The practice of patient-controlled analgesia (PCA) has been around for approximately four decades now. During this time there have been improvements to the technology and the understanding of how to use this form of patient pain control; however, there continues to be concern related to the safety and efficacy of PCA. As this analysis proceeds it will briefly explain what PCA is and how it is used, then delve into the benefits and the safety issues surrounding PCA use as it pertains to the patient and the nurse. Some of the benefits of PCA include improved pain management, improved use of nursing resources, increased patient satisfaction, and reduced pulmonary issues (Hicks, Sikirica, Nelson, Schein & Cousins, 2008). Some of the safety issues surrounding PCA use include infusion pump programing errors, basal infusion dosing, and proxy errors when using PCA by proxy (Ladak, Chan, Easty, & Chagpar, 2007). Therefore, the purpose of this report is to examine the benefits and risks of patient-controlled analgesia and how it relates to nursing practice.
Patient-controlled analgesia by way of an infusion pump allows patients experiencing moderate to severe pain as a result of surgery, trauma, cancer, and other chronic conditions, to administer their own pain medication. The most common type of medication used in infusion pumps today are opioid analgesics, because of their effectiveness and availability (Chumbley & Mountford, 2010). PCA infusion pumps provide the analgesia via intravenous or epidural routes allowing for almost instantaneous pain relief verses the delay in having the nurse prepare and administer each dose as needed. These pumps allow analgesia to be delivered with a basal (background) infusion rate, a bolus (pati...
... middle of paper ...
...6-283. doi: 10.1111/j.1440-172X.2007.00638.x
Ladak, S. J., Chan, V. W., Easty, T., & Chagpar, A. (2007). Right medication, right dose, right patient, right time, and right route: How do we select the right patient-controlled analgesia (pca) device?. Pain Management Nursing, 8(4), 140-145. doi: 10.1016/j.pmn.2007.08.001
Lindley, P., Pestano, C. R., & Gargiulo, K. (2009). Comparison of postoperative pain management using two patient-controlled analgesia methods: Nursing perspective. Journal of Advanced Nursing, 65(7), 1370-1380. doi: 10.1111/j.1365-2648.2009.04991.x
Wuhrman, E., Cooney, M. F., Dunwoody, C. J., Eksterowicz, N., Merkel, S., & Oakes, L. L. (2007). Authorized and unauthorized ("pca by proxy") dosing of analgesic infusion pumps: Position statement with clinical practice recommendations. Pain Management Nursing, 8(1), 4-11. doi: 10.1016/j.pmn.2007.01.002
Management of pain is very important when it comes to palliative care patients, considering that 55-95% of this patient population requires analgesia for pain relief (Creedon & O’Regan, 2010, p. [ 257]). But what is considered pain management? And why does pain continue to be inadequately treated? According to the article on chronic non-cancer pain in older people: evidence for prescribing, in the past few decades significant improvements have been made to the management of pain in palliative care. However, it is universally acknowledged that pain on a global scale remains inadequately treated because of cultural, attitudinal, educational, legal, and systemic reasons (Creedon & O’Regan, 2010, p. ...
The range of medications from anti-inflammatory to opioids is extreme, and have different effects on the human body. Medical professionals have to make the decision whether to give a patient a lower grade pain management drug or a higher grade drug, and they are the ones who have to determine how much pain the patient truly is in when most of a patient 's pain in unseen to the physical eye. “Pain as a presenting complaint accounts for up to 70% of emergency department visits, making it the most common reason to seek health care. Often, it is the only reason patients seek care,” and with this knowledge health care professional need to treat each patient equally in the sense that they are the emergency room or a physician 's office for a reason, and that reason is to relieve the pain they are in (American College of Emergency Physicians Online). The article from the American College of Emergency Physicians continues on to say that, “it is the duty of health care providers to relieve pain and suffering. Therefore, all physicians must overcome their personal barriers to proper analgesic administration,” this is in regards to medical professional who are bias toward specific patients, such as “frequent flyers” or even patients of certain class standing; no matter what their patient may look like or be like they must be treated equally and
Winfield, H., Katsikitis, M., Hart, L. and Rounsefell, B. (1989). Postoperative pain experiences: Relevant patient and staff attitudes. [online] 34(5): pp.543-552. Available at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8V-45WYV7R-7G&_user=10&_coverDate=12%2F31%2F1990&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=35e6b5e8c8f803b487b35d4ae3b06cef&searchtype=a[ [accessed 8/5/2013]
Opioids are used as pain relievers and although it does the job, there are adverse side effects. Opioids are frequently used in the medical field, allowing doctors to overprescribe their patients. The substance can be very addicting to the dosage being prescribed to the patient. Doctors are commonly prescribing opioids for patients who have mild, moderate, and severe pain. As the pain becomes more severe for the patient, the doctor is more likely to increase the dosage. The increasing dosages of the narcotics become highly addicting. Opioids should not be prescribed as pain killers, due to their highly addictive chemical composition, the detrimental effects on opioid dependent patients, the body, and on future adolescents. Frequently doctors have become carless which causes an upsurge of opioids being overprescribed.
