Pharmacy-managed patient-controlled analgesia service.
The implementation and functioning of a patient-controlled analgesia (PCA) service operated by staff pharmacists are described. The pharmacy-managed PCA service was introduced into the hospital in 1988. Pharmacists initiate PCA therapy upon physician request. Standard narcotic-dosing guidelines were developed for patients receiving PCA; criteria were also developed to allow the pharmacist to adjust the narcotic dose based upon the patient's response. The dosing guidelines were approved by the pharmacy and therapeutics committee. A hospitalwide education program introduced nurses and physicians to the pharmacy-managed PCA service. Of 299 patients who received PCA therapy in 1989, more than 90% were managed by staff pharmacists. Pharmacists calculate and program initial narcotic doses and are responsible for daily patient monitoring to determine the success of therapy. Using the established guidelines, pharmacists adjust the narcotic dose based upon patient response. A quality assurance review of the PCA service has documented its safety and success. A pharmacy-managed PCA service has increased the clinical involvement of pharmacists and provided safe and effective pain management for postsurgical patients.