Used as intended, patient-controlled analgesia (PCA)can be an effective pain management tool. As the name implies, PCA is intended for the patient’s own use. Allowing family members, visitors or even nurses to press the button--a practice--known as PCA by proxy--could lead to oversedation, respiratory depression or death, and puts you at risk for being sued.

The Institute of Safe Medication Practices recommends the use of protocols for safe administration and monitoring of PCA. The protocols should cover the selection of candidates for PCA and standardize orders for drug selection, dosing, lockout periods,patient monitoring and infusion. If your facility has adopted such protocols, follow them closely, both to safeguard your patient and avoid liability risk.

Teach your patient how to use the device at a time when he is alert; if he’s scheduled for surgery, this should be done preoperatively. Stress the dangers of PCA by proxy, and caution family members not to press the button unless the patient clearly expresses the need for pain medication and is in need of physical assistance. And avoid nurse-controlled PCA unless enhanced monitoring requirements are in place.