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Pain relief pumps: Don't push the button for patients

A pain relief system known as patient-controlled analgesia (PCA) allows patients to give themselves small but frequent doses of pain medicine without having to call a nurse. It is used most often in the hospital after surgery. The concept is simple: A pump containing pain medicine is attached to an intravenous (IV) line (which goes into a vein). When the patient feels pain, he or she pushes the button on the pump and they receive a dose of medicine. But the button on this pain relief system must be pushed only by the patient, not by others.

Patients themselves provide a measure of safety. If the patient is too sleepy, he or she will not push the button to give themselves more pain medicine. This built-in safety feature helps prevent patients from receiving too much medicine. But if other people push the button for the patient, the pump may deliver unneeded pain medicine that can lead to an overdose. An overdose of pain medicine can cause a patient to stop breathing.

Patients have died when well-intentioned friends or family members pushed the button for patients because they thought their loved ones were in pain, or they wanted to keep them comfortable while they slept. One was a teenager who died after receiving too much Dilaudid (hydromorphone), a very powerful narcotic (opioid). He was given the PCA pump after surgery. His mother pushed the button for him several times while he was sleeping. She believed she was making her son more comfortable. During the night, while his mother dozed at his side, the teenager stopped breathing after receiving too much pain medicine. 

For more than 20 years, the Institute for Safe Medication Practices (ISMP) has been warning healthcare providers and the public about this safety issue. Today, many hospitals teach patients and family members about the dangers associated with this practice, which is called PCA by proxy. Although tragedies like the one that happened with the teenager have greatly lessened in recent years, PCA by proxy continues to be a problem.

Most recently, a companion to an elderly patient in the hospital pressed the PCA button 7 times during 4 hours while the patient was sleeping. The medicine in the PCA pump was morphine, another powerful narcotic used to treat pain after surgery. The companion was aware that the patient himself could press the button every 6 minutes if he needed pain medicine. But the patient was asleep, so the companion pressed the button for him about every 30 minutes to keep him comfortable. The companion did not know that only the patient should press the button to deliver a dose of pain medicine. Fortunately, the elderly man’s breathing slowed but did not stop, so he was not harmed.

Here’s what you can do: After surgery, PCA gives you immediate access to your pain medicine when you need it. Thus, you should not be afraid to press the button to give yourself the medicine when you are in pain. If only YOU are pressing the button, the process is very safe. However, make sure that family and friends know not to push the button for you, or for anyone who is receiving PCA. Patients should not be given this pain relief system if they are not able to push the button for themselves (for example, very young children or confused adults). If you have any concerns about a patient’s inability to push the button for themselves, talk to a nurse. Do NOT push the button for the patient.

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