After discovering a lapse in documentation for PCAs in the Operating Room I created a short RN education inservice to correct this. Here is a presentation of my findings.

1. Documentation:
The Analgesia
Flow SheetStephanie Ricketts, RN
N693
Fall 2014

2. OBJECTIVES
 Assess risks associated with Patient
Controlled Analgesia
 Evaluate data collected from PACU and
OR
 Review intervention and
response

3. PATIENT CONTROLLED
ANALGESIA

4. PCA Risks
Opioid adverse effects
Pump Issues
Programming

5. NATIONAL STANDARDS
Pump Initiation (programing)
Two healthcare providers should independently double-
check
1. Drug selection and concentration confirmed
as that which was prescribed
1. PCA pump setting
1. Line attachment to patient and tubing
insertion to pump

6. Medication Errors involving
Patient-controlled Analgesia
A Retrospective Analysis of Medmarx

7. ERRORS
Fourfold
higher relative
risk of harm!
PCA = 1% of all reported errors
PCA = 6.5% of harmful outcomes
83% of Perioperative PCA
Errors
occur in PACU

8. “PCA errors certainly occur, both in programming and in
delivery, but any published estimate is likely to be only the tip
of the iceberg.”
-Executive Director, Anesthesia Quality Institute
POST-OP PCA Significance

9. PACU SURVEY
“All RNs in all surgical departments need to be PCA trained and competent, including
Kinau 3 and OR.”
“PAPERLESS EVERYONE! Make automatic dual sign off in MAR similar to signing off
insulin.”
“Put it in EPIC– no more paper.”
“Not sure, more documentation is not the answer”
“…They need to be properly documented at the
time they are started by the OR.”
“Wrong programming.”
“…When OR asks to have it programed for
patients not yet in the PACU.”

10. OR SURVEY
88% ≤ 5
12% ≥ 5
59% In the MAR
35% On the PCA flow sheet
0.06% Have PACU chart it
0.06% Other

11. CHART REVIEW
PACU
80%
Not
Documented
15%
OR
5%
Units Where Flow Sheets are
Initiated

12. PCA PROJECT
To eliminate stress on the PACU staff and decrease the
possibility for error with post-op PCA pumps.

13. RESPONSES
Now that the Analgesia Flow Sheets are in each OR filing cabinet,
how likely are you to use them when a PCA is initiated in the OR?
(On a scale from 1-10)
“If there is a
discrepancy
at the end
then we get in
trouble.”
“I don’t feel
comfortable
with PCAs. As
OR staff we
aren’t trained
on this.”

14. Conclusion & Suggestions for
Improvement
Only 5% of PCA’s are started in the OR

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