Give a PCA pump to patients in pain
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Patients in severe pain should not have to wait for the best pain management available while waiting in your ED, argues Kathryn Perlman, MS, RN, clinical specialist for the ED at Presbyterian Hospital of Dallas. "Often, patients such as those with fractured hips or sickle cell crises must wait for inpatient beds," she explains. While they wait, they usually get as-needed intravenous-push pain medications, says Perlman. "They must call for the nurse when they are in pain and then wait for the nurse to obtain, prepare, and administer the medication," she adds.
Don’t let pain escalate
In a busy ED, this wait could turn into a lengthy delay that results in escalating pain, increased demands for medication, patient dissatisfaction, and a frustrated nurse, says Perlman. Instead, ask the admitting physician to write orders for a patient-controlled analgesia (PCA) pump, she suggests. "Most hospitals have protocols and flow sheets already developed for PCA," she notes. (See Patient Controlled Analgesia Order Form, Patient Controlled Analgesia procedure, and PCA Flow Sheet.) Perlman cautions that you will need to check the patient’s allergies, make sure the patient is on a SaO2 monitor, and follow the protocol for your hospital.
Most PCA pumps are not complicated, and many ED nurses already know how to set them up, notes Perlman. She suggests having clinical pharmacists and nurses on the surgical floors inservice ED staff and provide support the first few times that the pumps are used. "Patients will be far more comfortable and satisfied, and the nurses [will be] better organized by using PCA pumps," she says.
[Editor’s Note: For more information about using PCA pumps in the ED, contact: Kathryn Perlman, MS, RN, Emergency Department, Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231-4496. Telephone: (214) 345-6301. Fax: (214) 345-6486. E-mail: [email protected].]
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