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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:
SEPTEMBER 2, 2014
Emily EdmondsCoordinator State Pain Forms
Pain Interest Group Nursing IssuesCNC Acute Pain Service Blacktown Hospital
Phone: 9881 7649 Email: [email protected]
Jenni JohnsonManager
Pain Management NetworkAgency for Clinical Innovation (ACI)
Phone: 9464 4636Email: [email protected]
OR
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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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PCA chart - adult
Page 1
Page 1Management guidelines
Yellow and Red Zone response instructions
Page 2
Page 2PCA prescription, program,
Neuraxial opioid + PCA, Naloxone prescription,
Oxygen therapy, PCA ceased
Page 3
Page 3PCA drug administration,
Drug discard , Naloxone administration
Booklet formatPrescription valid for 4 days
Observation pages for 4 days
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PCA chart - adult
Observation pages:for up to 4 days
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For detailed information regarding PCA prescribing and
management refer to local hospital PCA policy or procedure
Space provided for the contact details of your Acute
Pain Service or equivalent medical officer who
manages PCA
Instructions for managing patients whose
observations are in the Yellow or Red Zone
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Prescription page:
Page 2
Patient label and allergy adverse
reactions
PCA prescription
PCA program- Allows for 2 further
changes to the program
Record of administration of aneuraxial opioid
Prescription for naloxone
Oxygen therapy
Private patients: pain specialist referral, name and signature of the doctor making the referral
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PCA prescription:Below is an EXAMPLE prescription
Refer to hospital PCA policy for local guidelines on PCA prescribing
PLEASE REFER TO YOUR LOCAL HOSPITAL POLICY FOR STANDARDISED
PCA DRUG SOLUTIONS
SMITH 5/10/14PSmith
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)
PRIVATE PATIENTS: A pain specialist referral from the referring doctor
(name), signature and date
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PCA prescription:Below is an EXAMPLE prescription
Refer to hospital PCA policy for local guidelines on PCA prescribing
A PCA prescription is for one opioid only.When changing from one opioid to another, a new PCA chart must be
commenced
Morphine 60 mg
NIL
IV 60 mL
5/10/14 SMITHTSmith
PCA prescription to include: route, primary drug (e.g. morphine or fentanyl)
total amount in mg or microgram, total volume and primary drug concentration
Space is provided for an additional drug to be
added if needed
Space provided for pharmacist
reconciliation
Prescriber’s signature, printed name and
contact
1 mg/mL
7511
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PCA program:Below is an EXAMPLE programRefer to hospital PCA policy for
local guidelines on PCA prescribing
When changing from one opioid to another, a new
PCA chart must be commenced
1 mg 15
minsNIL10:005/10/14
1 mg 15 mins
09:006/10/14
SMITHTSmith
JACKS.Jack1.5 mg 1.5
PCA bolus dose (state unit of
drug and volume)
Lockout interval in minutes
Background infusion (State mg or microgram
and mL per hour)
Two additional rows are provided for changes to
the PCA program
Prescriber’s signature, print name
and contact
7511
3852
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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
Morphine Spinal 200 microgram
10:005/10/14 SMITHTSmith
7511
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Naloxone prescription:
Naloxone is indicated forSEDATION 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.
Naloxone X 4100 microgramIV5/10/14
SMITHTSmith2 -3
minutely 7511
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Oxygen guidance:
PCA can be ceased according to instructions in the medical record:
Date and time prompt provided(Check local policy for use of this prompt)
Give oxygen to maintain Sa02 above 95% Smith(SMITH) 6/10/14
Administration of oxygen therapy default as stated OR space is
provided for individual patient instructions for oxygen delivery
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Administration and discard of PCA opioid and administration of naloxone:
PCA commenced
Discard of any remaining PCA opioid or drug
Naloxone that may have been
administered
Page 3
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Administration and discard of PCA drug:
IF a PCA syringe or bag is empty when the next one is
commenced, document ‘NIL’ discarded
There are 14 rows provided to record PCA
administration and discard
Any opioid or drug remaining from a
syringe or bag to be recorded on the
corresponding row from its administration
10:005/10/14 THall SRose 20:005/10/14 BLoh JLucasNIL
20:00 BLoh JLucas 09:006/10/14 Plambert TBuckley15 mL5/10/14
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Record of naloxone administered:
08:30 IV 100 microgram06/10/14
Plambert TBuckley
08:33 IV 100 microgram06/10/14
Plambert TBuckley
08:36 IV 100 microgram06/10/14
Plambert TBuckley
08:39 IV 100 microgram06/10/14
Plambert TBuckley
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
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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.Observation pages
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Documenting observations: Pain Assessment: ‘R’ for rest ‘M’ for movement
R R
R R
R
M M R
M
M
1100 12001300
15001400
05/10/14
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Documenting observations: Sedation, respiratory rate, oxygen therapy, nausea and vomiting
2L2L 2L2L 6LNP NP NPNP FM
Assessments to be recorded graphically
as indicated
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)
A sedation score or a respiratory rate in the
‘Yellow Zone’ requires a Clinical Review by the Acute
Pain Service (or equivalent medical officer)
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Documenting observations:PCA delivery
JS
2mg
10mg
13mg
20mg
25mg
TJ
1mg
2
2 10 13
30
25
13 16 25
20
On
dan
estr
on
giv
en
JS JS JS JS TJ
NIL – – –
– – –
Total primary PCA dose (cumulative)
Circle the unit that is being used
Background infusion rate (if in use)
Total demands / successful demands (different pumps use different words to describe how many times the button is pressed)
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 initialTwo initials are required
for change of PCA program
JS
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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
