Documentation: The Analgesia

Flow SheetStephanie Ricketts, RN

N693Fall 2014

OBJECTIVESAssess risks associated with Patient

Controlled Analgesia

Evaluate data collected from PACU and OR

Review intervention and response

PATIENT CONTROLLED ANALGESIA

Less Pain

Earlier Discharge

PCA Risks

Opioid adverse effects

Pump Issues

Programming

NATIONAL STANDARDS

Pump Initiation (programing)

Two healthcare providers should independently double-check

1. Drug selection and concentration confirmed as that which was prescribed

2. PCA pump setting

3. Line attachment to patient and tubing insertion to pump

Medication Errors involving Patient-

controlled AnalgesiaA Retrospective Analysis of Medmarx

ERRORS

Fourfold higher

relative risk of harm!

PCA = 1% of all reported errors

PCA = 6.5% of harmful outcomes

83% of Perioperative PCA Errors

occur in PACU

“PCA errors certainly occur, both in programming and in delivery, but any published estimate is likely

to be only the tip of the iceberg.”-Executive Director, Anesthesia Quality Institute

POST-OP PCA Significance

PACU SURVEYSuggestions for Improvement

“All RNs in all surgical departments need to be PCA trained and competent, including Kinau 3 and OR.”

“PAPERLESS EVERYONE! Make automatic dual sign off in MAR similar to signing off insulin.”

“Put it in EPIC– no more paper.”

“Not sure, more documentation is not the answer”

Main Concerns

“…They need to be properly documented at the time they are started by the OR.”

“Wrong programming.”

“…When OR asks to have it programed for patients not yet in the PACU.”

OR SURVEYOn a scale from 1-10 how familiar are you with the Analgesia Flow Sheet?

88% ≤ 5

12% ≥ 5

Where do you document the initial dose of medication if

it occurs in the OR?59% In the MAR35% On the PCA flow sheet0.06% Have PACU chart it0.06% Other

CHART REVIEW

PACU80%

Not Doc-

umented

15%

OR5%

Units Where Flow Sheets are Initiated

PCA PROJECTTo eliminate stress on the PACU staff and decrease the

possibility for error with post-op PCA pumps.

RESPONSESNow that the Analgesia Flow Sheets are in each OR filing cabinet, how likely are you to use them when a PCA is initiated in the OR?

(On a scale from 1-10)

63% < 5 “If there is a discrepancy at the end

then we get in trouble.”

“I don’t feel comfortable with PCAs. As OR staff we aren’t trained on

this.”

Conclusion & Suggestions for Improvement

Only 5% of PCA’s are started in the OR

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