Patient Controlled Analgesia
(PCA)
Learning Guide
for Enrolled Nurses (Medication Endorsed)
MAH, MPH, MMH, MPHR
Adapted from the RN PCA Learning Guide and Competency by:
Cassandra Thompson Acting CNC Acute Pain Management
Mater Health Services
December 2010
Reviewed by:
Leanne Gleeson CNC Acute Pain Management
Acknowledgement:
Helen Stewart
Mater Misericordiae Health Services Brisbane Limited
Our
Mission
“In the spirit of the Sisters of Mercy, the Mater Hospital
offers compassionate service to the sick and needy,
promote an holistic approach to health care in response to
changing community needs and foster high standards in
health related education and research. Following the
example of Christ the Healer, we commit ourselves to
offering these services to all without discrimination.”
Our
Values
Care:
The spirit of compassion
Mercy:
The spirit of responding to one another
Dignity:
The spirit of humanity, respecting the
worth of each person
Quality:
The spirit of professionalism
Commitment:
The spirit of integrity
INDEX
Aims
Resources
Competency
EEN scope of practice – PCA’s
What is pain?
Pain assessment
Functional Activity Score (FAS)
Adverse effects of unrelieved pain
Barriers to effective pain relief
Optimising analgesia
The role of patient controlled analgesia (PCA)
Patient education
Complications
Management of opioid related side effects
PCA program check
PCA observations
PCA settings
Naloxone
Questions
References
Competency form
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Patient Controlled Analgesia for EN (Med)
AIMS
The aim of this guide is to:
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gain knowledge regarding Patient Controlled Analgesia
maximise safety and efficiency in the use of the PCA
increase understanding, knowledge and confidence amongst nursing staff in the use
of pain pumps
increase understanding and knowledge of acute pain management.
RESOURCES
In addition to this learning guide the following resources are available:
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CNC’S Acute Pain Management (Speed Dial: 77161 or 77139)
Clinical Facilitator or Nurse Educator
Clinical Nurse
“Alaris” (IVAC PCAM) Clinical Nurse Educator (Ph:0437 863 412)
“Hospira” (Gemstar) Clinical Nurse Educator (Ph: 0401 674 394)
Mater Education Centre website/ Nursing Learning Resources/ Useful Resources:
1. “Omnifuse” PCA Pump
2. “Gemstar” PCA Pump
3. “Alaris” PCAM Pump
HOW TO ATTAIN COMPETENCY
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Read this learning guide
Read the Mater Health Services PCA policy available from Docu-Cube
Complete the multiple choice questions of this learning guide
Ask a clinical assessor/nurse educator to mark your exam
Download the appropriate PCA clinical competency for your work area from the Mater
Education Intranet site as follows:
1. “Omnifuse” PCA Pump & “Grasby 3300” - MPH
2. “Gemstar” PCA Pump - MAH
3. “Alaris” PCAM Pump - MMH
Practice this competency in your clinical area
Complete the competency under supervision of an appropriate assessor
Send your completed competency to the Mater Education Centre for entry into MOVES.
HOW TO MAINTAIN COMPETENCY
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Annual competency is strongly recommended for nurses/midwives who infrequently care
for patient’s with PCA
For nurses/midwives who consistently care for patients with PCA’s it is strongly
recommended competency should be performed every 2 years
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Enrolled Nurse (Med) specific scope of practice
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Prior to caring for a patient with a PCA infusion, the Enrolled Nurse (Med) must possess
knowledge of the indications, usual dose, safe administration and signs of adverse
effects of any drug being administered by the PCA
The Enrolled Nurse (Med) may check the drawing up of the PCA and the programming
with an RN
The Enrolled Nurse (Med) can independently check the machine programming against
the orders with an RN
The Enrolled Nurse (Med) can check the PCA machine is operating correctly, and reports
concerns to the supervising RN
It is vital to inform an RN immediately if the patient is experiencing any adverse effects
or if assistance is required.
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PAIN
What is pain?
There are two broad categories of pain: acute and chronic. Acute or nociceptive pain is
defined as pain of limited duration that is related to a specific event or illness (Mann & Carr,
2006). It usually has an identifiable cause and is related to underlying disease or injury. Acute
pain is a protective mechanism which serves to warn the individual that ‘something is wrong’
and to seek help. In this way it is seen as a warning sign e.g. appendicitis. Once the
underlying mechanism has been identified and treated, pain should decrease as healing
occurs.
