Patient controlled analgesia--a pharmacy based service

Patient controlled analgesia (PCA) is a proven method of administering analgesics via programmable infusion devices to relieve postoperative pain and pain associated with terminal illnesses. In mid-1989, a pain management service was started in the authors' hospital by the anesthesiology service. Since pharmacists had been previously involved in PCA postoperative pain management, it was decided they would continue in that capacity with the pain management service. Responsibility for procuring, storing, and programming the pumps, as well as drug preparation and patient instruction remains an integral part of the daily operation of our pharmacy. Physician orders written by the anesthesiologists for PCA therapy are processed in the pharmacy computer. The drugs are prepared, and pumps are programmed and primed by the central intravenous (IV) admixture service. The pumps with the drugs and accessory administration set and supplies are sent to satellites where staff pharmacists aid the nurses in starting the pumps and training the patients in their correct use. All subsequent programming including dose changes, rate changes, boluses, bag changes, and problem resolution are the responsibility of the staff pharmacists. Pharmacists are periodically certified in programming skills as part of the department's quality assurance program. In 1990, over 1800 patients received the benefits of this innovative service.