Adherence of patient-controlled analgesia order form on an oncology unit

Objectives: Patient-controlled analgesia (PCA) provides several benefits including quicker patient access to pain relief. Successful inpatient pain management can also help improve patient satisfaction, increase the quality of care, and reduce length of hospital stay.   The objective of this study is to assess the documentation of criteria to determine adherence to the PCA order set and the effectiveness of pain management.    Methods:   The health system's electronic medical record system will be used to identify patients who, over a six?month period of time, received PCAs on one unit.  Baseline data will be collected to identify the number of patients treated with PCA pumps, appropriate pain assessments by physicians and nurses, occurrence of adverse events, and the use of ancillary medications for the treatment of adverse events. The PCA order set provides criteria for frequency of pain score measurement, vital signs and sedation scores which are at baseline, every 15 minutes for the first two hours, followed by every two hours for two measurements and then every four hours until the PCA is discontinued. The compliance with documentation will be analyzed by category and reported.  If opportunities for improvement are identified, a multi-disciplinary effort with nursing, information systems, and physicians will be initiated to address the issues and formulate a collaborative plan.   Results: A total of 33 patients were identified by generating a pharmacy report on the use of PCA pumps. Data reveals only a 45% documentation of pain scores for patients’ prior to the initiation of the PCAs and no pain score, vital sign, and sedation level documentation at the specified times. Conclusion: Systematic plans for improvement will best involve broad and multi-faceted changes in our approach to managing patients who receive PCA. The improvements utilized should incorporate the hospital information system, order form, policy, and staff education.