Patient-controlled analgesia (PCA) is a type of pain management that lets you decide when you will get a dose of pain medicine. In some situations, PCA may be a better way of providing pain relief than calling for someone (typically a nurse) to give you pain medicine. With PCA you don't need to wait for a nurse. And you can get smaller doses of pain medicine more often. With this type of pain treatment, a needle attached to an IV (intravenous) line is placed into one of your veins. A computerized pump attached to the IV lets you release pain medicine by pressing a handheld button. PCA can be used in the hospital to ease pain after surgery. Or it can be used for painful conditions like pancreatitis or sickle cell disease. It also works well for people who can’t take medicines by mouth. PCA can also be used at home by people who are in hospice or who have moderate to severe pain caused by cancer. Children as young as age 7 can benefit from PCA if they understand the idea behind the PCA and can follow instructions. But people who are confused, disoriented, or unresponsive can’t use PCA. How PCA WorksYour healthcare provider must prescribe a PCA pump for you. The pain reliever given through the pump will most likely be an opioid such as morphine or hydromorphone. This is what you may expect if a PCA is prescribed for you:
Safety Monitoring During PCA UseFrequent monitoring by your nurse is needed while you are using the PCA pump. The nurse may need to wake you up in order to check for breathing problems and other side effects. Family and friends staying with you during recovery should report any concerns of breathing problems or other side effects to the nurse right away. Risks of PCAPCA is safe and effective. The main risk is having a reaction to the opioid medicine. Side effects from opioids include:
You should be watched carefully for respiratory depression if you:
If used properly, PCA may actually reduce the risks linked to opioids because you are less likely to be overtreated or undertreated. Make sure that you are the only person who pushes the button for pain relief. If friends or family members also push the button as a way to help you, there is the danger that you might get oversedated and have trouble breathing. Also, your healthcare team should explain to everyone that you don’t have to push the button as often as allowed. You only need to press it if you need pain relief. Patient-controlled analgesia (PCA) has considerable potential to improve pain management. However, errors happen frequently, sometimes with tragic consequences. Part 1, “How Errors Occur,” was the topic of last month’s Medication Errors column. This month, Part 2 presents a checklist of efforts related to practice, systems, products, PCA pumps, and regulations that can help reduce the risks associated with this patient-centered technology.
The reports described in this column were received through the USP–ISMP Medication Errors Reporting Program (MERP). Errors, close calls, or hazardous conditions may be reported on the ISMP (www.ismp.org) or the USP (www.usp.org) Web site or communicated directly to ISMP by calling 1-800-FAILSAFE or via e-mail at gro.pmsi@ofni-pmsi. Articles from Pharmacy and Therapeutics are provided here courtesy of MediMedia, USA |