PCA — Patient-Controlled Analgesia

Patient-controlled analgesia lets the client self-administer predetermined doses of an opioid (typically morphine, hydromorphone, or fentanyl) by pressing a button connected to a programmable infusion pump. The provider orders four key parameters: a loading dose (initial bolus), a demand dose (amount per press, e.g., 1 mg morphine), a lockout interval (minimum time between doses, usually 6–10 minutes), and a maximum hourly or 4-hour limit. During the lockout, additional presses are ignored by the pump — this is the built-in overdose safeguard. Only the client presses the button. This is the cardinal safety rule: family members, visitors, and even nurses must never push it, because a drowsy patient who stops pressing is self-regulating. When someone else presses it, that feedback loop breaks, and respiratory depression can follow. Nursing responsibilities center on verifying pump settings against the order with a second nurse (dual verification), documenting pain scores and sedation levels every 1–2 hours, and monitoring respiratory rate. A sedation scale (e.g., Pasero) is more sensitive than respiratory rate alone for catching early overdose. If the RR drops below 10 or sedation deepens, hold PCA and have naloxone at the bedside.