Chronic pain is considered as pain without apparent biological value that has persisted beyond
the normal tissue healing time (MacLellan, 2006). It is linked with maladaptive behaviour and
responses which have adverse psychological consequences. Persistent (chronic) pain does not
have a predictable endpoint. It may occur as a result of an acute injury and it does not have a
purpose e.g. chronic back pain, phantom limb pain. Some acute pain states that might
progress to persistent pain include post traumatic pain, mastectomy and acute back pain.
There is some evidence to suggest that early analgesic intervention after surgery decreases
the risk of persistent pain (NHMRC, 2005).
Patients affected by persistent pain may be withdrawn and depressed and may have reduced
activity levels. Patients with persistent pain are frequently under treated because healthcare
providers fail to recognise that their pain is significant. It is essential healthcare providers
recognise, acknowledge and treat persistent pain to improve compliance with management
goals and patient outcome. A multidisciplinary treatment approach for chronic pain that
focuses on self-management and restoration of function is the goal of therapy (Turk &
McCarberg, 2005).
Another type of pain which may be associated with acute or chronic is neuropathic pain.
Neuropathic pain occurs as a result of damage, disease or injury to the central or peripheral
nervous system. The mechanism and treatment of neuropathic pain differs significantly from
acute nociceptive pain therefore recognition in its early stages and initiation of appropriate
therapy is essential to prevent ongoing sequelae (ANZCA, 2005).
Factors Affecting Pain
Pain is an individual experience which will be influenced by many factors including the
patients knowledge of pain and analgesia, their expectations of pain, past experiences, fear of
addiction, anxiety, culture, age, lack of information and the influence of healthcare
professionals responsible for their care. The cause of an individual’s pain will relate to the
degree of tissue damage however the context of that pain will shape the experience and
ongoing management (MaClellan, 2006).
The patient’s memory of previous pain experiences influences pain perception. Previous
negative experiences increases fear and anxiety which is associated with a heightened
awareness of pain.
The emotional response to pain will depend on the meaning of pain to the individual. Anxiety
and depression are predisposing factors which can impact on a patient’s response to pain.
Anxiety is often associated with pain because of underlying concerns or fears about disease or
disability.
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Pain Assessment
Subjective Information
The patient’s report of pain is the most reliable indicator of pain severity (ANZCA, 2005). Pain
assessment includes:
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Intensity at rest and on movement
Type (description)
Location
Onset
Duration
History of previous pain
Pain Intensity
Pain intensity is assessed by asking patients to rate their pain on a scale of 0 to 10 where 0
represents ‘no pain’ and 10 represent ‘worst pain imaginable’. Measurement of pain intensity
includes asking how much pain the patient has while at rest and if pain interferes with sleep.
Pain assessment on ‘movement’ and its impact on function is also determined.
Pain assessment should occur:
 on admission as the 5th vital sign and with routine observations
 before, during and after administration of analgesics
 as per PCA or Epidural/Regional Infusion Standing Orders if the patient is receiving
this method of analgesic therapy
Types of Pain
It is essential when performing a pain assessment to ask the patient to describe the pain
they’re experiencing.
Neuropathic or ‘nerve’ pain is associated with nerve injury or disease of the spinal cord or
peripheral nerves. Nerve injury results in the following signs and symptoms:
 Pins & needles
 Hot or cold or burning
 Episodic shooting pain
 Squeezing
 Electric shock
Further indicators of neuropathic pain are:
 Allodynia (non painful stimulus is painful e.g. light touch)
 Changes in colour, temperature and sweating in the affected or opposite limb.
Some surgical procedures have a higher risk of developing neuropathic pain. Two of the most
common are thoracotomy and mastectomy. Neuropathic pain may also occur as a result of
burn injuries.
Phantom Pain
Phantom pain is a form of neuropathic pain that occurs after amputation and is pain which is
experienced in the body part that has been amputated e.g. foot, breast. This occurs because
the brain is still receiving messages from the damaged nerves. Not all patients with
amputation will experience phantom pain however it is most likely to occur in patients who
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have had traumatic amputations (e.g. caused by an accident) or those with significant preoperative pain over a long period of time (ANZCA, 2005).
*Referred pain is pain that is distant from the site of origin or adjacent to it e .g. heart pain is
often referred to the arms.
Location of Pain
It is important to identify the location of pain to assist with determining what type of
analgesic is required. Pain may be located in one or more areas of the body or it may be
radiating from one area to another. In some instances pain may be long standing e.g.
arthritis, therefore the pain medication prescribed for acute pain may not appropriately treat
the pain that the patient is referring to.
