Policy Update: PCA pump management

As stated in an earlier post, a few of the hospital policies have been revised and/or updated recently. I recommend looking up the policies on Meditech and reading through them. On the blog, I will touch on the highlights. For PCA pump management:

• No concomitant PCA/epidural infusions. Do not infuse PCA and epidural at the same time.
• The physician must use the PCA order sheet. Non-standard doses may be ordered for chronic pain or pt on prolonged opiate regimen with verification of pharmacist and/or pain physician.
• Pts using PCA basal rates (continuous infusions) must be on continuous heart rate and SpO2 monitoring (excludes end-of-life care pts).
• Only pt or nurse is allowed to push the PCA button. Give PCA information sheet to family.
  
• PCA settings/meds must be checked and documented by two RNs: on initial PCA set-up, upon receiving an admission or transfer with a PCA, when settings are changed, and when a new syringe is inserted into the pump.
• Clear pump volumes at the end of each shift and document on PCA flow sheet.
• Use a dedicated IV line whenever possible. Check compatibility of IV fluids when combined with opiate.
  

Document:

• At the initiation of PCA and dosing changes: HR, BP, RR, SpO2, and level of sedation q 1 hr x 4, and then RR q 2hr until PCA is DC'd.
• For respiratory depression, give O2 and Narcan per PCA order sheet.
  
• Pt's pain level on Daily Nursing Assessment form.
  
• When PCA is DC'd - amounts of med used and wasted, co-sign waste in Pyxis.

Reference: Management of the Patient Using PCA Pump for Pain Control, Standard 13.002