by Sean Power
The Physician-Patient Alliance for Health and Safety has increasingly received questions about the use of patient-controlled analgesia (PCA) in home care settings. After some investigation, here are six resources on PCA use at home that should be reviewed by anybody considering PCA for pain management at home.
It bears emphasizing that PCA use without appropriate safety measures could be dangerous. This article serves only as an introduction to the topic and is in no way comprehensive. Talk to your doctor about PCA use at home.
Take Advantage of Pain Pump Advances
David Bernard, Outpatient Surgery Magazine
Bernard provides an overview of some of the latest technological developments in PCA pumps. Collecting input from anesthesiologists, Bernard touches several bases: patient control, pieces and parts, filling and billing, and safety.
Bernard’s article discusses the free PCA Safety Checklist put forward by the Physician-Patient Alliance that guides decisions while using PCA, and cites “6 Steps to Preventing Pain Pump Pitfalls” by PPAHS.
Patient and Caregiver Controlled Analgesia in the Home Care Setting
Published by the University of Michigan Hospitals and Health Centers, this article provides guidelines on PCA at home. Written for medical professionals, the set of guidelines describes procedures for prescribing orders, keeping records, preparing and dispensing drugs, programming devices, training patients and caregivers, and monitoring patients.
Patients considering PCA use at home should bring a copy of these guidelines and ask their doctors for advice.
PCA in outpatients with cancer pain
C. Schiessl et. al., Schmerz
Made available through the US National Library of Medicine, National Institutes of Health, this research looks at parenteral analgesia for cancer pain patients in the home-care setting over the course of 1,692 treatment days. Studying 46 consecutive palliative cancer patients with PCA, the study analyzes data on care intensity, logistics, and outcome.
Cancer patients should familiarize themselves with this research to understand the variables surrounding opioid consumption and pain control for home-care PCA.
Patient Controlled Analgesia in Palliative Care
Eric Prommer, MD, Medical College of Wisconsin
Dr. Prommer provides a general overview for clinicians considering PCA for their patients. The article offers a brief look at some key concepts. The article should be regarded as an introductory piece to the topic.
Developing Patient Controlled Analgesia (PCA) in the home for children and young people (CYP)
T. Boggs et al., BMJ Supportive & Palliative Care
Highlighting the fact that the availability of evidence on the use of PCA for CYP receiving palliative care is limited, the authors attempt to identify issues and challenges in developing a home PCA service for CYP patients.
The research paper concludes that PCA use in home is feasible but resource intensive.
Worth mentioning is that the article explains that PCA use is appropriate only for a small number of CYP patients. Therefore there exists a shortage of research and information on the topic. Patients and parents of children need to discuss with their doctors whether PCA use makes sense.
Patient/proxy patient controlled analgesia: use in palliative care
While PCA by proxy has a history of patient safety concerns, the article suggests that terminally ill and palliative care patients exhibit different traits that make proxy PCA, in the view of the authors, acceptable for certain patient populations with appropriate training. The authors seek to outline guidelines for identifying patients who fit the bill for proxy PCA.
Should you decide to explore PCA use at home as a pain treatment option, be sure to discuss with your doctor any safety concerns. The PCA Safety Checklist can be a great way to start the conversation. It is available for free in Microsoft Word check-able format here and can be downloaded as a PDF here.