Transcript Presentation Title - 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]
SEPTEMBER 2, 2014
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
Yellow and Red Zone
response instructions
Page 2
PCA prescription, program,
Neuraxial opioid + PCA,
Naloxone prescription,
Oxygen therapy, PCA ceased
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Page 3
PCA drug administration,
Drug discard ,
Naloxone administration
PCA chart - adult
Observation pages:
for up to 4 days
5
For detailed information
regarding PCA prescribing and
management refer to local
hospital PCA policy or procedure
Instructions for managing
patients whose
observations are in the
Yellow or Red Zone
6
Space provided for the
contact details of your Acute
Pain Service or equivalent
medical officer who
manages PCA
Prescription page:
Patient label and
allergy adverse
reactions
Private patients:
pain specialist referral,
name and signature of the
doctor making the referral
PCA prescription
PCA program
- Allows for 2 further
changes to the program
Record of administration of a
neuraxial opioid
Prescription for naloxone
Oxygen therapy
7
PCA prescription:
Below is an EXAMPLE prescription
Refer to hospital PCA policy for
local guidelines on PCA prescribing
Prescriber to complete
patient allergy and ADR
section in full
Handwrite patient
details OR affix patient
label
(First prescriber to check
patient label is correct)
PSmith
SMITH
PRIVATE PATIENTS:
A pain specialist
referral from the
referring doctor
(name), signature
and date
5/10/14
PLEASE REFER TO YOUR LOCAL HOSPITAL
POLICY FOR STANDARDISED
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
5/10/14
TSmith
1 mg/mL
7511
SMITH
Space is provided for an
additional drug to be
added if needed
PCA prescription to include:
route, primary drug
(e.g. morphine or fentanyl)
total amount in mg or
microgram, total volume and
primary drug concentration
Prescriber’s
signature, printed
name and contact
9
Space
provided for
pharmacist
reconciliation
PCA program:
Below is an EXAMPLE program
Refer to hospital PCA policy for
local guidelines on PCA prescribing
Lockout
interval in
minutes
PCA bolus dose
(state unit of
drug and
volume)
5/10/14
6/10/14
10:00
1 mg
09:00
1.5 mg
1
1.5
Background infusion
(State mg or microgram
and mL per hour)
5
mins
5
mins
NIL
1 mg
Two additional rows are
provided for changes to
the PCA program
1
TSmith
SMITH
7511
S.Jack
JACK
3852
When changing from one
opioid to another, a new
PCA chart must be
commenced
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Prescriber’s
signature, print name
and contact
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

5/10/14
10:00
Morphine
200
microgram
Spinal
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TSmith
SMITH
7511
Naloxone
prescription:
5/10/14
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
microgram
12
X4
2 -3
minutely
TSmith
SMITH
7511
Oxygen guidance:
Administration of oxygen therapy
default as stated OR space is
provided for individual patient
instructions for oxygen delivery
Give oxygen to maintain Sa02 above 95% Smith(SMITH) 6/10/14
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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Administration and discard
of PCA opioid and
administration of naloxone:
Discard of any
remaining PCA
opioid or drug
PCA
commenced
Naloxone that may
have been
administered
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Administration and discard of PCA drug:
5/10/14
5/10/14
10:00
20:00
THall
BLoh
Any opioid or drug
remaining from a
syringe or bag to be
recorded on the
corresponding row
from its administration
SRose
5/10/14
20:00
NIL
JLucas
6/10/14
09:00
15 mL
IF a PCA syringe or bag is
empty when the next one is
commenced,
document ‘NIL’ discarded
15
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
naloxone standing order is in available
06/10/14
08:30
IV
100 microgram
Plambert
TBuckley
06/10/14
08:33
IV
100 microgram
Plambert
TBuckley
06/10/14
08:36
IV
100 microgram
Plambert
TBuckley
06/10/14
08:39
IV
100 microgram
Plambert
TBuckley
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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
05/10/14
M
M
R
M
R
R
R
M
R
R
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Documenting observations:
Sedation, respiratory rate, oxygen therapy,
nausea and vomiting
A sedation score or a
respiratory rate in the
‘Yellow Zone’ requires a
Clinical Review by the Acute
Pain Service
(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
NP
2L
NP
2L
NP
6L
FM



Assessments to be
recorded graphically
as indicated 
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
Documenting observations:
PCA delivery
Total primary PCA dose (cumulative)
Circle the unit that is being used
2
mg
10
mg
13
mg
20
mg
NIL
–
–
–
2
13
16
25
30
2
10
13
20
25
Total demands / successful demands
JS
–
TJ
(different pumps use different words to describe
how many times the button is pressed)
–
1
mg
Background infusion rate (if in use)
Ondanestron given
–
25
mg
JS
JS
JS
JS
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TJ
JS
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
Two initials are required
for change of PCA program
The next slide details 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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