Only patient should administer patient-controlled analgesia

AORN Journal,  June, 2005  

• E-mail
• Print
• Link

Family members and caregivers who want to keep patients from suffering may actually put them at risk by becoming involved in administering patient-controlled analgesia (PCA), according to a Dec 20, 2004, news release from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Patient-controlled analgesia uses a computerized pump hooked up to the patient's IV, and the patient receives pain medication by pressing a button. An oversedated patient is not able to push the button, which ensures the patient cannot administer an overdose. Problems can arise, however, when a well-intentioned family member or health care professional administers PCA (ie, PCA by proxy) in an attempt to keep the patient comfortable because this may result in over-sedation, respiratory depression, or even death.

Specific recommendations to prevent PCA-by-proxy errors were developed by JCAHO in cooperation with the United States Pharmacopeia and the Institute for Safe Medication Practices. The recommendations include

* ensuring that patients are appropriate candidates for PCA (eg, appropriate age, mental status, level of consciousness, intellectual capacity);

* carefully monitoring the heart rates, blood pressure, and breathing of patients receiving PCA; and

* educating patients, their family members, and caregivers about the proper use of PCA and the dangers of having others administer the medication.

In addition, written instructions given to family members should emphasize that PCA doses are not to be administered by proxy.

Joint Commission Issues Alert on Dangers of Family Members, Caregivers Delivering Patient Controlled Analgesia (news release, Oakbrook Terrace, Ill: Joint Commission on Accreditation of Healthcare Organizations, Dec 20, 2004) http://www.jcaho.org/news+room /news+release+archives/jcaho_122004.htm (accessed 6 Jan 2005).

COPYRIGHT 2005 Association of Operating Room Nurses, Inc.
COPYRIGHT 2005 Gale Group