Dan Johnson, MD, regional department chief for palliative care for Kaiser-Permanente in Colorado, says the level of experience with the PCA is highly variable among physicians he works with. “Some know how to use the PCA and actually do it quite well. Many others are not adequately trained,” he says. “When I test residents with a few questions, they customarily do very poorly. Some of the answers I see make me nervous.”
Dr. Johnson offers a refresher on the PCA for hospitalists in the Denver area who attend an annual palliative care retreat. Those who come regularly seem to retain the information he offers. “If I were in a hospital that had not rolled out PCA standing orders, I’d make sure that there were educational units provided for hospitalists,” he says. “I’d also investigate how to develop standing orders for the hospital.” TH
Larry Beresford is a frequent contributor to The Hospitalist.
- Hudcova J, McNicol E, Quah C, et al. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev. 2006;4.
- Ballantyne JC, Carr DB, Chalmers TC. Postoperative patient-controlled analgesia: Meta-analyses of initial randomized controlled trials. J Clin Anesth. 1993 May/June;5(3):182-193.
- D’Arcy Y. New pain management options: Delivery systems and techniques. Nursing. 2007 February; 37(2):26-27.
- Pasero C, McCaffery M. Safe use of a continuous infusion with IV PCA. J PeriAnesthesia Nursing. 2004 Feb;19(1):42-45.
- Joint Commission. Patient-controlled analgesia by proxy. Available at www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_33.htm. Last accessed July 12, 2007.
- Wuhrman E, Cooney MF, Dunwoody CJ, et al. Authorized and unauthorized (“PCA by Proxy”) dosing of analgesic infusion pumps: Position statement with clinical practice recommendations. Pain Manag Nurs. 2007 Mar;8(1):4-11.
- Prommer E. Fast Fact and Concept #92, Patient controlled analgesia in palliative care. End-of-Life/ Palliative Education Resource Center, Medical College of Wisconsin, Milwaukee:www.eperc.mcw.edu/ff_index.htm.
- Owen H, Plummer JL, Armstrong I, et al. Variables of patient-controlled analgesia. 1. Bolus size. Anaesthesia.1989 Jan.;44(1):7-10.
- Vicente KJ, Kada-Bekhaled K, Hillel G, et al. Programming errors contribute to death from patient-controlled analgesia. Can J Anesth. 2003;50:328-332.