Transcript PCA - Agency for Clinical Innovation

PCA (patient controlled analgesia) Chart – adult
Education Slide Presentation
A presentation prepared by the
Pain Interest Group Nursing Issues
in association with the Agency of Clinical Innovation
Pain Management Network
Please direct comments to:
Emily Edmonds
OR
Coordinator State Pain Forms
Pain Interest Group Nursing Issues
CNC Acute Pain Service Blacktown Hospital
Phone: 9881 7649
Email: [email protected]
Jenni Johnson
Manager
Pain Management Network
Agency for Clinical Innovation (ACI)
Phone: 9464 4636
Email: [email protected]
March 21, 2013
PCA (patient controlled analgesia) chart - adult
The PCA prescription and observation chart for adult patients has been
developed by a team of experts in the field of acute pain including clinical
nurse consultants, anaesthetists and pharmacy representatives.
This PCA chart is not suitable for use in paediatric patients.
Standardisation of this chart promotes best practice in prescribing, pain
assessment and management of adverse effects in those patients receiving
an opioid via PCA.
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Aim of this presentation:
This presentation aims to explain
 how to use the chart for prescribing a PCA
 how to record the administration and discard of
drugs used for PCA
 how to complete the clinical observations
 guidelines on the management of patients receiving
PCA including the management of adverse effects
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Booklet format
Prescription valid for 4 days
Observation pages for 4 days
PCA chart - adult
Page 1
Management guidelines
Page 2
PCA prescription
- PCA program
- Neuraxial opioid + PCA
- Naloxone prescription
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Page 3
PCA drug administration
- Drug discard
- Naloxone administration
PCA chart - adult
Inside pages:
Observation pages for up to 4 days
Back page:
Clinical Review and
Rapid Response Criteria
5
(Between the Flags)
Prescription page:
Patient label and
allergy adverse
reactions
PCA prescription
PCA program
- Allows for 2 further
changes to the program
Record of administration of a
neuraxial opioid
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Prescription for naloxone
OR ‘sticker affixed’ stating
existing standing order
PCA prescription:
Below is an EXAMPLE prescription
Refer to hospital PCA policy for
local guidelines on PCA prescribing
Handwrite patient
details OR affix patient
label
Prescriber to complete
patient allergy and ADR
section in full
PSmith
SMITH
(First prescriber to check
patient label is correct)
Private patients:
require a
signature from
the referring
Doctor to the Pain
Service
22/4/13
PLEASE REFER TO YOUR
LOCAL HOSPITAL POLICY FOR
PCA DRUG SOLUTIONS
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PCA prescription:
IV
Morphine
Below is an EXAMPLE prescription
Refer to hospital PCA policy for
local guidelines on PCA prescribing
60 mg
A PCA prescription is for one opioid only.
When changing from one opioid to
another, a new PCA chart must be
commenced
60 mL
NIL
TSmith
22/04/13
SMITH
Space is provided for an
additional drug to be added
if necessary
PCA prescription to include
route, primary drug
(e.g. morphine or fentanyl),
total amount in mg or
microgram and total volume
Prescriber’s signature
and printed name
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Space
provided for
pharmacist
reconciliation
PCA program:
23/04/13
10:00
09:00
Lockout
interval in
minutes
PCA bolus dose
(state unit of
drug and volume)
Primary drug and
concentration
State: mg or
microgram per mL
Date
and
time
22/04/13
Below is an EXAMPLE program
Refer to hospital PCA policy for
local guidelines on PCA prescribing
Background infusion
(State mg or microgram
and mL per hour)
Morphine
1mg
1mg
1
5
mins
NIL
Morphine
1mg
2mg
2
5
mins
1mg
When changing from one
opioid to another, a new
PCA chart must be
commenced
Two additional rows are
provided for changes to
the PCA program
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1
TSmith
SMITH
S.Jack
JACK
Prescriber’s
signature and
print name
Neuraxial opioid + PCA:
IF a dose of opioid has been administered via
the spinal or epidural route during a
procedure, AND the patient is to receive a PCA,
the following is to be completed
The frequency of observations
(hourly for 6 hours or hourly for 12 hours)
must be determined by the
medical officer who administered
the opioid dose

