ieMR Quick Reference Guide NCA Administration

ieMR Quick Reference Guide

NCA Administration - Paediatrics

MA - NCA Administration Paediatrics, v1.0, MA024, 28/07/2021

Townsville Hospital and Health Service Page 1

Contents

PCA/NCA Paediatric PowerPlan ....................................................................................... 1

Review Nursing Protocol .................................................................................................. 2

Commencing the PCA/NCA on the MAR .......................................................................... 2

Documenting the PCA/NCA commencement in Interactive View .................................. 5

Document Pain Infusion Observations (Ongoing) .......................................................... 6

Fluid Balance (Hourly) ....................................................................................................... 7

Document Nurse Controlled Bolus Doses and Rate Change (MAR) ............................. 7

Changing Bags – MAR ...................................................................................................... 9

Discontinuing the PCA/NCA ........................................................................................... 11

Discontinuing the PowerPlan (APMS Only) ................................................................... 12

Nurse Controlled Analgesia (NCA) for paediatric patients will be ordered via the PCA/NCA

Paediatric PowerPlan.

PCA/NCA Paediatric PowerPlan

The PCA/NCA Paediatric PowerPlan details can be reviewed on the Orders page. The

Orders page will display any link to relevant state-wide guidelines, as well as yellow

‘persistent note’ instructions.

Ordering and management of pain infusions must be in accordance with

local TUH procedures.

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Review Nursing Protocol

If the Nursing Protocol phase has been initiated, CareCompass tasks will appear for

clinicians to action. Completing vital signs and pain infusion observations should be

routinely completed as part of your nursing care. Ongoing management and modification

of these patient care tasks is the responsibility of the clinician caring for the patient and

should be updated in accordance with the patient’s clinical condition and TUH APMS

procedure.

If the Nursing Protocol has not been previously initiated:

1. Navigate to the Orders Page.

2. Locate the PCA/NCA Paediatric PowerPlan.

3. Select the Nursing Protocol phase.

4. Review all patient care orders and modify if required.

5. Select Initiate Now and Orders for Signature and Sign.

6. Enter password and OK.

Commencing the PCA/NCA on the MAR

Within the Townsville Hospital and Health Service, Patient and Nurse Controlled

Analgesia (PCAs/NCAs) are administered through a CADD Solis pump.

Pain infusion medication orders will sit within the Continuous Infusions section on

the MAR.

1. Navigate to the MAR to review the medication order.

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2. Rick click on the PCA/NCA order and select Order Info from the menu.

3. Prepare the medication as per the Order Info.

4. Program the CADD Solis pump from the Order Info.

5. At the bedside, perform verbal PPID and Allergy check.

6. Launch the Medication Administration Wizard (MAW).

There is no Begin Bag task on the MAR – all infusions are started through the

MAW.

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7. Scan your patient’s wristband to complete PPID.

8. Select the correct PCA/NCA order in the MAW.

9. Click on the results column to open the administration window.

10. Complete any required details:

• Site- Peripheral intravenous cannula

• Rate- e.g. 2mls/hr (background rate) as per order

• Morphine Dose- as per order (e.g. mg/hr)

• Witnessed by- Name

11. Click OK to Begin Bag (#1).

12. Witness to enter password.

13. Click Sign.

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14. Refresh the MAR and confirm the Begin Bag task has commenced.

Pain infusions are true continuous infusions which means a new bag can be

replaced every 24 hours or earlier if required. The End Bag task will allow the

clinician to complete End Bag documentation however the order will not

discontinue.

Documenting the PCA/NCA commencement in Interactive View

1. Navigate to Interactive View → Paediatric Lines- Devices

2. Select Pain Infusion

3. Select Pain Infusion Dynamic Group

This only needs to be completed if the APMS/PACU have not already created a

dynamic group - this will set up the information for ongoing monitoring and

documentation of the PCA

4. Complete required fields:

• Infusion type- PCA/NCA/MCA/Continuous opioid infusion

• Drug infusing- e.g. Morphine

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5. Click Ok.