Of seventy-eight emergency department nurses who completed the education program, the post-test scores have significantly increased by 12.6 % than the pre-test. The majority of the participants, about 88%, reported that the program went effectively and feel the confidence of assessing the pain with the pediatric patients. In addition, the author reviewed 60 patients’ EMR for two weeks after the nurses have completed the education program for demographics means and nurse’s pain-related documentations. Although the majority of patients (87%, n=52) had documentation of pain assessment at triage, only 32% (n=11) of the patients got pharmacological or non-pharmacological interventions for pain. Also, below 30% of had documentation of the characteristics of pain quality, onset, and progression. Pain assessment scales are well used after completing education program, but the characteristics of pain represented the lowest protocol adherence. The nurses in this project demonstrated an increase in knowledge and comfort level in assessing pediatric pain assessment when the EMR reviewed, the majority of the participants' adherence to use of correct pain scale and pain assessment at triage, but nonadherence to document the characteristic of pain and post-intervention have found.
In the medical profession, personnel are asked to make judgments or draw conclusions based on measureable results. Physical assessments, vitals, CT scan, MRI, biopsy are all activities engaged in to prove abnormalities and make decisions as to the way forward. So having hunches are not considered reliable and rightly so. To decide to give a particular medication because of a mere hunch can lead to serious errors. However, pain which is now considered a part of the vital signs is based on the patients’ philosophy or view point and we (nurses) are told not to ignore but respond. This is highly subjective. It’s viewed how the patient sees it and not as tangible or measurable as the other ways of proving when something is abnormal. The situation to be presented will disclose a patient’s ordeal due to a nurse’s approach to or understanding of pain management. It will also assess whether the nurse responded in accordance to protocol.
Volles, D. F. (2011, April 11). University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures. Retrieved May 12, 2011, from University of Virgina Health System: University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures
For instance, if controlling the pain been an issue during the previous shift, then the going off duty nurse need to address this issue to the oncoming nurse regarding what pain medications were administered and how effective these medications were. Similarly, if the patient is using a patient-controlled pump, then the both nurses should clear the pump together. When both nurses clear the controlled pump that was used by the patient to control his or her pain during the previous shift allows the oncoming nurse to assess how much medication patient used during the previous shift and how the patient’s pain is being managed. Thus, it is important for both nurses to address any issues and plan for pain management because their priority during their shift is to keep their patient comfortable and
As a pain killer, morphine is used in hospitals around the United States for pain management and post-surgery. The main types of consumption is through smoking, snorting, rectal, I.V, orally, and through injection. A pump can also be used to administer the drug to the patient. Most times pumps are used in extreme cases of nerve disorders which usually entail a catheter being microscopically implanted into the spinal cord. The use of a pump is normally for pain management. Pumps are filled with a months or less supply of the drug, which is administered from the abdomen to the spinal area of pain. It basically numbs erratic nerve function and allows a normal life to be had by the patient. Morphine can also be us...
Brody, Michael, and Donald Martin. “The Role of Anesthesiologists.” Physicians Protecting Patients. N.p. N.d. Web. October 21, 2015. An anesthesiologist is a physician who has received at least 8 years of schooling and has completed a residency program dealing with anesthesiology. Now, a licensed physician, an anesthesiologist deals with the administration of anesthesia during many medical procedures, including surgical or obstetric procedures, and pain management for acute and chronic illnesses, or cancer related pain. Anesthesiologists are also in charge of “anesthesia care teams” that include the anesthesiologist, an anesthesia assistant, certified registered nurse anesthetist, and an anesthesia technician. As the leader of the care team, the anesthesiologist is responsible for assessing the patient before, during, and after medical procedures, as well as developing and monitoring performance and quality of practices and standards in regards to administering anesthesia. The entirety of
Effective treatment of cancer pain is essential for ensuring the best outcomes for cancer patients, in terms of physical, psychological and social aspects. Although there are no NICE guidelines for management of cancer pain, WHO guidance should be used to inform clinical practice. Careful assessment is a critical element of the process to ensure that patients are offered the treatment which is likely to offer the best outcomes, yet without providing a greater than necessary risk of complications such as tolerance and addiction to opioids. The main outcome that this paper highlights is that “Pain is what the patient says it is and exists when he says it does” (McCaffery 1983
The concept of pain management will be explored in relationship to patients that are post-operative. A problem has been identified on one of the floors in a hospital that I work on with patients that are post-operative after having joint replacement surgery. The patients are coming to the floor with pain and it is difficult to control their pain level. The result is patients that are unsatisfied with their pain management during their hospital stay.
Stomberg, M., Sjöström, B., & Haljamäe, H. (2003). The Role of the Nurse Anesthetist in the Planning of Postoperative Pain Management. AANA Journal, 71(3), 197.
A fundamental aspect of pediatric healthcare is to help reduce a child’s pain during hospitalization (Ullán et al., 2014). In recent years, there has been an increase in the amount of emerging research that focuses on children’s pain, which in turn has positively impacted the development and expansion of services that aid in treating pain in pediatric patients. There has been improvement in the standards and guidelines surrounding the practices of pediatric pain management. The fundamental points of these standards and guidelines are that pediatric pain should be: “treated aggressively, taken seriously, and managed by multimodal means”—including nonpharmacological approaches (Ullán et al., 2014, p. 274). It has been proposed that a central
The major concepts deduced from the hypothesis fall under three categories: (1) multimodal intervention, (2) attentive care, and (3) patient participation. Multimodal intervention includes the concepts of potent pain medication, pharmacological adjuvants, and non-pharmacological adjuvants. Attentive care relates to the assessment of pain and side effects and intervention along with reassessments. Patient participation includes goal setting and patient education. The resulting outcome of these three categories working together is the balance between analgesia and side effects.