Patient Safety Issues With Patient-Controlled Analgesia

Yvonne D'Arcy, MS, CRNP, CNS

Topics in Advanced Practice Nursing eJournal. 2007;7(1) 

In This Article


Patient-controlled analgesia (PCA) was introduced into hospitals in the 1970s to improve the quality of postoperative pain control, and since then it has been a popular option. Patients like PCA and find the therapy easy to use. Recently, there has been a great deal of concern about the safety of PCA. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Institute for Safe Medication Practices (ISMP) have reviewed the safety issues surrounding the use of PCAs and made recommendations on how to use PCA therapy safely. The ISMP is a nonprofit organization with the sole focus of promoting safe medication use and preventing medication errors with a nonpunitive approach. Three areas in particular have been cited by JCAHO and ISMP as most problematic:

  • Patient selection;

  • Pump and human errors; and

  • PCA by proxy.

This article addresses the current issues surrounding the safe use of PCA for pain relief in acute care.


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