A Policy for Nurse-Administered Analgesic Dosing Through a Patient-Controlled Analgesic Device

Abstract

Patient-controlled analgesia (PCA) has improved pain management in the hospital setting by decreasing the time it takes for patients to obtain intravenous analgesics and to allow for titration based on activity and level of pain. However, when patients are inappropriate for PCA because of cognitive impairment or physical inabilities, they are unable to obtain analgesics in such a timely manner and must wait longer periods of time for analgesics. In our institution, all of our continuous narcotic infusions are administered using a PCA machine for security purposes. But when the patients needed extra medication, the nurses would have to obtain these medications elsewhere. We developed a policy so that the PCA machine could be used to deliver the extra medication by the nurses when needed. This allows the nurse to perform a pain assessment, determine a need for analgesia, administer the prescribed dose, and document this information without leaving the bedside. When the nurse returns to evaluate the effectiveness of this dose, an additional dose of medication may be administered if indicated. We have found this to be invaluable for unplanned dressing changes, line placements, transfers, and other causes of active pain. It has also been useful for giving small doses of fentanyl to cognitively challenged elderly patients who would otherwise be ineligible for this medication. The outcome is diminished time needed to administer analgesia to the physically and cognitively impaired patients as well as decreasing nursing workload. PCA has replaced intermittent injections of narcotics for most patients. However, for those who are cognitively impaired or physically unable to press a PCA button, they must wait longer for their pain relief. In our institution, we developed a policy that allows nurses to administer narcotics using a PCA machine (Nurse Administered Analgesic Dosing), which decreases the time for medication delivery and improves patient comfort. The purpose of this clinical project is to educate nurses about how to safely use PCA devices to improve the delivery of PRN analgesics.