Pain History
Determine the duration of the pain and what makes it better or worse. Is it continuous or
intermittent? Has the patient experienced this type of pain before and if so what relieved it?
What makes the pain worse e.g. exercise and when does the pain occur e.g. after meals? Ask
the patient about different types of pain they might commonly experience e.g headaches.
Objective Information – Functional Activity Score
Physiotherapy, activity and rehabilitation are an important phase of a patient’s recovery and
sense of well being. Strong pain relief is often required to assist the patient through this
phase. To determine if pain impacts on function the functional activity score (FAS) is used.
FAS is the midwife/nurses assessment of the patients pain and is therefore an objective
measurement. This tool is used in MMH (refer to carepaths).
Functional Activity Score (FAS)
Does pain interfere with function?
A = does not interfere
B = partly interferes
C = completely interferes
Inadequate analgesia is an adverse event.
In MAH pain scores ≥ 4
In MMH pain scores ≥ 4 or (FAS=C)
In MPH’s pain score ≥ 4
Require further assessment by the EEN/RN. Encourage PCA bolus.
If pain is unrelieved contact APS MAH speed dial 6647, APS MMH speed dial 6616, or contact
MO for private patient’s.
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Adverse Effects of Unrelieved Acute Pain
Cardiovascular
Tachycardia, hypertension, increased peripheral vascular
resistance, increased myocardial oxygen consumption,
myocardial ischaemia, altered regional blood flow, DVT,
pulmonary embolism
Respiratory
Gastrointestinal
Reduced lung volume, atelectasis, decreased cough, sputum
retention, infection, hypoxemia
Decreased gastric and bowel activity
Genitourinary
Urinary retention
Neuroendocrine/Metabolic
Increased catabolic hormones e.g. glucagon, vasopressin,
renin, angiotensin
Decreased anabolic hormones e.g. insulin, testosterone
Catabolic state leads to hyperglycaemia, increased protein
breakdown, impaired wound healing and muscle wasting
leading to increased pain
Chronic (persistent) pain due to central sensitization
Central Nervous System
Adapted from MacIntyre & Schug, 2007.
Barriers to Effective Pain Relief
Under treatment of severe acute pain coupled with the physiological response to surgery, can
have a number of effects and may lead to complications such as myocardial ischaemia,
infarction or pneumonia. Unrelieved acute pain may also lead to chronic persistent pain.
Knowledge and resources exist to provide adequate and safe analgesia to the majority of the
population who suffer pain, however numerous studies indicate that approximately 50% of
the population still experience severe pain after surgery (MacIntyre & Schug, 2007).
Possible barriers to effective pain relief include:
 A belief that pain is not harmful
 Concerns that pain relief will obscure a diagnosis or mask signs of a surgical
complication
 A tendency to underestimate a patient’s pain
 Lack of recognition by clinicians of the variability in patients pain perception
 Lack of regular and frequent assessment
 Fears that patients will become addicted to opioids
 Concerns about a high risk of respiratory depression with opioids
 Inadequate patient education
 Patient reluctance to ask for analgesia
 Lack of understanding of inter-patient variability in opioid requirements
 Lack of recognition that age is a better predictor of opioid requirement than weight in
the adult patient
 Prolonged dosage intervals
 Insufficient flexibility in dosing schedules
 Lack of understanding of the need to titrate analgesics to meet the needs of the
patient
 Lack of accountability for pain management
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Optimising Analgesia
Under treatment of pain can lead to increased patient anxiety and stress. Pain management
involves controlling pain before it becomes established. Ways in which to optimise a patient’s
analgesia include:
 Pre-emptive analgesia, e.g. before moving, deep breathing. Allow time for the
analgesia to take effect
 Treat side effects early and adequately
 Adjunctive analgesia e.g. NSAID’s, may be required
 Patient’s should not be sedated
 Believe the patient’s pain assessment
 Act on the assessment
The Role of Patient Controlled Analgesia (PCA)
PCA refers to a mode of analgesia that allows a patient to self administer small and frequent
doses of opioid as required. PCA is administered via a programmable infusion pump that
delivers medication intravenously. Compared to conventional modalities of pain relief (IMI, SC
or IV), PCA offers greater patient satisfaction without increasing the incidence of opioidrelated side effects (MacIntyre & Schug, 2007).