6. Double click the top cell to activate the column.

7. Complete all relevant fields, example:

8. Green tick to Sign.

9. Enter Witness details and password.

Document Pain Infusion Observations (Ongoing)

1. Navigate to Care Compass.

2. Locate the Pain Infusion Observations, Pain Assessment and Vital Signs tasks.

3. Highlight each relevant task and click Document.

4. In Interactive view, complete any required information, example:

• Pump settings checked & locked

• Line care

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• Patent IV access

• Comments: record the reservoir volume (e.g. RV = 90mls)


Note: Cumulative dose is completed by APMS on ward rounds (leave these

sections blank)

Fluid Balance (Hourly)

1. Navigate to Interactive View.

2. Select Fluid Balance.

3. Locate the pain infusion (Morphine Additive).

4. Click in Fluid Balance Cell to document the background infusion amount as per the

pump – enter a volume: e.g. 2 mL (for the full hour).

6. Select OK and green tick to Sign.

Document Nurse Controlled Bolus Doses and Rate Change (MAR)

Bolus Dose

1. Navigate to the MAR and locate the Morphine additive infusion order.

2. Select the Pending task cell to launch the administration window and mini fluid balance.

3. Select Bolus from the mini menu.

4. Document the Bolus infused volume (e.g. 1mL as per the order).

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5. Adjust the From and To times accordingly if required (to reflect the time the bolus is infused over)

6. Enter Nurse Witness.

7. Select Apply.

8. Enter witness password and OK.

Rate Change

9. Select Rate Change from the mini menu

10. Document the Rate Change as per the order (e.g. increase to 2.5mL/hr).

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11. Enter Nurse Witness.

12. Select Apply.

13. Enter witness password and OK.


15. Refresh the MAR.

Changing Bags – MAR

Note: If the patient does not use all the reservoir within twenty-four (24) hours, it

must be discarded, and a new reservoir attached.

To waste volumes from the existing PCA/NCA bag:

1. Locate the pain infusion order on the MAR.

2. Click on the Pending task to open the Administration Window.

3. Click on Waste in the mini Administration Window.

4. Record the Wasted volume from the previous bag:

5. Enter Witnessed by name and click Apply.

6. Enter witness password and green tick to Sign.

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Discarded volumes will also need to be documented in Interactive View with a

Nurse Witness.

To commence the next bag in the MAR:

7. At the patient’s bedside perform allergy check and verbal PPID.

8. Navigate to the MAW and scan the patient’s wrist band ID.

9. Select the relevant pain infusion order.

10. Click the result column.

11. Complete required fields (note the Bag # has increased by 1):

12. Click OK.

13. Enter witness password.

14. Sign.

15. Refresh the MAR.

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Interactive View will also need to be completed when a new bag has been

commenced and can be indicated by selecting New bag from the Assessment

type.

Discontinuing the PCA/NCA

1. On the MAR, select the End Bag task.

2. Record the Waste as previous bag changes and enter the nurse witness.

The infusion order will remain active on the MAR until the PowerPlan is

discontinued by the Registered Nurse/Midwife or APMS

If the PowerPlan has been discontinued prior to the Waste being documented,

complete the following steps:

1. Locate the discontinued PCA/NCA order on the MAR (the order will appear in grey)

2. Right click on the order sentence and select Additional dose.

3. Select Waste from the mini menu and follow the steps for previous bag changes.

Inactivate the dynamic group:

1. Navigate to Interactive View → Adult Lines & Devices

2. Navigate to the Pain Infusion tab and locate the appropriate dynamic group.

3. Select Activity and Discontinue.

4. Complete relevant fields, example:

• Discontinue reason select: Infusion ceased by APS/Anaesthetics

• Anticoags and removal checked with APS: Yes/No/N/A

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• Catheter removal: (e.g. Tip inspected, Tip intact)

• Discarded volume and Discarded units

5. Click on the Nurse/Midwife witness field and select Yes

6. Click on the green tick to Sign (witness to enter name and password).

7. Refresh.

8. Right click on the dynamic group heading- e.g. PCA/NCA/MCA/Continuous opioid

infusion

9. Select inactivate.

The dynamic group has now been inactivated. You can review information by click

on the arrow beside the infusion name.

Discontinuing the PowerPlan (APMS Only)

1. Navigate to the Orders page.

2. Locate the relevant PowerPlan (e.g. PCA/NCA Paediatric).

3. Right click and select: Discontinue

4. Select Orders for Signature

5. Sign (enter password).

6. Navigate to the MAR and Refresh.

7. The PCA/NCA is now in a discontinued state.

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Documents

ieMR Quick Reference Guide NCA Administration