TITLE: GUIDELINE FOR THE USE OF THE PATIENT CONTROLLED ANALGESIA (PCA) AND CONTINUOUS FLOW SHEET, MR# 74

INSTRUCTIONS:

1. Place patient’s identification sticker in the upper left hand corner.
2. Record insertion of each syringe or epidural bag on e-Chart.
3. Record date and time orders are programmed.
4. Record PCA dosage and lockout. Record continuous rate. Record 4 hour dose limit. Any changes in orders are recorded in the next space across the sheet and are dated.
5. Two nurses sign verifying the information programmed is correct.
6. Record month, day, year that therapy is being charted in the appropriate "A" or "P" slot.
7. Record total PCA dosage delivered each 12 hours.
8. Record loading dose received and time received if appropriate every 12 hours.
9. Record continuous dose received each 12 hours.
10. Record total amount of narcotic delivered each 12hours. (Add PCA Dose, loading dose, and continuous dose.)
11. Record level of pain score (LOP) using the code and the time assessed..
12. Record the level of sedation (LOS) score using the code and the time assessed.
13. Record respirations per protocol. For PCA, every 4 hours, record in the complete block. For epidurals, record four rates to each subdivided box from top to bottom as illustrated for q 1 hr. assessments and record 2 rates to each subdivided box for q 2 hr. assessments.

14. The nurse signs each 12 hours verifying the dose delivered and assessments.
15. Document on e-Chart when the syringe or bag is discontinued.
16. Waste and witness any residual PCA syringe contents using the Pyxis function.
17. Waste any residual epidural bag in the medication room sink, record on e-Chart and have a witness.

RESOURCE PERSON(S): Candy Conners, BSN, RN; Carol Cox, MPH, RN;
JoEllen Austin, PharmD, Rowena Garcia, Director of Pain Management