PCA overcomes the wide variability in opioid requirements between individual patients
(between 8 to 10 fold). The intensity of acute pain is rarely constant therefore when using a
PCA, the individual is able to titrate their analgesia according to their level of pain. In this way
patients are more likely to maintain their opioid serum concentrations within a therapeutic
range (analgesic corridor).
Patient Selection
A number of factors have to be considered when selecting a patient for PCA. Great care must
be taken to ensure that this form of modality is appropriate (McCaffery & Pasero, 1999). The
use of PCA is contraindicated in the following category of patients:
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Patient’s with cognitive impairment who are unable to understand how to use the
machine
Non-English speaking patients unless an interpreter is available to explain how to use
the machine
Patient’s with a physical disability or those who have limited manual dexterity to press
the button themselves
Patients who don’t wish to manage their own analgesia
Pre-operative dementia
Post-operative confusion
NB: Difficulty understanding or inability to manage the technique, language
barrier, confusion, or a physical disability that impedes use of the PCA button is a
contraindication to PCA. Inform the APS/VMO if this applies to your patient.
Patient Education
With appropriate instruction, patients selected for PCA should be able to achieve a level of
comfort to enable acute rehabilitation (effective cough and mobilisation). Patients must
understand how to use PCA if they are to obtain safe and effective pain relief. Education
should begin pre-operatively, whenever possible, followed by continuous reinforcement of the
technique post-operatively.
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Patient information required to assist understanding of PCA includes:
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When the PCA button is pressed the pump is activated to deliver pain medication into
the intravenous line
Possible side effects include nausea and vomiting, drowsiness, itch, difficulty passing
urine, confusion, hallucinations, constipation
Only one dose can be delivered in any set period (e.g. 5mins), no matter how often
the button is pushed
The PCA button is pushed to keep pain under control and before doing something
which is likely to be painful e.g. physiotherapy
The medication doesn’t work immediately, allow 5-10 minutes for it to make a
difference
Do not wait until pain becomes severe before pressing the PCA button
Complete pain relief may not be possible
Only the patient is to push the PCA button
Report any side effects or pain that is not controlled
The risk of addiction is minimal when used for acute pain
Complications of PCA
Complications associated with PCA may be related to the side effects of the drugs used, the
equipment involved or management by staff or patients.
Opioid Related Side Effects
Opioid related side effects may occur regardless of the route of administration. Side effects
include:
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Sedation
Respiratory depression
Nausea and vomiting
Pruritus
Urine retention
Confusion
Decreased bowel activity/constipation
Hypotension
Management of Opioid Related Side Effects
Sedation
The most serious complication of excess opioid consumption is respiratory depression: the
best indication of impending respiratory depression is increasing sedation
(MacIntyre & Schug, 2007). Sedation score is used to assess levels of consciousness
according to the following tool:
Sedation Score
S = Sleep – rouses with light touch or mild stimulation
0 = Awake
1 = Mild – occasionally drowsy, easy to rouse
2 = Moderate – rouseable but not able to stay awake (eg. will wake easily, but tends to fall
asleep during conversation); assess respiratory rate & refer to Naloxone policy
3 = Severe – difficult to rouse or unrouseable; refer to Naloxone policy
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Sedation score = 2 and respiratory rate = 8 or greater
1. Administer oxygen if not contraindicated
2. RN to cease opioid/remove PCA button
3. Monitor sedation score, respiratory rate and oxygen saturations every hour until
sedation score less than 2.
4. Contact APS:
Speed dial 6647 (MAH),
Speed dial 6616 (MMH),
or for private/intermediate patient’s their Anaesthetist/Medical Officer
5. Document findings and observations on the acute observation chart and in the
patient’s notes
Sedation score = 2 and respiratory rate < 8/min or sedation score = 3
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6.
7.
Ring staff assist buzzer
Stay with the patient
Administer 6L oxygen via Hudson mask as per naloxone policy if not contraindicated
Continue to wake the patient and encourage breathing
Initiate Met call (555) when assistance arrives
Monitor sedation score, respiratory rate and oxygen saturations
Contact APS:
Speed dial 6647 (MAH),
Speed dial 6616 (MMH),
or for private/intermediate patient’s their Anaesthetist/Medical Officer
8. RN to initiate Naloxone policy
9. Cease opioid/remove PCA button
10. Document findings and outcomes on the acute observation chart and in the patients
notes
If a patient has experienced pain and has used a significant amount of opioid
e.g. during physiotherapy, opioid related sedation can occur once the cause of the
pain has been removed or ceased
Respiratory Depression
Respiratory depression occurs by a direct action of the opioids on the respiratory centres in
the brain stem. Decreased respiratory rate is a late and unreliable sign of opioid induced
respiratory depression. Respiratory rate and breathing pattern should be counted over one
full minute for assessment.
