Caring for a Patient Receiving Patient Controlled Analgesia

Goal: The patient reports increased comfort and decreased pain; and shows no signs of adverse effects, oversedation, or respiratory depression.

1. Gather equipment. Check the medication order against the original physician’s order according to agency policy. Clarify any inconsistencies. Check the patient’s chart for allergies.

2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.

3. Prepare the medication syringe or other container, based on facility policy, for administration. (See Chapter 5, Medications, for additional information.)

4. Perform hand hygiene and put on PPE, if indicated.

5. Identify the patient.

6. Show the patient the device, and explain its function and the reason for use. Explain the purpose and action of the medication to the patient.

7. Plug the PCA device into the electrical outlet, if necessary. Check status of battery power, if appropriate.

8. Close the door to the room or pull the bedside curtain.

9. Complete necessary assessments before administering medication. Check allergy bracelet or ask patient about allergies. Assess the patient’s pain, using an appropriate assessment tool and measurement scale. (See Fundamentals Review 10-1 through 10-6.)

10. Check the label on the prefilled drug syringe with the medication record and patient identification. Obtain verification of information from a second nurse, according to facility policy. If using a barcode administration system, scan the barcode on the medication label, if required.

11. If using a barcode administration system, scan the patient’s barcode on the identification band, if required.

12. Connect tubing to prefilled syringe and place the syringe into the PCA device. Prime the tubing.

13. Set the PCA device to administer the loading dose, if ordered, and then program the device based on the medical order for medication dosage, dose interval, and lockout interval. Obtain verification of information from a second nurse, according to facility policy.

14. Put on gloves. Using antimicrobial swab, clean connection port on IV infusion line or other site access, based on route of administration. Connect the PCA tubing to the patient’s IV infusion line or appropriate access site, based on the specific site used. Secure the site per facility policy and procedure. Remove gloves. Initiate the therapy by activating the appropriate button on the pump. Lock the PCA device, per facility policy.

15. Remind the patient to press the button each time he or she needs relief from pain.

16. Assess the patient’s pain at least every 4 hours or more often, as needed. Monitor vital signs, especially respiratory status, including oxygen saturation at least every 4 hours or more often as needed.

17. Assess the patient’s sedation score and end-tidal carbon dioxide level (capnography) at least every 4 hours or more often as needed.

18. Assess the infusion site periodically, according to facility policy and nursing judgment. Assess the patient’s use of the medication, noting number of attempts and number of doses delivered. Replace the drug syringe when it is empty.

19. Make sure the patient control (dosing button) is within the patient’s reach.

20. Remove gloves and additional PPE, if used. Perform hand hygiene.