PATIENT CARE MANUAL PROCEDURE

Transcription

1 PATIENT CARE MANUAL PROCEDURE NUMBER III-130 PAGE 1 OF 5 APPROVED BY: CATEGORY: Vice President and Senior Operating Officer, Rural Health Services & Professional Practice Lead Medication Administration PURPOSE The purpose of this procedure is to provide instruction and act as a resource for nursing staff who provide care for patients utilizing PCA pumps. 1.0 APPLICABILITY Patient care provider staff who have successfully completed the learning package and have demonstrated competency to the program Clinical Educator. 2.0 INDICATIONS FOR USE Use of a PCA pump may be appropriate when; 2.1 The patient can benefit from more constant serum levels of the opioid for enhanced pain relief and decreased incidence of side effects (eg. sedation and respiratory depression). 2.2 The patient has the mental alertness and cognitive, physical and psychological ability to manage their own pain. If a patient is unable to operate the PCA pump independently, he/she is not good candidate for PCA. NOTE Patients, family and staff must be reminded that only the patient may administer PCA doses.

2 PAGE 2 OF GATHER EQUIPMENT PCA pump brand - Abbott Lifecare 4100 Plus II Infuser, Hospira Lifecare PCA set (Y-type IV set), mini-bore with anti-siphon valve Pre-mixed narcotic vial (syringe) IV administration set to maintain IV infusion Naloxone, syringe, alcohol swab, needle 4.0 PROCEDURE Staff shall: 4.1 On patient return from operating room/recovery room (or initiation), staff shall exercise an independent double check for correct pump settings and rate changes. Refer to Patient Care Policy/Procedure #III-73, Independent Double Checks Medication Administration. 4.2 Ensure IV site is patent. PCA may be infused via a central venous catheter. 4.3 Follow Patient Care Orders: Intravenous Patient Controlled Analgesia preprinted patient care orders (form MS 53719). Notify the attending physician or Nurse Practitioner when patient is experiencing persistent inadequate analgesia after titration and adjuncts have been ineffective. 4.4 Monitor the patient using the guidelines on the Pain Assessment and Analgesic Monitoring Flow Sheet Guidelines (form #CH-1346) and record information on the Adult Inpatient Assessment and Analgesic Monitoring Flow Sheet (form CH-1343). Visually confirm that the medication/ concentration and volume in syringe is correct. 4.5 Ensure IV Naloxone is readily available (tape the bag containing the equipment for injection with the Naloxone ampoule to PCA pump). Check the expiry date on the Naloxone vial and ensure the vial is intact. NOTE: For pump operation, please refer to the manufacturer s operating manual.

3 PAGE 3 OF Qualified staff 1 may change the PCA vial (syringe) and/or program or change parameters on the PCA pump (i.e. PCA dose, lockout interval) after obtaining physician s orders. NOTE: Loading dose function should not be used on inpatient care units. Qualified staff working in Recovery Room and ICU/CCU may use loading dose function. 4.7 Qualified staff is responsible for clearing "dose history and total delivered" as per unit policy. 4.8 Ensure that PCA pumps remain plugged-in as much as possible when in use and when not in use (i.e. waiting for pick-up). 5.O MAINTAINING PCA IV LINE 51 PCA tubing is changed every 72 hours. Label tubing with date. 5.2 PCA must always be accompanied by maintenance IV. 5.3 Blood or blood components must be administered via a separate IV line. (EXCEPTION: Blood may infuse via a separate lumen in a multi-lumen central line simultaneously with PCA.) 5.4 If a medication is to be infused and is not listed on Y-site compatibility list, call Pharmacy. 1 Qualified Staff are Health practitioners who are authorized to administer medications in accordance with their respective practice Regulations under the Health Professions Act (or other legislation) and who are permitted to administer medications in accordance with Covenant Health site/program based policy.

4 PAGE 4 OF DISCONTINUING PCA THERAPY NURSING ALERT: Alternate analgesic and adjunct patient care orders must be obtained prior to discontinuation of PCA. Adjunctive analgesic and side-effect management medications are in effect only during PCA analgesia. Medications for the pre-printed order sheet are automatically discontinued when PCA analgesia is discontinued. 6.1 Detach main IV line from PCA set and connect to IV catheter/catheter extension. 6.2 Unlock PCA infuser with key and remove from pole. 6.3 Remove syringe from pump. if empty, discard in sharps container (note double signature required for narcotic wastage per Patient Care P/P #III-35, Controlled Substances)) if syringe contains medication, sign for narcotic wastage on Narcotic Administration Record and discard the syringe in sharps container 6.4 Return pump to soiled utility room for pick-up by SPD. Remember to plug-in. 7.0 PATIENT TEACHING 7.1 Pre-operative Teaching - Patient teaching is initiated as per Learning Module and unit/site practice. 7.2 Post-operative Teaching - Patient teaching is initiated/reinforced per unit/site practice. Assess the patient s ability to comply with instruction. Reinforce pre-operative teaching and the importance of not allowing family members or visitors to press button for patient, etc. Encourage patient to tell staff if analgesia is inadequate.

5 PAGE 5 OF DOCUMENTATION 8.1 Monitor the patient using the Pain Assessment Flow Sheet and recording the information from the PCA pump on to the Pain Assessment Flow Sheet. Adult Inpatient Pain Assessment and Analgesic Monitoring Flow Sheet (form #CH-1343) - Record information using charting guidelines. 8.2 Medication Vials - All vials (syringes) attached or wasted must be documented on the Narcotic Administration Record and/or the Pxyis system. 8.3 Medication Administration Record (MAR) - Record medication vials administered on the patient specific MAR. 9 REFERENCES 1. San Diego Patient Safety Taskforce, PCA Guidelines of Care; December Institute for Safe Medication Practices: Safety Issues with Patient Controlled Analgesia Part I - How errors Occur; ISMP Medication Safety Alert; July Institute for Safe medication Practices Canada; Lowering the Risk of Medication Errors: Independent Double Checks; ISMP Canada Safety Bulletin; January 2005 Vol5 Issue PCA Learning Module, February 2010 available in site libraries