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The NSW Standardised PCA (Patient Controlled Analgesia)
Observation Chart - adult
A presentation prepared by the Pain Interest Group Nursing Issues
in association with the Agency of Clinical Innovation Pain Management Network
Please direct comments to:
December 2012
Emily Edmonds Coordinator State Pain Forms
Pain Interest Group Nursing Issues CNC Acute Pain Service Blacktown Hospital
Phone: 9881 7649 Email: [email protected]
Jenni Johnson Manager
Pain Management Network Agency for Clinical Innovation (ACI)
Phone: 9464 4636 Email: [email protected]
OR
The NSW Standardised PCA chart - adult
The new NSW PCA prescription and observation chart for adult patients has been developed by a team of experts in the field of acute pain including clinical nurse consultants, anaesthetists and pharmacy representatives.
This PCA chart is not suitable for use in paediatric patients.
Standardisation of this chart promotes best practice in prescribing, pain assessment and management of adverse effects in those patients receiving an opioid via PCA.
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Aim of this presentation
This presentation aims to explain
how to use the chart for prescribing a PCA
how to record the administration and discard of drugs used for PCA
how to complete the clinical observations
guidelines on the management of patients receiving PCA including the management of adverse effects
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NSW PCA chart - adult Booklet format Prescription valid for 4 days
Observation pages for 4 days
Page 1 Management guidelines Page 2
PCA prescription - PCA program
- Neuraxial opioid + PCA - Naloxone prescription
Page 3 PCA drug administration
- Drug discard - Naloxone administration
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Inside pages: Observation pages for 4 days
Back page: Clinical Review and
Rapid Response Criteria (Between the Flags)
NSW PCA chart - adult
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PCA Prescription:
Prescriber to complete patient allergy section in full
Handwrite patient details OR affix patient
label (First prescriber to check patient label is correct)
Private patients: require a
signature from the referring
Doctor to the Pain Service
PLEASE REFER TO YOUR LOCAL HOSPITAL POLICY FOR PCA DRUG
SOLUTIONS
SMITH PSmith 01/03/13
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Below is an EXAMPLE prescription Refer to hospital PCA policy for
local guidelines on PCA prescribing
PCA prescription:
PCA prescription to include route, primary drug (e.g.
morphine or fentanyl), total amount in mg or microgram
Space is provided for an additional drug to be added
if necessary
Total volume of solution
Space provided for pharmacist
reconciliation
Prescriber’s signature and printed name
Morphine ____mg NIL IV ___mL
01/03/13
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SMITH PSmith
Below is an EXAMPLE prescription Refer to hospital PCA policy for
local guidelines on PCA prescribing
PCA Program:
Primary drug and concentration State: mg or
microgram per mL
Two additional rows are provided for changes to
the PCA program
PCA bolus dose (state unit of
drug + volume)
Lockout interval in minutes
Background infusion (State mg or microgram
= mL per hour)
Prescriber’s signature and
print name
Date and time
Morphine 1mg 1mg 1 5
mins NIL 10:00 01/03/13
Fentanyl 20 microg 1
5 mins NIL 09:00 02/03/13
SMITH PSmith
JACK S.Jack
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Below is an EXAMPLE program Refer to hospital PCA policy for
local guidelines on PCA prescribing
10 Micrograms
Neuraxial opioid + PCA:
IF a dose of opioid has been administered via the spinal or epidural route during a
procedure, AND the patient is to receive a PCA, the following is to be completed
Morphine Spinal 200 micrograms
10:00 01/03/13 SMITH PSmith
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The frequency of observations (hourly for 6 hours or hourly for 12 hours)
must be determined by the medical officer who administered
the opioid dose
Naloxone prescription:
Naloxone X 4
100 micrograms
IV 01/03/13 SMITH PSmith 2 -3
minutely
Naloxone is indicated for SEDATION SCORE 3 (difficult to rouse or unresponsive) OR
SEDATION SCORE 2 (constantly drowsy unable to stay awake) and a
RESPIRATORY RATE LESS THAN OR EQUAL TO 5 breaths per minute.
