Patient-Controlled Analgesia

May 22, 2017 | Healthcare Risk, Quality, & Safety Guidance

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Pain Management

Patient-controlled analgesia (PCA) can be a valuable tool in managing patients' pain. However, misuse of the pump can circumvent its safety features, leading to oversedation, respiratory depression, and death. PCA is a high-risk treatment (San Diego Patient Safety Council). Adverse events involving PCA pumps are four times as likely to cause harm as other medication errors—many of these are due to inadequate patient screening or monitoring. (ISMP "Fatal") Patients who receive PCA are considered to be at greater risk for respiratory depression just because they are receiving PCA, according to the Institute for Safe Medication Practices (ISMP). Therefore, patients' appropriateness for PCA therapy should be carefully considered. This includes patient factors such as increased weight and opioid tolerance, as well as capability to self-administer the medication in a safe manner. (ISMP "Beware") Patients with paralysis, cognitive difficulties, a history of substance abuse, or with decreased manual dexterity should not be considered for PCA therapy (Lisi). For more on patient appropriateness, see the section Select Patients Carefully. Specifically, two patient groups are at higher levels of risk and may not always be candidates for PCA use: pediatric and elderly populations.

Because the administration of the medication becomes the responsibility of the patient, clear and actionable policies and procedures for education regarding safe administration need to be enacted and followed. The Joint Commission requires such policies to be in place and adhered to; for more information on regulatory standards and accreditation requirements from the Centers for Medicare and Medicaid Services, the Joint Commission, and Det Norske Veritas (DNV), see the Regulations and Standards​ section below.

When reviewing or updating organization PCA policies and procedures, it is imperative to identify the stakeholders who can provide input and who will be working within these parameters on the front line. This includes nursing, pharmacy, pain management, anesthesia, information technology, and any others necessary. Organizations should consider using standard order sets because they "ensure consistent and...

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