Continuous Ambulatory Delivery Device Use for Patients Managed by an Inpatient Palliative Care Team.

BACKGROUND: The use of Patient Controlled Analgesia (PCA) via a Continuous Ambulatory Delivery Device (CADD) is a common and effective means of pain and symptom management for hospitalized patients with a malignancy. Studies exploring the indications for starting such a device for hospitalized inpatients referred to inpatient palliative care teams are limited. AIM: This retrospective chart review aims to explore indications, timing of initiation, and barriers to the use of a CADD. METHODS: Over a six month period, during daily inpatient palliative care consult team rounds, patients who required a CADD were enrolled in this study. Sixty-one adult patients were identified who required a pump for symptom control. The team's database sheets were used to capture patient demographics. RESULTS: The main reasons for initiating a Continuous Ambulatory Delivery Device in the above setting included: lack of efficacy of oral opioids and to increase patient autonomy of their pain management. Approximately 20% of patients required transfer to another unit that could accommodate the CADD. The median length of stay for these patients was 13 days, with a median length of half a day for a pump to be started. CONCLUSIONS: This initial study provides the Palliative Care Consult Team with information on the indications for the use of a CADD. The lack of universal access to a CADD in various areas of our hospital due to differences in departmental protocols may compromise good symptom management and patient safety. These results strengthen the argument that the existing hospital policy requires revamping to improve CADD access. A CADD has been shown to provide hospitalized patients, with a malignancy, with timely access to effective symptom management, and in turn, reducing their length of stay in hospital. These findings will help inform this organization's CADD policy and support the need to broaden access to this device.

ASPMN Position Statement: Authorized Agent Controlled Analgesia.

The American Society for Pain Management Nursing (ASPMN) has reviewed and updated its position statement on the use of authorized agent controlled analgesia (AACA) for patients who are unable to independently utilize a self-dosing analgesic infusion pump, commonly known as patient-controlled analgesia (PCA). ASPMN continues to support the use of AACA to provide timely and effective pain management while promoting equitable care for vulnerable patient populations who are unable to use PCA. ASPMN does not support the use of "PCA by Proxy" in which unauthorized individuals activate PCA for a patient. This position statement includes an updated review of the evidence related to AACA. Clinical practice recommendations for authorized agents, nurses, prescribers, and organizations are provided with an emphasis on the importance of appropriate authorized agent selection, education, diligent patient assessment and medication management.

Colocación de analgesia controlada por el paciente epidural por vía venosa periférica / Inserting epidural patient controlled analgesia into a peripheral venous line

Se presenta un caso comunicado en la base de datos del Sistema de Notificación en Seguridad en Anestesia y Reanimación. El evento se produce en una paciente sometida a cirugía abdominal a la que se coloca preoperatoriamente un catéter epidural para analgesia. Al finalizar la intervención se traslada a la Unidad de Reanimación, donde se programa la analgesia controlada por el paciente (PCA). Por error, se conecta la PCA a una vía venosa periférica, detectándose precozmente sin que le produzca daño a la paciente. El análisis de este incidente permitió implantar un nuevo protocolo de administración de fármacos a través de PCA, lo que incluye la obligatoriedad de prescribir las PCA en el sistema electrónico, un sistema de doble chequeo antes de la conexión de la PCA, el etiquetado de las bolsas de medicación y las líneas tanto en el extremo proximal como en el distal, la estandarización de la visita diaria a los pacientes y el control mensual de los resultados obtenidos (AU)

A case is reported from the Safety Reporting System in Anaesthesia and Resuscitation database. The event occurred in a patient undergoing abdominal surgery in whom an epidural catheter was inserted for analgesia. After the intervention, the patient was transferred to the recovery unit where the patient controlled analgesia (PCA) is programmed. Due to an error, the PCA was connected to a peripheral venous line, which was detected early without harm to the patient. Communication and analysis of this incident served to introduce a new drug delivery protocol through PCA pumps, including the obligation to prescribe the PCA in the electronic system, a dual computerised check immediately before connecting PCA, labelling the medication bag as well as the proximal and distal lines, standardisation of daily visits to patients, and monthly monitoring of results (AU)

Analgesia controlada por el paciente (PCA) pediátrico

La aparición de las bombas de infusión para analgesia controlada por el paciente (PCA), en la población pediátrica y en el adulto han demostrado constituir uno de los mayores avances en la terapia del dolor. La analgesia controlada por el paciente (PCA), es un método efectivo y eficaz para la administración de fármacos analgésicos. El sistema ha demostrado ser superior en el manejo del dolor a los métodos convencionales del uso de dosis fijas de analgésicos intravenosos o las inyecciones intramusculares. no hay que olvidar que el manejo adecuado de la analgesia postoperatoria en el niño, constituye un componente básico e integra de los estándares del cuidado del paciente pediátrico