1. When setting up the PCA, make sure your tubing is primed appropriately.

This includes the

small y-site tubing that goes from the maintenance/TKO fluid into the main PCA tubing. You can
prime it with a saline syringe, or the maintenance/TKO fluid itself.
2. You must have two RNs sign off on all PCA settings when you set it up, when you change the
syringe, when you change any of the settings, to verify pump settings when the patient arrives on
the unit, or during handoff at change of shift.
3. You do NOT need two RNs to bolus the PCA. Document the bolus in the doc flowsheet under
the Pain Management tab, not on the MAR.
4. PCA monitoring does not require continuous pulse ox monitoring. The doctor will decide whether
its indicated or not based on the individual patients risk factors (older age, female sex, obesity,
narcotic sensitivity, etc.). You can definitely recommend it to the physician if you feel the patient
needs closer monitoring. You can also ask the doctor if the pulse ox can be discontinued if the
patient has been stable on the PCA for over 24 hours.
5. Hospital policy requires close monitoring of a patients sedation level while theyre on a PCA. You
should be checking all vitals Q4H. Respiratory rate and sedation should be checked (and
charted!):
Q1H for the first 12 hours the patient is on a PCA
Q2H for the second 12 hours
Q4H for the rest of the time the patient is on the PCA
If you bolus the PCA, or increase the settings, you have to check respiratory rate and
sedation level:
Q30M for one hour
Then return to baseline monitoring based on how long the patient has had the PCA
6. Document sedation levels using the Moline-Roberts Sedation Scale. You can find this line under
either the Vitals tab or the Pain Management tab. There are two tip sheets on using the sedation
scale located on your EPIC dashboard.
7. Guardrails not allowing you to program your settings correctly? Check your profile to make sure
youre in the correct one for your patient. Opioid nave, opioid tolerant, and Palliative Care are the
three different profiles, and each one has a different set of Guardrails, allowing for different dosing
parameters.
8. If your doctor orders the Palliative Care/Oncology order set, a Palliative Care consult is required
and will automatically be ordered as part of the EPIC order set. This is a physician to physician
consult, though, so the ordering doc should make sure they talk to the Palliative Care team.
9. Subcutaneous PCAs? Yes, its a thing! The PCA policy is being updated to reflect the how-tos of
using a subcutaneous PCA, but in the meantime, talk to Aurora, Barb W, Kyle, or Annsley about
how these work.