Prescription and Management of Intravenous （处方和管理静脉）.pdf

Prescription and Management of Intravenous Patient Controlled Analgesia December 2012 Introduction Scope This policy is intended for use in all Western Australian public hospitals and departments where intravenous patient controlled analgesia (PCA) is prescribed. It aims to ensure that prescription, administration and monitoring of PCA is safe and appropriate for most patients. High-risk patients (e.g. those with head injuries, pre-existing respiratory disease such as obstructive sleep apnoea, or renal/hepatic failure) will require more intensive monitoring or dose adjustment. This document describes minimum standards for the provision of routine PCA care, but therapy and monitoring should be adjusted for the individual patient’s condition. Background Patient controlled analgesia (PCA) refers to a method allowing a person in pain to deliver their own pain relief. The PCA pump is programmed by the prescriber or a competent Registered Nurse (RN); two RNs are required to program the PCA together. Prescription of a small bolus dose, use of “lockout” intervals and strictly patient use only contribute to the safety of the technique. It is used for the more continuous control of moderate to severe pain, where oral or intermittent analgesia would be less effective. Fentanyl and morphine are the most commonly used opioid in PCA regimens in Western Australia, although other opioids may be considered in selected cases. In principle, PCA enables a patient to self-control the amount and timing of analgesia received, and may improve patient satisfaction, when compared with conventional parenteral opioid regimens (Acute Pain Management: Scientific