Scenario 1:
Part 1
You receive a new order for your patient to start a PCA. Verbalize which items need
to be ordered through Epic and what you will grab from your PAR room.
Once the module arrives, you need to attach it to your brain, and set up the
prescribed medication. Your MAR has the following orders:
Hydromorphone in NS PCA 30 mg / 30 mL (1 mg / mL)
Initial Loading Bolus: None
Continuous (Basal) Rate (mg/hr): None
Demand Dose (mg): 0.2 mg
Lockout Interval (minutes): 8 minutes
RN PRN bolus every 1 hour as needed for pain (Notify MD if more than 2 doses are
given in 4 hours) (mg): 0.2 mg
Part 2
Your patient c/o 8 out of 10 pain and you need to give an RN bolus.
Part 3
After your second RN bolus dose, your patient continues to c/o of pain. After calling
the MD, your orders change to the following:
Hydromorphone in NS PCA 30 mg / 30 mL (1 mg / mL)
Initial Loading Bolus: None
Continuous (Basal) Rate (mg/hr): 0.2 mg/hr
Demand Dose (mg): 0.4 mg
Lockout Interval (minutes): 8 minutes
RN PRN bolus every 1 hour as needed for pain (Notify MD if more than 2 doses are
given in 4 hours) (mg): 0.4 mg
Part 4
It is time to grab your I/O’s. Scroll through to find:
 How many times did your patient push the button?
 How many doses were actually delivered?
 How much volume was delivered?
 After entering into Epic, clear your pump
Part 5
It is now change of shift.
Perform your independent double check with your partner.
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Scenario 2:
Part 1
Due to a medication shortage issue, your patient is switched from Hydromorphone
to Fentanyl. Your new orders are:
Fentanyl PCA Infusion 1500mcg / 30mL (50mcg/mL)
Initial Loading Bolus: 20 mcg
Continuous (Basal) Rate (mcg/hr): 20 mcg/hr
Demand Dose (mcg): 10 mcg
Lockout Interval (minutes): 10 minutes
RN PRN bolus every 1 hour as needed for pain (Notify MD if more than 2 doses are
given in 4 hours) (mcg): 20 mcg
Part 2
Your patient is starting to get a little too drowsy, so you pause the PCA while you go
talk to the MD.
Part 3
After a short pause, your patient starts to c/o of the pain seeping through. Your MD
changes your orders to the following:
Fentanyl PCA Infusion 1500mcg / 30mL (50mcg/mL)
Initial Loading Bolus: None
Continuous (Basal) Rate (mcg/hr): None
Demand Dose (mcg): 10 mcg
Lockout Interval (minutes): 10 minutes
RN PRN bolus every 1 hour as needed for pain (Notify MD if more than 2 doses are
given in 4 hours) (mcg): 20 mcg
Part 4
It is time to grab your I/O’s. Scroll through to find:
 How many times did your patient push the button?
 How many doses were actually delivered?
 How much volume was delivered?
 After entering into Epic, clear your pump
Part 5
It is now change of shift.
Perform your independent double check with your partner.
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Scenario 3:
Part 1
You get a new patient from the PACU who is on the following PCA orders:
Morphine PCA infusion 150mg/30mL (5mg/mL)
Initial Loading Bolus: 1 mg
Continuous (Basal) Rate (mg/hr): None
Demand Dose (mg): 0.5mg
Lockout Interval (minutes): 8 minutes
RN PRN bolus every 1 hour as needed for pain (Notify MD if more than 2 doses are
given in 4 hours) (mg): 1mg
Part 2
Your patient would like to go to sleep, and the light on the PCA demand dose button
is bothering him. You need to turn the light off.
Part 3
After losing the demand dose button in the bed for the fifth time, you suggest to the
patient that it would be best to turn the light back on. He agrees.
Part 4
The syringe is now empty and needs to be replaced. After replacing the syringe, you
receive the following alarm: Occlusion
Verbalize your resolution.
Part 5
After realizing you forgot to open your roller clamp, you do so, but as soon as the
pump starts you receive another alarm: Drive not engaged
Verbalize your resolution.
Questions & Concerns: Please contact your Alaris team
Jill Cartwright Phone (720) 848-6963
or Sylvia Park- (720) 848-7189
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