This section MUST be completed in full OR a sticker affixed which states the standing
order PRIOR to any administration of naloxone.
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Administration and discard of PCA opioid and administration of naloxone:
PCA commenced
The fold out section includes space for the documentation of : - PCA commenced - Discard of remaining PCA opioid or drug - Naloxone administration
Discard of any remaining PCA opioid or drug
Naloxone that may have been
administered
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Administration and discard of PCA drug
IF a PCA syringe or bag is empty when the next one is
commenced, document ‘NIL’ discarded
10:00 01/03/13 THall SRose 20:00 01/03/13 BLoh JLucas NIL
20:00 BLoh JLucas 09:00 02/03/13 Plambert TBuckley 15 mL
There are 14 more rows provided for more than
one PCA that is commenced
Any opioid or drug remaining from a
syringe or bag MUST be recorded on the
corresponding row from its administration
01/03/13
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Record of naloxone administered:
Naloxone may only be administered when the prescription section of the PCA chart
has been completed in full OR if a standing order sticker is affixed
08:30 IV 100 micrograms 02/03/13 Plambert TBuckley
08:33 IV 100 micrograms 02/03/13 Plambert TBuckley
08:36 IV 100 micrograms 02/03/13 Plambert TBuckley
08:39 IV 100 micrograms 02/03/13 Plambert TBuckley
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Clinical Review & Rapid Response Criteria
The back page of the PCA chart displays instructions explaining when to make a
clinical review or a rapid response.
These instructions incorporate track and trigger
color zones (from the Between the Flags Program)
to detect the deteriorating patient
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PCA Management Guidelines are provided on the ‘fold-out’
front page of the PCA chart
For detailed information regarding PCA prescribing and management refer to local hospital PCA policy
PCA can be ceased according to instructions in the medical record:
Date and time prompt provided (Check local policy for use of this prompt)
There is space provided for the contact details of your Acute Pain Service
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Observations
The PCA chart provides observations for a maximum of 4 days.
If the PCA continues beyond 4 days, a new PCA chart must be started and
a new prescription written.
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A patient label must be affixed or details written on each page that
records observations
Pain Score
Sedation
Respiratory rate
Nausea or vomiting
PCA delivery
Comments
Initial
Documenting observations: Pain Assessment: ‘R’ for rest ‘M’ for movement
R R R
R
R
M M M
M
M
01/03/13
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Documenting observations: Sedation, respiratory rate & oxygen therapy
A Sedation Score or a Respiratory Rate in the
‘red zone’ requires a Rapid Response to be initiated
AND contact the Acute Pain
Service (or equivalent medical officer)
A Sedation Score or a Respiratory Rate in the ‘yellow zone’ requires a
Clinical Review by the Acute Pain Service
(or equivalent medical officer)
0
14
0 1
14 12
2
10
2L 2L 2L 2L
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Documenting Observations: Nausea or vomiting, PCA delivery
Nausea or vomiting assessment
Total primary PCA dose (cumulative)
Circle the unit that is being used
Background infusion rate (if in use)
Total demands / good demands (different pumps use different words to describe
how many times the button is pressed)
PCA program checked: once per shift and on patient transfer
- to ensure the pump program matches the prescription
Comments section blank for free text
Assessor’s initial
On
dan
estr
on g
iven
no
2 mg
no no no yes
10 mg
13 mg
20 mg
25 mg
JS JS JS JS JS
1 mg
1 mg
1 mg
1 mg
-
2
2 10 13
30
25
13 16 25
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The next two slides detail the front page PCA Management Guidelines
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The standardisation of this chart promotes best practice in prescribing, pain assessment and management of adverse
effects in those patients receiving an opioid via PCA.
Comments or questions can be directed to your implementation officer or the project leaders
Emily Edmonds or Jenni Johnson (contact details introduction slide)
The feedback register can be located on the ACI website:
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