not take q1h vitals for the first 12h. The order clearly states bp checks q4h. But I did monitor pain and resp q1h like I was supposed to. I'm just curious what other PCA policies consist of? I just hope I am not in the wrong by not documenting q1h bp's when the order clearly states q4h. Any thoughts?

[ashleyisawesome, BSN, RN]

if you did exactly what the orders said, you didnt do anything wrong, but i can tell you what our protocols are on our ortho surgical floor:

q 30 min vitals x3 as soon as the arrive on the floor. q1h vitals, neuro, sedation, pain checks x4h, then q4h everything until they are off the PCA. I probably would have questioned the order if they didnt include vitals q1h with all he other assessments (or just done them regardless because thats what we usually do), especially because B/Ps can really bottom out with post op pts, plus narcs.

[sunnyskies9]

oh sorry. I forgot to add. this pt was not immediately post op. she had surgery the day before. we do q1h vitals x4 on our immediate post ops. but the resident ordered the PCA the morning after surgery. Also, we do get a complete set of vitals 15 min after the loading dose of the PCA. but then after that the order was q4h bp's.

[liveyourlife747]

We do routine vitals on those who are post-op, q30 min x4, q1 hr x4, q4 hr x 48 then q8. These are with or without pcas, but usually pca people are q4 vitals. We have cont pulse ox on our pt as well. I can understand the concept of q1hr vitals, but who has time for that on a busy med/surg floor? I always assess pain, sedation, and Amt of narcotics used at least q4hr, we clear pumps q8hrs and record it on a sheet. HTH

[Altra, BSN, RN]

The orders you received were inconsistent, but if I had an order to record "vitals" q whatever ... I would not omit BP. Particularly when giving meds which can affect BP.