A Comparison Study—Oral Patient-Controlled Analgesia Versus Traditional Delivery of Pain Medication Following Orthopaedic Procedures

Abstract

BACKGROUND: Orthopedic surgical patients have reported significantly lower numeric pain scores using a Wi-Fi oral patient-controlled analgesia (PCA) device compared to patients receiving oral as-needed (PRN) medication by manual administration. More than 90% of nurses using the oral PCA device have agreed that the device saved them time. The manual administration of PRN pain medication is frequently delayed and consumes a significant amount of nursing time. Delays in PRN pain medication delivery have been classed as missed nursing care, called an error of omission. PURPOSE: The purpose of this timing study was to examine if the use of the oral PCA device would reduce the nursing time to accomplish the delivery of PRN oral pain medication compared to the manual administration by nursing staff. METHODS: Each total task for the manual and device administration of a single PRN delivery of an oral pain medication was divided into subtasks. Personal data assistant (PDA) devices were programmed to enable the collection of timing data for each subtask for both methods. RESULTS: The manual administration time was 12.7 minutes per single dose beginning with the patient medication request and ending with pain reassessment. The oral PCA device steps to program the device, deliver one of eight doses of medication, and discharge the patient from the device required 2.06 minutes of nursing time. Reloading an additional eight-dose tray required 40 seconds of nursing time per dose of medication administered. CONCLUSION: The oral PCA saved 84% of the nursing time to administer each dose of PRN medication manually. These data provide evidence that the oral PCA device would reduce the nursing time to deliver a single dose of PRN oral pain medication.