Oxygen Saturations
Supplemental oxygen at 2l/min via nasal prongs is beneficial in the post-operative setting and
may reduce background hypoxemia. Oxygen saturations are most accurate when monitored
continuously. With patients on PCA, saturations should be maintained above 93% and
when measured should be taken over at least one minute. Inform RN and contact APS or
VMO if patients have oxygen saturations that are deteriorating or if the patient requires
higher concentrations of supplemental oxygen to maintain saturations. If the patient is using
a Hudson mask, the minimum flow of oxygen should be 4l/min
Nausea/Vomiting
If nausea or vomiting occurs an anti-emetic should be given, if ineffective, an alternative antiemetic should be given.
Individual patients may appear to be more sensitive to one particular opioid then others
therefore opioid rotation may have to be considered for persistent nausea and vomiting. Anti-
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emetics are most effective when given prior to vomiting becoming established. Patient review
should occur and further anti-emetics given if nausea persists. Also consider that the opioid
may not be the only cause of nausea and vomiting e.g. paralytic ileus.
Pruritis
Low dose Naloxone might be prescribed if itch is troublesome to reverse the side effect of the
opioid without reversing the analgesic effect. Although not effective for opioid induced pruritis
an antihistamine is sometimes prescribed. It is preferable to use a non-sedating antihistamine
e.g. Loratadine.
Urine Retention
Perform a bladder scan and contact the patients ward medical officer.
Confusion
Contact APS to review patient for an alternative mode of analgesia.
Constipation
Administer any prescribed aperients. Encourage high fibre diet and fluids if the patient is able
to tolerate an oral diet. Contact APS or ward medical officer.
Hypotension
Determine lying and sitting blood pressure. Keep patient in bed if compromised and contact
ward medical officer/VMO or APS.
PCA giving sets include an anti-syphon and anti-reflux valve. This is to prevent the build up
and administration of a serious overdose of opioid.
All PCA’s are to have maintenance fluids connected to the PCA line on the side arm which
contains the anti-reflux valve. This is to enable the opioid to be continuously flushed and to
maintain patency in case of any adverse events.
All opioids administered via PCA must be contained within a locked container to prevent
tampering and the risk of self administered opioid over dose.
Program Check, Connection/Line Check to be performed:
 Commencement of each shift
 On return from another ward or department
 At each bag or syringe change
Program Check:
(Check that the following are within
parameters of current prescription)
 Medication being administered
 Bolus dose
 Infusion rate (if applicable)
 Lock-out time
Connection/Line Check:
 Between pump and line
 Between line and patient
 Between line and infusion bag/syringe
 Line with anti-reflux and anti-syphon insitu
 Cannula site
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PCA Observations
Routine post-operative observations should be performed as per the post operative care
management policy, accompanied with PCA observations: hourly for 8 hours then
 2 hourly for 16 hours then
 4 hourly thereafter
PCA observations include:
 Sedation score
 Respiratory rate & SpO2
 Nausea and vomiting
 Pain score rest & movement
 FAS (MMH)
 Cumulative dose
 Demands and deliveries
Also:
 Temperature, BP 4th hourly,
 Cannula check once/shift
 Urinary output once/shift
 After APS/MO initiated PCA bolus dose, perform observations 5 minutely for 20
minutes
 If the opioid is changed observations are to recommence as when PCA first
commenced
If your patient is sleeping:
 Monitor breathing pattern, respiratory rate and oxygen saturations over one minute,
 If respiration rate is less than 10, oxygen saturations less than 93% or irregular noisy
respirations, wake patient and assess level of sedation,
 If when performing observations patient does not rouse with stimulation wake patient and
assess level of sedation.
PCA Settings
Bolus Dose is the amount of drug the patient receives when the handset or demand button
is pressed.
Lockout Period is the time from the end of the delivery of one successful bolus until the
machine allows the patient to receive another bolus.
Demands/Deliveries; Demands/Good is a record of the number of times the patient
presses the handset in order to demand a dose compared to the number of times the patient
actually receives a dose.
When the machine delivers a dose it is recorded as a ‘Good Demand’ or ‘Deliveries’,
depending on the machine. This is an important tool to use to determine if the bolus dose is
adequate to cover the patient’s pain, if not, the number of demands will be much higher then
the number of good deliveries. It also might indicate if the patient does not know how to use
the PCA button and requires further education.
