Alternative delivery system for controlled drugs in the surgical intensive care unit

Faced with a serious shortage of qualified nurses for critically ill patients, methods to reduce the time required to deliver care without sacrificing quality are needed. A non-electronic device designed as a patient-controlled analgesic (PCA) was evaluated as a nurse-controlled device (NCA). Twenty-five intubated patients received morphine sulfate (MS) with the nurse-controlled device (NCA) and 12 by standard IV push policy. The average nursing time for narcotic dosing with the standard policy was 5 minutes/unit dose. A total of 1,183 NCA doses were given over 77 patient days. The average doses per patient day were 15 (2-38). The average nursing time was 22 seconds/NCA dose. The NCA saved 85 nursing minutes/patient day. Annual nursing labor costs were reduced by $77,000.00 with NCA. Total costs for standard IV push narcotic use were $36.43/patient day versus $35.45/patient day for NCA. Using this protocol, the NCA system saved $8,500.00 annually. By increasing the duration of PCA use to 72 hours, the annual savings would become $49,500.00. These data indicate that a simple NCA can deliver controlled drugs rapidly and safely, save valuable nursing time, and decrease the cost of ICU care.