A multidisciplinary approach to patient controlled analgesia

Patient controlled analgesia (PCA) is an innovative method for delivering intravenous analgesia, which requires therapeutic and technical expertise from various health care professionals. This article describes a multi-disciplinary process of implementing a PCA program including approaches to solving problems encountered. A pharmacy and therapeutics subcommittee was established with various aspects of the program assigned to the medical, nursing and pharmacy staffs, intravenous (IV) therapy team, and clinical equipment support. A detailed comparison of PCA pumps was prepared to aid in selection. A pharmacy-based protocol describes the role of each health care professional. Usage guidelines are presented and evaluated. Physician order sheets and narcotic disposition forms were designed specifically for PCA. Problems encountered include dedicated IV access, PCA use in specialized hospital units, and use in pediatric patients. A multi-disciplinary approach was successful in implementing and maintaining a quality PCA program. Similar approaches should be used for other sophisticated drug-delivery systems.