HF 7697

Patient Controlled Analgesia (PCA) by Proxy and Authorized Agent Controlled Analgesia (AACA)

Analgesia is the medical word for pain relief. With patient-controlled analgesia (PCA), patients can give their own dose of pain medicine.

Authorized Agent Controlled Analgesia (AACA)

A family member or caregiver may become a designated Authorized Agent. To assist, they will push the button on the PCA pump when the patient looks to be in pain.

This happens when the patient cannot use PCA because of young age, developmental stage, injury, or illness.

Only the designated Authorized Agent is allowed to push the button.

The patient’s nurse can also become an Authorized Agent and push the PCA button. This happens when nobody is able to be at the bedside or comfortable pushing the button.

How IV PCA Works

The PCA system has three parts:

  1. A pump which is kept next to the bed.

  2. A control button at the end of a cable which you keep at your side.

  3. Pain medicine in the pump that is connected to your IV.

The PCA pump is carefully set up by two nurses. Your nurse will set the pump to give the amount of medicine that the doctor has ordered for you. These medicines can give great pain relief.

PCA Directions

Press the button to send the medicine into the IV. There is a short time (often 6-10 minutes) after you press the button when the button will be locked. This is for the patient’s safety. It gives the medicine a chance to work. Once enough time has passed, the control button will light up and you can give more medicine if needed.

It is common to have to press the button several times each hour to keep pain under control. The patient will need less over time.

Side Effects

  • Nausea

  • Itching

  • Sleepiness

  • Decreased breathing

  • Death, if not carefully watched

PCA and Safety

A nurse will check on the patient often. If a patient becomes too sleepy or their breathing slows too much, there are things the nurse can do to help. The nurse can:

  • Stop the PCA and let the medicine wear off.

  • Give another medicine to reverse the effects of the PCA.

Requirements of the Authorized Agent (AA)

The AA is the person who is allowed to push the PCA button for the patient. The medical team caring for the patient will talk with the family to figure out who the AA will be. Staff members will check with the AA every shift to make sure they understand how to act safely as the AA.

The Authorized Agent must:

  • Know the patient well.

  • Know the risks and benefits of the medicine and PCA.

  • Be able to tell when the patient is in pain by listening to the patient.

  • Understand physical behaviors (like jaw clenching, or grimacing) that show the patient is in pain.

  • Know when it is safe and not safe to give a dose of medicine.

  • Call for help if they notice a change in patient’s breathing.

  • Be able to spend a lot of time at the bedside.

Risks

If the AA does not understand the patient’s signs of pain, they may give too little or too much pain medicine.

  • Too little pain medicine will cause the patient to remain in pain.

  • Too much pain medicine can cause sleepiness, abnormal breathing and in rare cases, death.

Safety Guidelines for the Authorized Agent

It is safe to push the button if the patient:

  • Tells you they are in pain or shows signs of pain and:

    • The patient is awake and breathing normally.

    • The patient is awake and breathing fast.

It is not safe to push the button if the patient:

  • Is sleeping or looks sleepy.

  • Is hard to wake up.

  • Has changes in their breathing pattern such as:

    • Long pauses between breaths.

    • Slower breathing.

If you are concerned about the patient’s safety:

  1. Press the call button and ask for someone to check on the patient.

  2. Try to wake up the patient. Ask them to take a deep breath while you wait for a staff member.

  3. Do not push the PCA button until a staff member checks the patient then tells you it is ok to push the button again.

If the Authorized Agent Needs to Leave

Talk to the nurse as soon as you can if you need to leave the patient’s bedside. If you need to leave for the night or for several days, the team will need time to make a plan. You cannot give permission to another person to push the pain button. If a new person becomes the AA, the team will need to teach the new AA how to safely use the PCA.

Changes to the Pain Plan

The care team may decide to change what pain medicine to use if:

  • The patient’s pain is not well controlled.

  • The patient has too many bad side effects.

  • The patient can use pain medicine in another way.

Other Ways You Can Help

  1. Look for signs of pain. If you think the patient is in pain, please call the nurse. You can share the signs of pain you are seeing. You and the nurse can discuss how to get better pain control for the patient.

  2. Try other pain control methods. You can still help the patient manage their pain by providing comfort and distraction from the pain. You can try:

  • Reading a book.

  • Singing quietly.

  • Other things you use at home.