HOUSTONPatient satisfaction with patient-controlled analgesia (PCA)
rose from 75% to 90% with an education program implemented by Elizabeth
Fogarty, RN, and colleagues from the gastrointestinal surgery unit at The
University of Texas M. D. Anderson Cancer Center. The patient and staff
education program is now being used in nursing practice throughout the
The project objectives were to improve patient satisfaction with PCA and
to improve pain control in the hope that it would decrease idleness and
pulmonary complications by increasing mobility and improving inhalation
ability. "We traced the steps of the patient through the clinic, pre-op
clinic, post anesthesia care unit, surgical intensive care unit, and
gastrointestinal inpatient unit and added representatives from each of those
areas to our team," Mrs. Fogarty reported. "We also added an
anesthesiologist, nursing instructor, patient educator, and
quality-improvement representative for advice and guidance."
The teams’ brainstorming produced a cause and effect "fishbone
diagram" which revealed educational deficits among patients and staff.
The researchers surveyed 30 patients for baseline knowledge. "Looking
two cycles back in the quality improvement process, we determined that
education of patients on PCA pumps needs to start in the clinic," Mrs.
A staff survey revealed that there was an unmet need for a standard
approach to teaching and managing patients on PCA pumps. The team developed
a PCA Guideline Sheet and on-line educational materials. The guidelines were
incorporated into the unit’s standards for nursing pain assessment and
management and were included in a lesson plan for educating staff. Staff
education emphasized consistency in all areas of patient care, from pre-op
clinic to patient discharge after surgery.
The guidelines include assessment, intervention, reassessment, and side
- Assessment includes use of a numeric pain scale to measure pain at
rest, pain with activity, and level of pain acceptable to the patient.
Assessment also takes into account the patient’s ability to cough and to
breathe deeply, pain site, pain characteristics such as duration and
frequency, and pump details such as whether the PCA control button can be
easily reached by the patient.
- Intervention includes education of patient and family about pain
management in general and about use of the pump in particular. This
incorporates "reassurance to the patient that use of the prn medication
schedule will not cause the patient to get too much medication or to become
an addict," Mrs. Fogarty said.
- Reassessment is done by administering the pain survey again after the
- Side effects evaluated include nausea, pruritis, drowsiness,
constipation, and paresthesia.
"After patient education materials were used and the staff was
educated, we resurveyed the patients for improvement. Patient satisfaction
with pain control increased from 75% to 90%. Because of the high success
rate, we chose to incorporate these methods and guidelines into nursing
practice within our entire institution," Mrs. Fogarty reported.