UNIVERSITY HOSPITAL AND CLINICAL PROGRAMS

 

PROFESSIONAL NURSING ORGANIZATION

 

POLICY STANDARDS

 

 

 

ADDENDUM:      J.25

 

EFFECTIVE:        10/07

                     

REVISION:          

 

APPROVAL:        10/07

 

 

 

SUBJECT:  CARE AND MAINTENANCE FOR PATIENT RECEIVING PATIENT CONTROLLED ANALGESIA (PCA) THERAPY

 

 

PURPOSE:  To allow patients with pain to self-administer an analgesic at a dosage pre-determined by the physician, using the PCA pump.

 

 

DEFINITIONS: 

  1. Loading Dose:  A bolus dose given prior to initiating PCA therapy.

  2. Lock-Out Interval:  Pre-determined period during which the patient can not initiate doses.

  3. PCA Dose:  Amount administered each time the patient activates the pump.

  4. Four Hour Limit:  Pre-determined maximum drug volume, which can be delivered during any four hour period.

  5. Basal Rate:  Amount administered continuously.

 

POLICY:

                 1.      Competency:  The RN must demonstrate competency in PCA therapy.

                 2.      Patient/Family Education:  Patient and family members/significant others will be educated on PCA therapy and instructed that the patient and only the patient is to press the button for pan medication.  In addition, the patient and family members/significant others will be educated on the dangers of others pressing the button for the patient.

                3.      Physician’s Orders:  A written physician’s order for PCA therapy shall include:

                     a.       Type of analgesic

                     b.      Rate (IV solution)

                     c.       Loading dose (if applicable)

                     d.      PCA dosage

                     e.       Four hour dose limit

                     f.        Basal Rate ( if applicable)

                     g.       Medication concentration

               4.      Verification for Initial Set-Up, Change in Settings and Transfer:

                     a.       The Registered Nurse (RN) who initiates PCA therapy shall verify the medication does and setting with a second RN prior to initiation.

                     b.      In addition, a RN shall verify the medication dose and setting with a second RN when there is a change in settings or with the transferring RN when a patient is received from another unit/area.

                    c.       Documentation of the verification is made in the electronic medical record.

             5.      Assessment and Monitoring of Patient on PCA therapy:

                   a.       Initiation of Therapy:

             1.      Obtain baseline vital signs, level of consciousness, and pain assessment

             2.       Verify there are no known allergies to analgesic being prescribed.

             3.       Verify patent IV access.

             4.       Verify order is present for maintenance IV infusion.  The PCA therapy requires a maintenance IV infusion.

             5.      Set up PCA pump per physician orders.  Refer to Procedure for Initiation and Maintenance of Patient Controlled Analgesia (PCA) Using the Alaris® PCA Pump

            6.       Record PCA settings 

                   b.      Maintenance of Therapy:

            1.      Note every 4hours:  respirations, pain assessment, sedation level

Record PCA setting and verify PCA pump:

                   i.        During assessment each shift

                  ii.        At the time of any change in medication or settings.  Double check change with second RN and record in electronic medical record.

           2.      Record running total of analgesic every 12 hours.

           3.      DO NOT clear the pump.

           4.      Change PCA tubing per policy.

           5.      Discontinue PCA therapy and notify MD if patient:

                 i.      Has a respiratory rate of <10/minute

                ii.      Has a significant change in level of consciousness

               iii.   Has an adverse reaction to the analgesic