Supersedes: all previous additions Description of Amendment(s):
Originated By: Dr. R Walker, Dr. G. Meakin, D. Jonas, A. Adams Designation: Lead clinician pain management, Consultant Anaesthetist, Lecturer/practitioner, Principal pharmacist Approved by: Medicines Management Committee & Children’s Pain Team Sub Committee Approval Date: [if required]
All Patients
Adults Only
Children Only
All Staff
Staff Group (Nursing & Medical)
X Other (please insert)
Issue Date: September 2008 Circulated by: Children’s Pain Team Issued to: Circulation List
Review Date: September 2010 Responsibility of: Children’s Pain Team
Nurse Controlled Analgesia (NCA) Protocol Dr. R Walker/Dr. G Meakin, D. Jonas/A. Adams Sept 2008
(Review Sept 2010)
Page 1 of 3
POLICY CONTROL PAGE (2) CIRCULATION DOCUMENT Circulation List:
For Information
All new Policies need to ensure that they do not impact adversely or have a differential impact that cannot be justified. The Trust, through the corporate team, will ensure that all new policies have equalities and diversities initial impact assessment during their development and that this is completed prior to Board approval. The Trust has a duty to publish Equality Impact assessments under the Race Relations Amendment Act 2000. Please contact the Equality and Diversity Department if you have any queries on 0161 276 6897.
This document is to be disseminated to all relevant staff, any required discussion or training should be detailed.
The Policy must be posted on the intranet: Date Posted:
Nurse Controlled Analgesia (NCA) Protocol Dr. R Walker/Dr. G Meakin, D. Jonas/A. Adams Sept 2008
(Review Sept 2010)
Page 2 of 3
Children’s Pain Team NURSE CONTROLLED ANALGESIA PROTOCOL (N.C.A.) (All drug doses to be prescribed on patient’s medication prescription sheet.)
All nursing staff who will be involved in the care of a child with N.C.A. must have received training in the use of this technique and be aware of the potential consequences of the intervention. Nursing staff must be RSCN or RN Child having successfully completed the IV administration course. Nursing staff must also adhere to the trust drug policy for administration of controlled drugs EQUIPMENT IVAC P5000 MK II. (PCA pump) An anti-syphon valve must be used to prevent uncontrolled emptying of the syringe (PCA infusion set). This dedicated infusion set also incorporates an anti-reflux valve. PATIENT SELECTION Age less than 6 months: must be nursed in a High Dependency Area. Children above 6 months are suitable for this technique providing there is no contraindication to the use of morphine. DRUG DILUTION Morphine dose: 1milligram/kg mixed to a total of 50 millilitres with Normal Saline. (Maximum dose in any syringe = 50milligrams) Bolus dose: 1 ml = 20 microgram/kgBackground infusion: 0 – 20 microgram/kg/hour Lock out interval: 20 – 60 minutes Total Maximum 4 hourly dose: 320 microgram/kg. (Maximum 10 milligram) Changes to the above protocol can only be made by a consultant anaesthetist MONITORING All children must in addition to the normal ward observations be managed with the N.C.A. OBSERVATION FORMS and continuous pulse oximetry. All observations must be recorded hourly. In addition, the respiratory rate and sedation score must be recorded 20-30 min after giving a bolus dose of morphine. CRITERIA FOR ADMINISTRATION OF A BOLUS DOSE (Check scoring criteria on N.C.A. chart) 1. The pain score is 7 or more on scale of 0-10. 2. Sedation score should be no greater than 1 3. Oxygen saturation is greater than the minimum selected which has been documented by the prescribing anaesthetist. 4. Respiratory rate is above minimum rate for age of the child (See criteria on N.C.A. chart) The patient must be monitored by continuous pulse oximetry. PROCEDURE FOR ADMINISTRATION OF A BOLUS DOSE 1. The fulfilment of the above criteria must be checked prior to any bolus dose being given and signed for on the patients N. C. A. observation form by the child’s allocated nurse for that shift, who must be RSCN or RN Child Branch having successfully completed the IV Administration Course and training in the use of N.C.A. 2. The bolus dose is given by the child’s allocated nurse for the shift. 3. The administration of the bolus dose is signed for by the nurse administering the dose on the patients observation form at the time that it is given. 4. The administration of a bolus dose is witnessed and countersigned by two nurses. 5. In addition, the respiratory rate and sedation score must be recorded 20-30 min after giving a bolus dose of morphine on the N.C.A. observation form. Evaluate effectiveness, record pain score. 6. The patient is monitored by using the N.C.A. Observation Chart at minimum of one hourly interval. Nurse Controlled Analgesia (NCA) Protocol Dr. R Walker/Dr. G Meakin, D. Jonas/A. Adams Sept 2008
