This document provides instructions for patient-controlled analgesia (PCA) medication administration and documentation. It lists common PCA medications and outlines requirements for verifying PCA syringe counts at shift changes and documenting amounts. It also describes PCA settings like the 4-hour medication limit and lockout time between doses. Procedures are provided for charting PCA medication as effective or ineffective, discontinuing orders, loading new syringes, and changing PCA medications.

1. PCA
Medications for PCA infusions include: Demerol, Morphine, Nubain
and Dilaudid
 Standard PCA orders or specific orders may be used by the
physician.
 The PCA Syringe Count must be verified by two licensed nurses at
initiation, shift change, syringe change, dose change, and transfer
of care.
 At the change of shift, the on-coming and off-going licensed
nurses should check the amount left in the syringe and the amount
the computer says remains. Document these amounts on the end
of shift PCA syringe count form. If the amounts do not match
within 3 ml, complete the PCA discrepancy form.

2. PCA (continued)
The maximum amount of medication that is delivered within a
4 hour time frame is the 4 hour limit
The time period during which the patient administered dose
cannot be activated by the patient is called the Limit Dose Time

3. PCA (continued)
To chart PCA medication shift totals or 4 hour totals as EFFECTIVE:
• From PCA screen, touch “Effective”
• Option to change the protocol
• Enter amount left in syringe, amount or amount wasted
• Click on OK and OK at bottom
To chart medication as INEFFECTIVE:
• Touch “Ineffective “
• Select the ineffective reason
• Enter amount left in syringe, amount used
• Click on OK and OK at bottom
* Always enter assessment data on PAGE 2 *

4. PCA (continued)
To discontinue the PCA medication:
• When the syringe volume is charted as being zero, system will
prompt to discontinue the order
• Touch the D/C Order Box to change to “Y”
• Touch the OK Box and Update the information, and the PCA will
be discontinued
To load a new syringe:
• Update default protocol or make necessary changes
• When the syringe volume is charted as being zero, the system
will prompt you to discontinue
* PATIENT MAY NOT LEAVE THE UNIT WHILE ON PCA *

5. PCA (continued)
When there is an order to change medications on a PCA, the nurse will
discontinue the first medication by documenting the amount received
and/or amount wasted in the PCA application of CPSI and then selecting
the Y in the final box “DISCONTINUE ORDER”.
Once updated, the medication
is discontinued and the PCA
Medication Selection menu
will display. Choose the new
medication, verify the
protocol, and update. Have
another nurse verify the
medication and protocol with
you before removing from the
Pyxis.