Background Infusion is a continuous infusion that can be added by the APS or VMO. It
may be used in patients who are normally on long term opioids and who are opioid
dependent.
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Hourly limit is programmed so that an identified amount of opioid cannot be exceeded in an
hourly timeframe.
Total Amount of Drug includes all bolus doses and background infusion if prescribed.
Loading Dose is administered to patients before the commencement of PCA and is usually
performed in recovery. They are also used for inadequate analgesia and may be prescribed by
the APS or VMO.
Naloxone
Naloxone is an opioid antagonist and works at the opioid receptor site. It is rapidly
metabolised and has a short half life. It is used to reverse sedation and respiratory depression
after opioid overdose. Naloxone must always be available on wards if patients are receiving
opioids.
As an Endorsed Enrolled Nurse you are unable to
administer intravenous Naloxone, although you are able to
assist the Registered Nurse.
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Patient Controlled Analgesia for EN (Med)
Patient controlled Analgesia: Multiple Choice Questions
Question 1:
What is the first sign of opioid-induced respiratory depression?
a) Increased sedation level
b) Decreased sedation
c) Hypotension
d) Apnoea
Question 2:
If a patient is on a PCA, a sedation score of 2 is
a) Indicative that the patient is becoming moderately drowsy
b) A trigger for closer monitoring
c) An indication to contact the APS/VMO
d) All of the above
Question 3:
Naloxone is an opioid antagonist and is used for opioid induced respiratory depression. An
indication for its use is:
a) Sedation score of 2
b) Sedation score of 2 and Respiratory rate < 10
c) Sedation score of 3
d) None of the above
Question 4:
What would you do if sedation score is 3 or sedation score 2 with respirations less than 8?
a) Ensure patient is receiving oxygen and monitor saturations
b) Cease infusion/remove PCA button
c) Notify RN to give naloxone
d) Call code Green/MET protocol
e) All of the above
Question 5:
What is the minimum flow rate (litres/min) required when administering oxygen via a Hudson
mask?
a) 5
b) 2
c) 8
d) 4
Question 6:
What are some common side effects of opioids?
a) Hypotension and pruritis
b) Tachycardia
c) Bradycardia
d) Nausea and vomiting
e) sedation
f) a and d and e
g) b and c
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Patient Controlled Analgesia for EN (Med)
Question 7:
All PCA’s must have a dedicated PCA giving set because:
a) It prevents the back flow of the opioid into the maintenance line
b) It has a non-reflux and anti-syphon valve
c) It prevents the build up and administration of a serious overdose of opioid
d) All of the above
e) a and b only
Question 8:
You must perform PCA checks:
a) after returning from theatre or other department
b) at the beginning of each shift
c) after each syringe/bag change
d) all of the above
Question 9:
If your patient has a PCA and is continuously vomiting what would you do?
a) Notify ward call
b) Ask APS to review patient
c) Perform a set of observations
d) Take the PCA button away from the patient
Question 10:
PCA observations include:
a) sedation score
b) respiratory rate & SpO2
c) pain score rest & movement
d) all of the above
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References:
Australia and New Zealand College of Anaesthetists & Faculty of Pain Medicine, (2005). Acute
Pain Management: Scientific Evidence, 2nd Edition; Australian Government.
MacLellan, K. (2006). Management of Pain. Nelson Thornes Ltd: Cheltenham.
Mann, E. & Carr, E. (2006). Pain Management. Blackwell Publishing: Oxford.
McCaffery, M. & Pasero, C. (1999). Pain: Clinical Manual, 2nd Edition. Mosby: Missouri.
MacIntyre P. & Schug. S. (2007). Acute Pain Management: A Practical Guide, 3rd Edition.
Saunders: Edinburgh.
Turk, D & McCarberg, B. (2005). Non-pharmacological treatments for chronic pain. A disease
management context. Disease Management and Health Outcomes, 13(1): 19-30.
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Patient Controlled Analgesia for EN (Med)
Patient Controlled Analgesia Learning Guide
WORKSHEET for EN (Med)
Please return this Cover sheet to Mater Education Centre for
recording
Name: ________________________
Designation (RN) _______________
Payroll No: _____________________
Clinical Area: __________________
Name of Assessor: (Please PRINT)
Signature of Assessor:
............................................................
.................................................
Mater Education Centre
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