JULY
2004
Volume 28 •
No. 7
PCA order sets streamlined
Effective June 21, order sets for patient controlled analgesia (PCA) were changed at SHC in an effort to ensure safety and efficiency.
The June issue of the hospital's Drug Information Newsletter reported that the computerized physician order entry (CPOE) system, LastWord, will offer the following PCA order sets:
Morphine 1 mg/mL PCA (Standard)
Morphine 5 mg/mL PCA (Concentrated)
Fentanyl 50 mcg/mL IV PCA
Hydromorphone 1 mg/mL IV PCA
Prior
PCA order sets will be eliminated. However, physicians will still have
the option to delete, supplement or revise PCA orders, said Cynthia Chan,
a Pharm.D., who wrote the Drug Information Newsletter article.
Prebuilt PCA screens for morphine, hydromorphone, and fentanyl will also include associated PCA nursing care and adjunct medication orders.
PCA order sets previously required nurses to follow up on the physicians' orders and complete the required patient orders. The new process allows the physician to choose and complete the order in one step. Chan noted.
The change follows national recommendations in 2003 by the United States Pharmacopoeia- Institute for Safe Medication Practices Medication Errors Reporting Program. The new procedures were developed at SHC by a Health Care Failure Mode and Effects Analysis (FMEA) group that addressed issues of pain control, safety and physician education related to PCA. The group served under the auspices of the Medical Staff's Pharmacy and Therapeutics Committee, chaired by Kenneth Woodrow, a Menlo Park psychiatrist and adjunct faculty member.
Instructions, including changes in procedures, are available on nursing stations and are summarized in the DI Newsletter article.
The DI article notes that national studies report that PCA is an effective pain control method that greatly increases patient satisfaction with pain control when applied properly.
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