Pain Management Nursing
Volume 8, Issue 1 , Pages 4-11 , March 2007

Authorized and Unauthorized (“PCA by Proxy”) Dosing of Analgesic Infusion Pumps: Position Statement with Clinical Practice Recommendations

  • Elsa Wuhrman, MS, RN,C, FNP, BC

      Affiliations

    • Columbia University Medical Center, New York, New York
    • Corresponding Author InformationAddress correspondence to Elsa Wuhrman, MS, RN, C, FNP, BC, Acute Pain Services, New York Presbyterian Hospital-Columbia University Medical Center, 622 West 168th St., PH505, New York, NY 10032.
    • ,
  • Maureen F. Cooney, MS, FNP, RN,C

      Affiliations

    • Westchester Medical Center, New York Medical College, Valhalla, New York
    • ,
  • Colleen J. Dunwoody, MS, RN,C

      Affiliations

    • University of Pittsburgh Medical Center Presbyterian Shadyside, Pittsburgh, Pennsylvania
    • ,
  • Nancy Eksterowicz, MSN, RN,C APN

      Affiliations

    • University of Virginia Health System, Charlottesville, Virginia
    • ,
  • Sandra Merkel, MS, RN,C

      Affiliations

    • Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, Michigan
    • ,
  • Linda L. Oakes, MSN, RN,C, CCNS

      Affiliations

    • St. Jude Children’s Research Hospital, Memphis, Tennessee.

References 

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  2. American Nurses Association (ANA). Code of ethics for nurses with interpretive statements. Washington, D.C: American Nurses Association; 2001;
  3. American Pain Society (APS). Principles of analgesic use in the treatment of acute pain and cancer pain. (5th ed.). 2003;Glenview, IL
  4. Anghelescu D, Burgoyne L, Oakes L, Wallace D. The safety of patient-controlled analgesia by proxy in pediatric oncology patients. Anesthesia Analgesia. 2005;101:1623–1627
  5. Ballantyne J, Ryder E. Postoperative pain in adults. In:  Ballantyne J editors. The Massachusetts General Hospital handbook of pain management. Philadelphia: Lippincott, Williams, & Wilkins; 2002;p. 294–295
  6. Berde C, Solodiuk J. Multidisciplinary programs for management of acute and chronic pain in children. In:  Schechter N,  Berde C,  Yaster M editor. Pain in infants, children, and adolescents. (2nd Ed.). Philadelphia: Lippincott Williams & Wilkins; 2003;p. 473–475
  7. Beyer J, Simmons L. Home treatment of pain for children and adolescents with sickle cell disease. Pain Management Nursing. 2004;5(3):126–135
  8. Cox J, Oakes L. Home infusion therapy: Essential characteristics of a Successful education process: Grounded theory study. Journal of Infusion Nursing. 2005;28(2):99–107
  9. Forrest W, Smethurst P, Kienitz M. Self administration of intravenous analgesics. Anesthesiology. 1970;33:363–365
  10. Gureno M, Reisinger C. Patient controlled analgesia for the young pediatric patient. Pediatric Nursing. 1991;17(3):251–254
  11. Jacobi J, Fraser G, Coursin D, Riker R, Fontaine D, Wittbrodt E, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical Care Medicine. 2002;30(1):121
  12. Jonas D. Parent’s management of their child’s pain in the home following day surgery. Journal of Child Health Care. 2003;7(3):150–162
  13. Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Sentinel event alert on patient controlled analgesia by proxy. 2004;December 20, issue 33. Retrieved from: http://jcaho.org/about+us/news+letters/sentinel+event+alert.sea_33.htm
  14. Lehr V, BeVier P. Patient-controlled analgesia for the pediatric patient. Orthopaedic Nursing. 2003;22(4):298–304
  15. Liebert M. Journal of Palliative Medicine. 1998;1:315–328Retrieved from: http://www.hospicecare.com/Ethics/fohrdoc.htm
  16. Macintyre P. Safety and efficacy of patient-controlled analgesia. British Journal of Anaesthesia. 2001;87(1):36–46
  17. Monitto C, Greenberg R, Kost-Byerly S, Wetzel R, Billett C, Lebet R, et al. The safety and efficacy of parent-/nurse-controlled analgesia in patients less than six years of age. Anesthesia Analgesia. 2000;91:573–579
  18. Noah V. PCA by proxy: Minimizing the risks. Nursing. 2003;33(12):17
  19. Nurse Advise-ERR. Safety issues with patient-controlled analgesia (Part I. How errors occur). Institute for Safe Medication Practices Safety Alert. 2005;3(1):1–3
  20. Nurse Advise-ERR. Safety issues with patient-controlled analgesia (PCA) (Part II. Practical error-reduction strategies). Institute for Safe Medication Practices Safety Alert. 2005;3(2):1–3
  21. Pasero C, McCaffery M. Unconventional PCA; making it work for your patient. American Journal of Nursing. 1993;93(9):38–41
  22. Pasero C, McCaffery M. Authorized and unauthorized use of PCA pumps. American Journal of Nursing. 2005;105(7):30–33
  23. Pasero C, Portenoy R, McCaffery M. Opioid analgesics in McCaffery, M. & Pasero, C. In: Pain: Clinical Manual. (2nd ed.). St. Louis, MO: Mosby; 1999;p. 161–299Chap. 6
  24. Sechzer P. Studies in pain with the analgesic-demand system. Anesthesia Analgesia. 1971;50:1–10
  25. Taylor S, Voytovitch A, Kozol R. Has the pendulum swung too far in postoperative control. The American Journal of Surgery. 2003;186:472–475
  26. Weldon B, Connor M, White P. Pediatric PCA: The role of concurrent opioid infusions and nurse controlled analgesia. Clinical Journal of Pain. 1993;9(1):26–33
  27. Yaster M, Krane E. Pediatric Pain Management and Sedation Handbook. St. Louis: Mosby; 1997;Chap 6

PII: S1524-9042(07)00003-3

doi: 10.1016/j.pmn.2007.01.002

Pain Management Nursing
Volume 8, Issue 1 , Pages 4-11 , March 2007

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