Authorized and Unauthorized (“PCA by Proxy”) Dosing of Analgesic Infusion Pumps: Position Statement with Clinical Practice Recommendations

Unconventional Use of a PCA Pump: Nurse-Activated Dosing

“…1 This method is referred to as ''nurse-activated dosing'' (NAD) and ''nurse-controlled analgesia,'' and has a long history of use in patients of all ages. 1,2,[5][6][7][8][9] NAD is supported by a position paper with clinical practice recommendations developed by the American Society for Pain Management Nursing, 7,8 and is endorsed by other nursing specialty organizations such as the Oncology Nursing Society and the Hospice and Palliative Care Nurses Association (Table 1 for guidelines for the use of NAD).…”

“…1,2,[5][6][7][8][9] This therapy is referred to as ''caregiver-controlled analgesia'' or ''parent-controlled analgesia,'' depending on who is authorized to manage the patient's pain. 1,9 Caregiver-controlled analgesia, parent-controlled analgesia, and NAD are collectively referred to as ''authorized agent-controlled analgesia''.…”

“…1,9 Caregiver-controlled analgesia, parent-controlled analgesia, and NAD are collectively referred to as ''authorized agent-controlled analgesia''. 7,8 In all cases of authorized agentcontrolled analgesia, the control of analgesia is returned to patients (ie, PCA) if and when they are able to assume it. 1 Criteria for determining which patients are candidates for NAD, policies and procedures, nursing and patient/family education regarding the therapy, and monitoring guidelines should be developed before the unconventional use of a PCA pump.…”

Pain Management

“…Doses can be cautiously restarted at 50 % of the original dose once the patient is alert and if they are experiencing pain. Many institutions have developed protocols for authorized agent-controlled analgesia (AACA) for children <6 years which can include either nurse-controlled or caregiver-controlled analgesia as long as the caregiver is consistently available, competent, and properly educated and the authorized agent is designated in the medical order (Wuhrman et al 2007 ).…”

Emerging Trends and New Approaches to Acute Pain Management

“…Because of the importance of adequate analgesia for all patients in the perioperative setting and for those with chronic and cancer-related pain, the American Society for Pain Management Nursing (ASPMN) supports the use of authorized agents to deliver analgesia doses. 16 In the proper setting, a family member or other agent can provide invaluable assistance in helping to deliver optimal analgesia to patients who are unable to activate their IV PCA device on their own. To be safe and effective, however, a process must be established to ensure that the agent is properly educated to identify when it is appropriate to dose the patient.…”