Question regarding PCA

[DScully]

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I have a question about writing a PCA dose...This is probably very basic but I just want to make sure I am absolutely correct on this one.

Let say I want to do dilaudid 0.1mg q10mins lock out time but want to keep the maximum dose to be 2mg for every 4 hrs (instead of 0.1*6*4 = 2.4mg). I can still write this order, right?

In other words, the max 4hr-dose is either equal or less than the theoretical dose (calculated by 0.1*6*4 = 2.4) and can very well be a different number than the calculated dose.

I know people tend to write it so that the max hourly dose = the calculated dose = i.e., 0.1*6=0.6mg (in this case), but I thought the whole idea of having a 3rd semi-independent variable (i.e., the max dose you write as the part of the order set) is to allow additional control over the PCA.

Can anyone tell me if I get this completely messed up? 😕

 

[Pooh & Annie]

I have a question about writing a PCA dose...This is probably very basic but I just want to make sure I am absolutely correct on this one.

Let say I want to do dilaudid 0.1mg q10mins lock out time but want to keep the maximum dose to be 2mg for every 4 hrs (instead of 0.1*6*4 = 2.4mg). I can still write this order, right?

In other words, the max 4hr-dose is either equal or less than the theoretical dose (calculated by 0.1*6*4 = 2.4) and can very well be a different number than the calculated dose.

I know people tend to write it so that the max hourly dose = the calculated dose = i.e., 0.1*6=0.6mg (in this case), but I thought the whole idea of having a 3rd semi-independent variable (i.e., the max dose you write as the part of the order set) is to allow additional control over the PCA.

Can anyone tell me if I get this completely messed up? 😕

I don't think most people are using 4hr max dosing orders anymore. The original idea came out of concerns for patient safety, but I don't think it's really born any benefits. In your example, what benefit does that order provide? If your patient is maxing out, what benefit is there in not providing them with they're bolus dosing for that last 40 minutes? Are you worried that after 3hrs 20mins of 0.1mg boluses they're suddenly going to cross that threshold and become apneic? All you've got is an unhappy patient and an expected page from nursing. If you're concerned about safety, order continuous pulse ox.

 

[pgg]

Let say I want to do dilaudid 0.1mg q10mins lock out time but want to keep the maximum dose to be 2mg for every 4 hrs (instead of 0.1*6*4 = 2.4mg). I can still write this order, right?

Sure. Why would you want to?

I know people tend to write it so that the max hourly dose = the calculated dose = i.e., 0.1*6=0.6mg (in this case), but I thought the whole idea of having a 3rd semi-independent variable (i.e., the max dose you write as the part of the order set) is to allow additional control over the PCA.

Pumps do allow for that flexibility, but again, the real question is, what do you hope to accomplish by using it?

There are a couple reasons why futzing around with that 3rd variable has fallen out of favor

1) It makes the settings needlessly complex. Complexity begets errors.

2) There really isn't a compelling reason to permit a patient to stack their PCA hits up front, which is what a 1- or 4- hour lockout < dose x interval does. In fact, there are generally good reasons NOT to do this.

 

[pjl]

The only benefit I have heard of is that if you are not writing for enough per dose or too long an interval, and the patient is maxing out every 10 min hit, then you will definitely get a call about it when they reach their 4 hour max at 3 hrs 20 minutes.
I prefer not to receive such phone calls.

PS. Your order is completely legit. It is somewhat common practice despite the answers above to use a 4 hour lockout of less than the calculated.