PCA Documentation
Download as PPTX, PDF4 likes3,556 views
The document addresses the risks and safety concerns associated with patient-controlled analgesia (PCA), highlighting that PCA errors occur predominantly in the post-anesthesia care unit (PACU) and are often due to programming mistakes. It emphasizes the need for all RNs in surgical departments to be trained in PCA and suggests improvements like eliminating paper documentation in favor of electronic systems. The conclusion advocates for better monitoring practices and thorough documentation to enhance patient safety and minimize medication errors.
PCA Documentation
- 1. Documentation: The Analgesia Flow SheetStephanie Ricketts, RN N693 Fall 2014
- 2. OBJECTIVES Assess risks associated with Patient Controlled Analgesia Evaluate data collected from PACU and OR Review intervention and response
- 4. PCA Risks Opioid adverse effects Pump Issues Programming
- 5. NATIONAL STANDARDS Pump Initiation (programing) Two healthcare providers should independently double- check 1. Drug selection and concentration confirmed as that which was prescribed 1. PCA pump setting 1. Line attachment to patient and tubing insertion to pump
- 6. Medication Errors involving Patient-controlled Analgesia A Retrospective Analysis of Medmarx
- 7. ERRORS Fourfold higher relative risk of harm! PCA = 1% of all reported errors PCA = 6.5% of harmful outcomes 83% of Perioperative PCA Errors occur in PACU
- 8. “PCA errors certainly occur, both in programming and in delivery, but any published estimate is likely to be only the tip of the iceberg.” -Executive Director, Anesthesia Quality Institute POST-OP PCA Significance
- 9. PACU SURVEY “All RNs in all surgical departments need to be PCA trained and competent, including Kinau 3 and OR.” “PAPERLESS EVERYONE! Make automatic dual sign off in MAR similar to signing off insulin.” “Put it in EPIC– no more paper.” “Not sure, more documentation is not the answer” “…They need to be properly documented at the time they are started by the OR.” “Wrong programming.” “…When OR asks to have it programed for patients not yet in the PACU.”
- 10. OR SURVEY 88% ≤ 5 12% ≥ 5 59% In the MAR 35% On the PCA flow sheet 0.06% Have PACU chart it 0.06% Other
- 11. CHART REVIEW PACU 80% Not Documented 15% OR 5% Units Where Flow Sheets are Initiated
- 12. PCA PROJECT To eliminate stress on the PACU staff and decrease the possibility for error with post-op PCA pumps.
- 13. RESPONSES Now that the Analgesia Flow Sheets are in each OR filing cabinet, how likely are you to use them when a PCA is initiated in the OR? (On a scale from 1-10) “If there is a discrepancy at the end then we get in trouble.” “I don’t feel comfortable with PCAs. As OR staff we aren’t trained on this.”
- 14. Conclusion & Suggestions for Improvement Only 5% of PCA’s are started in the OR
- 15. REFERENCES9 Sources of danger with patient controlled analgesia pumps. (2012, May 28). Retrieved November 18, 2014, from http://mkt.medline.com/clinical-blog/acute-care/9-sources-of- danger-with-patient-controlled-analgesia-pumps/ Chumbley, G., Hall, G., & Salmon, P. (2002). Patient-controlled analgesia: what information does the patient want?. Journal Of Advanced Nursing, 39(5), 459-471. doi:10.1046/j.1365-2648.2002.02311.x D'Arcy, Y. (2007). Patient safety issues with patient-controlled analgesia. Topics In Advanced Practice Nursing,7(1), Chumbley, G., & Mountford, L. (2010). Patient-controlled analgesia infusion pumps for adults. Nursing Standard,25(8), 35-40. Hicks, R., Sikirica, V., Nelson, W., Schein, J., & Cousins, D. (2008). Medication errors involving patient-controlled analgesia. American Journal Of Health-System Pharmacy, 65(5), 429-440. doi:10.2146/ajhp070194 Hoare, K., Sousa, K., Person, L., De Ryke, P., & Piper, J. (2000). Comparing three patient-controlled analgesia methods. MEDSURG Nursing, 9(1), 33-39. IGNACIO, J. J., CHAN Moon, F., TEO Shi, H., TSEN Li Mee, M., & GOY, R. (2012). Research in brief - The effect of music on pain, anxiety, and analgesic use on adults undergoing an orthopaedic surgery: A pilot study.Singapore Nursing Journal, 39(4), 49-51. Lavand'homme, P., & Kock, M. (1998). Practical Guidelines on the Postoperative Use of Patient-Controlled Analgesia in the Elderly. Drugs & Aging, 13(1), 9-16. Lindley, P., Pestano, C., & Gargiulo, K. (2009). Comparison of postoperative pain management using two patient-controlled analgesia methods: nursing perspective. Journal Of Advanced Nursing, 65(7), 1370-1380. doi:10.1111/j.1365-2648.2009.04991.x McKenzie, R., Rudy, T., & Ponter-Hammill, M. (1992). Side effects of morphine patient-controlled analgesia and meperidine patient-controlled analgesia: a follow-up of 500 patients. AANA Journal, 60(3), 282-286. Mann, C., Pouzeratte, Y., & Eledjam, J. (2003). Postoperative patient-controlled analgesia in the elderly: risks and benefits of epidural versus intravenous administration. Drugs & Aging, 20(5), 337-345. Karanikolas, M., Aretha, D., Kiekkas, P., Monantera, G., Tsolakis, I., & Filos, K. (2010). Intravenous fentanyl patient-controlled analgesia for perioperative treatment of neuropathic/ischaemic pain in haemodialysis patients: a case series. Journal Of Clinical Pharmacy & Therapeutics, 35(5), 603-608. doi:10.1111/j.1365-2710.2009.01114.x Patient incidents. (n.d.) Retrieved November 19, 2014, from http://www.promisetoamanda.org/patient-incidents/ Peplau's Theory of Interpersonal Relations: Hildegard. E. Peplau. (2013, September 9). Retrieved November 7, 2014, from http://currentnursing.com/nursing_theory/interpersonal_theory.html Post-Surgical Patients Require Better Monitoring. (2011, August 9). Retrieved November 19, 2014, from http://ppahs.org/2011/08/09/post-surgical-patients-require-better- monitoring-for-improved-patient-safety-anesthesia-patient-safety-foundation-guidelines-recommend-using-capnography-and-oximetry-to-continuously-monitor-patients/ Stoelting, R., & Overdyk, F. (n.d.). Essential monitoring strategies to detect clinically significant drug-induced respiratory depression in the postoperative perios. Retrieved November 19, 2014, from http://www.apsf.org/announcements.php?id=7 Thomas, V., & Rose, F. (1993). Patient-controlled analgesia: a new method for old. Journal Of Advanced Nursing,18(11), 1719-1726. doi:10.1046/j.1365-2648.1993.18111719.x