22/04/13
10:00
Morphine
Spinal
10
200
micrograms
TSmith
SMITH
Naloxone
prescription:
02/04/13
Naloxone
Naloxone is indicated for
SEDATION SCORE 3 (difficult to rouse or unresponsive) OR
SEDATION SCORE 2 (constantly drowsy unable to stay awake) and a
RESPIRATORY RATE LESS THAN OR EQUAL TO 5 breaths per minute.
IV
100
micrograms
X4
This section MUST be completed in full OR
a sticker affixed which states the standing
order PRIOR to any administration of
naloxone.
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2 -3
minutely
TSmith
SMITH
Administration and discard
of PCA opioid and
administration of naloxone:
PCA
commenced
The fold out section includes
space for the documentation of :
-
PCA commenced
Discard of remaining PCA opioid or drug
Naloxone administration
Discard of any
remaining PCA
opioid or drug
Naloxone that may
have been
administered
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Administration and discard of PCA drug:
22/04/13
22/04/13
10:00
20:00
THall
BLoh
Any opioid or drug
remaining from a
syringe or bag MUST be
recorded on the
corresponding row
from its administration
SRose
22/04/13
20:00
NIL
JLucas
23/04/13
09:00
15 mL
IF a PCA syringe or bag is
empty when the next one is
commenced,
document ‘NIL’ discarded
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BLoh
JLucas
Plambert
TBuckley
There are 14 rows
provided to record PCA
administration and
discard
Record of naloxone administered:
Naloxone may only be administered when
the prescription section of the PCA chart
has been completed in full OR if a
standing order sticker is affixed
02/03/13
08:30
IV
100 micrograms
Plambert
TBuckley
02/03/13
08:33
IV
100 micrograms
Plambert
TBuckley
02/03/13
08:36
IV
100 micrograms
Plambert
TBuckley
02/03/13
08:39
IV
100 micrograms
Plambert
TBuckley
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Clinical Review &
Rapid Response
Criteria:
The back page of the PCA
chart displays instructions
explaining when to make a
Clinical Review or a Rapid
Response.
These instructions incorporate
Track and Trigger color zones
(from the Between the Flags Program)
to promote the recognition of
the deteriorating patient
associated with the
administration of opioids
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Clinical Review Criteria:
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Rapid Response Criteria:
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PCA Management Guidelines
are provided on the ‘fold-out’
front page of the PCA chart
For detailed information
regarding PCA prescribing
and management refer to
local hospital PCA policy
or procedure
PCA can be ceased according to
instructions in the medical record:
Date and time prompt provided
(Check local policy for use of this prompt)
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There is space provided for
the contact details of your
Acute Pain Service or
equivalent medical officer
who manages PCA
Observations:
A patient label must be affixed or
details written on each page that
records observations
The PCA chart provides observations
for a maximum of 4 days.
If the PCA continues beyond 4 days,
a new PCA chart must be started and
a new prescription written.
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Documenting observations:
Pain Assessment: ‘R’ for rest ‘M’ for movement
22/04/13
M
M
R
M
R
R
R
M
R
R
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Documenting observations:
A sedation score or a
respiratory rate in the
‘Yellow Zone’ requires a
Clinical Review by the Acute
Pain Service
Sedation, respiratory rate & oxygen therapy
(or equivalent medical officer)










A sedation score or a
respiratory rate in the
‘Red Zone’ requires a Rapid
Response to be initiated
AND
contact the Acute Pain
Service
(or equivalent medical officer)
2L
NP
2L
2L
NP
NP
Oxygen Device Key
shown on front PCA
Management
Guidelines page
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2L
NP
6L
FM
Assessments must be
recorded graphically
as shown
Documenting observations:
Nausea or vomiting, PCA delivery


2
mg
10
mg
1
mg
1
mg
2
13
10
2


13
mg
20
mg
25
mg
1
mg
1
mg
NIL
16
25
30
13
20
25
JS
Nausea or vomiting
assessment
Total primary PCA dose (cumulative)
Circle the unit that is being used
Background infusion rate (if in use)
Total demands / good demands
(different pumps use different words to describe
how many times the button is pressed)

Ondanestron given


JS
JS
JS
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TJ
PCA program checked: once per shift
and on patient transfer
- to ensure the pump program matches
the prescription
Comments section blank
for free text
Assessor’s initial
The next two slides detail the front page
PCA Management Guidelines
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The standardisation of this chart promotes best practice in
prescribing, pain assessment and management of adverse
effects in those patients receiving an opioid via PCA.
Comments or questions can be directed to your
implementation officer or the project leaders
Emily Edmonds or Jenni Johnson
(for contact details see introduction slide)
The feedback register can be located on the ACI website:
http://www.aci.health.nsw.gov.au/networks/pain-management/acute-pain-forms
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