Abstract ID: A26
Abstract Title: A Policy For Nurse Administered Analgesic Dosing Via A Patient Controlled Analgesic (PCA) Device
Authors: Willoughby MD P1, Santangelo RN MS D2, Santora RN MS C3
SUNY @ Stony Brook Stony Brook New York USA1, SUNY @ Stony Brook Stony Brook New York USA2, SUNY @ Stony Brook Stony Brook New York USA3
Poster Type: Either
ABSTRACT BODY
Patient Controlled Analgesia (PCA) has improved pain management in the hospital setting by decreasing the time it takes for patients to obtain intravenous analgesics and to allow for titration based on activity and level of pain. However, when patients are inappropriate for PCA because of cognitive impairment or physical inabilities, they are unable to obtain analgesics in such a timely manner and must wait longer periods of time for analgesics. In our institution, all of our continuous narcotic infusions are administered using a PCA machine for security purposes. But when the patients needed extra medication, the nurses would have to leave the bedside in order to obtain these medications elsewhere.
We developed a policy for nurse administered analgesic dosing (NAAD). This policy allows the nurse to do a pain assessment, determine a need for analgesia, administer the prescribed dose via the PCA machine and document this information on the PCA/NAAD flow sheet without leaving the bedside. When the nurse returns to evaluate the effectiveness of this dose, an additional dose of medication may be administered via the PCA machine if indicated.
Typically we set the demand dose the same as a regular PCA demand dose and the lockout period at thirty minutes or longer. A continuous infusion is used if necessary. The 4-hour limit allows for 2-4 doses plus any continuous infusion.
We have found this to be invaluable for unplanned dressing changes, line placements, transfers, and other causes of active pain. It has also been useful for giving small doses of fentanyl to cognitively challenged elderly patients who would otherwise be ineligible for this medication. The outcome is diminished time needed to administer analgesia to the physically and cognitively impaired patients as well as decreasing nursing workload. The purpose of this abstract is to educate physicians and other pain management practioners about how to safely use PCA devices to improve the delivery of PRN analgesics.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A26