PCA (patient controlled analgesia) Chart adult Education ... · PCA (patient controlled analgesia)...
Transcript of PCA (patient controlled analgesia) Chart adult Education ... · PCA (patient controlled analgesia)...
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:
March 21, 2013
Emily Edmonds 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]
OR
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 Booklet format
Prescription valid for 4 days Observation pages for 4 days
Page 1 Management guidelines
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Page 2 PCA prescription
- PCA program - Neuraxial opioid + PCA
- Naloxone prescription
Page 3 PCA drug administration
- Drug discard - Naloxone administration
Inside pages: Observation pages for up to 4 days
PCA chart - adult
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Back page: Clinical Review and
Rapid Response Criteria (Between the Flags)
Prescription page:
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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
Prescription for naloxone OR ‘sticker affixed’ stating
existing standing order
PCA prescription:
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Below is an EXAMPLE prescription Refer to hospital PCA policy for
local guidelines on PCA prescribing
SMITH 22/4/13 PSmith
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: require a
signature from the referring
Doctor to the Pain Service
PLEASE REFER TO YOUR LOCAL HOSPITAL POLICY FOR
PCA DRUG SOLUTIONS
PCA prescription:
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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
22/04/13 SMITH TSmith
PCA prescription to include route, primary drug
(e.g. morphine or fentanyl), total amount in mg or
microgram and total volume
Space is provided for an additional drug to be added
if necessary
Space provided for pharmacist
reconciliation
Prescriber’s signature and printed name
PCA program:
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Below is an EXAMPLE program Refer to hospital PCA policy for
local guidelines on PCA prescribing
Morphine 1mg 1mg 1
5
mins NIL 10:00 22/04/13
2mg 2
5
mins 1mg 09:00 23/04/13
SMITH TSmith
JACK S.Jack
Morphine 1mg 1
Primary drug and concentration State: mg or
microgram per mL
Two additional rows are provided for changes to
the PCA program
PCA bolus dose (state unit of
drug and volume)
Lockout interval in minutes
Background infusion (State mg or microgram
and mL per hour)
Prescriber’s signature and
print name
Date and time
When changing from one opioid to another, a new
PCA chart must be commenced
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
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Morphine Spinal 200
micrograms
10:00 22/04/13 SMITH TSmith
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
Naloxone prescription:
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.
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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Naloxone
X 4
100
micrograms IV
02/04/13 SMITH
TSmith 2 -3
minutely
Administration and discard of PCA opioid and administration of naloxone:
The fold out section includes space for the documentation of : - PCA commenced - Discard of remaining PCA opioid or drug - Naloxone administration
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PCA commenced Discard of any
remaining PCA opioid or drug
Naloxone that may have been
administered
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 MUST be recorded on the
corresponding row from its administration
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10:00 22/04/13 THall SRose 20:00 22/04/13 BLoh JLucas NIL
20:00 BLoh JLucas 09:00 23/04/13 Plambert TBuckley
15 mL 22/04/13
Record of naloxone administered:
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08:30 IV 100 micrograms 02/03/13 Plambert TBuckley
08:33 IV 100 micrograms 02/03/13 Plambert TBuckley
08:36 IV 100 micrograms 02/03/13 Plambert TBuckley
08:39 IV 100 micrograms 02/03/13 Plambert TBuckley
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
Clinical Review & Rapid Response Criteria:
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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)
There is space provided for the contact details of your
Acute Pain Service or equivalent medical officer
who manages PCA
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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A patient label must be affixed or details written on each page that
records observations
Documenting observations: Pain Assessment: ‘R’ for rest ‘M’ for movement
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R R
R R
R
M M R
M
M
22/04/13
Documenting observations: Sedation, respiratory rate & oxygen therapy
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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2L 2L 2L 2L 6L
NP NP NP NP FM
Oxygen Device Key shown on front PCA
Management Guidelines page
Assessments must be recorded graphically
as shown
Documenting observations: Nausea or vomiting, PCA delivery
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Ondanestron given
2
mg
10
mg
13
mg
20
mg
25
mg
JS JS JS JS TJ
1
mg
1
mg
1
mg
1
mg
NIL
2
2 10 13
30
25
13 16 25
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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)
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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