The Dreaded PCA Key

Last week I had the pleasure to, once again, meet and deal with our health care system. Due to an undisclosed condition (my health, my choice), I had to have open/classic liver surgery (the kind that comes with a hefty scar and recovery period). And while I came out safe, sound, and pleased with the results, there’s one little caveat that I will forever keep at the forefront should I ever need to revisit it again. I’m not talking about things to know regarding hospitals, insurance or procedures. It’s a simple tool called Patient Controlled Analgesia (or PCA for short). 

PCA is used post-surgically to give patients control over the amount of pain and discomfort they experience. This machine allows the patient to administer their own pain relief through a button-controlled perfusion. During my pre-op assessment, I was informed that this was likely to be used in my case and I was ecstatic! Getting on-demand pain relief sounded like an amazing option and it gave me that much more confidence to move forward without fear of pain.

So the surgery came and went and I woke up in intensive care, with the IV hooked up and ready to go. Unfortunately, there were a few hitches that no one had anticipated, This is where the story of the dreaded PCA key begins:

Upon waking up, I found out that the PCA machine, which controls on-demand dosing, was brand spanking new. Excited as I am about technology, I thought that was a good thing. Yet, for some odd reason, no one decided to train the nurses on using this new piece of hardware. I guess the administration just expected it to work exactly the same as the old machine. Luckily, my nurse had it handled in under 2 minutes so I avoided any unnecessary pain.

We quickly found out that the concentration on my pain IV was just too low. It was not working and my pain level was slowly but surely increasing. After the anesthesia team gave me a visit, we found better combination and the time came to change it up. Keep in mind that at this point, my pain level was at ~ 5/10, which is fairly substantial. This is where the key comes into play. By California law (I presume), all narcotics need to be kept in a locked container. And so the hospital deployed clear plastic containers around each narcotic IV bag, with a key to keep it safe. You would assume that keys would be easily accessible for something so important as pain management medicine. NOPE!

Both in the SICU and the PCU, nurses had the HARDEST time finding a key that worked with my PCA machine and the IV box. One nurse came in and said….we have two keys….one has to work….yet magically none of them did. Either keys got mixed up between floors, or whoever is in charge of providing keys was smoking the wrong stuff, and I was in pain because of it.

This isn’t the nurses’ fault, as in my eyes, they gave it their absolute all in my care and moved as fast as possible to find a key. This is a fault of hospital logistics (whichever team handles this), failing to realize the need for either MORE keys, or a better way of tracking the keys. If you don’t trust your nurses with a permanent key, or you’re not allowed by law, then find a way to best track your patient’s pain management pathways. Without those keys, your patients could be in deep deep pain.

Perhaps an electronic key tracker? How about a little dongle that beeps on demand? How about you change from key to a magnetic lock? The simplest way would be to obviously just give nurses more keys, although I’m not quite sure how willing hospitals or the law would be in this case. Someone enlighten me!

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