Critical Reflection on Patient Safety and PCA Practice in Healthcare

This reflective journal entry critically examines patient safety standards encountered during a clinical placement involving patient-controlled analgesia (PCA). The author discusses the benefits of PCA in pain management, including improved patient satisfaction and self-management of pain, while also acknowledging potential risks such as programming errors, patient monitoring issues, and medication errors. The reflection highlights the importance of adhering to the National Safety and Quality Health Service Standards (NSQHS) to ensure safe and quality care. The author contrasts their initial perception of nursing-controlled analgesia with the advantages of PCA, emphasizing the significance of patient education, regular monitoring, and verification of PCA settings. The reflection concludes with the author's commitment to integrating these safety practices in their future nursing career, prioritizing patient well-being through the effective and safe use of PCA.

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NAME:
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Safety Quality Standards in Patient
Controlled Analgesia–Reflection
The following write-up is a critical reflection on patient safety standards in my placement
experience. In my placement, I was involved in a patient controlled analgesia that provided me
with an opportunity to learn and experience the importance of safe quality care. The patient
controlled analgesia plays an important role to improving pain management. The use of patient
controlled analgesia reduces pain intensity while improving patient’s satisfaction as compared to
non patient controlled analgesia (Perret, Fletcher, Firth, & Yates, 2015). The patient was in
control over analgesic drug for better titration that maximized pain relief at the same time with
minimal risk of overdose (Van de Velde, & Carvalho, 2016). The self management of pain by
the patient was an important factor on patent’s psychological wellbeing as they are able to
administer medication immediately they feel the pain even without a need for a carer or nursing
administering it. Although patient controlled analgesia has advantages of efficiency and minimal
risks, there are critical issues that could compromise safety and quality care of the practice.
These issues were programming errors, patient monitoring and medical errors. To minimize
these errors, we assessed the ability of the patient to use the device, periodically monitored,
ensured we checked the PCA device and followed medication safety standards. The patient was
able to use the PCA to manage pain until when he was able to take the medicines orally.
I was amused to learn how safety practices enhance the effectiveness of using PCA
device in pain management. The safety measures ensured the patient was able to use the device
and get pain relief when needed that enhanced patient satisfaction and minimized risks of
medical errors. Seeing the patient relaxed without experiencing pain or having to wait for
someone else help with administration was pleasing. Before this experience, I thought nursing
controlled analgesia was more effective and safe than PCA. I realized that non-PCA cannot be
available when needed as compared to patient controlled analgesia because it the patient who
feels the pain. I felt that effectively use of PCA has far many advantages in pain management as

compared to non-patient controlled analgesia. I must admit that failure to upload high safety
standards can adversely affect the patient’s health.
I found the National Safety and Quality Health Services Standards important to
maintaining and delivering safe and quality care when using PCA. The reason why I though
nursing controlled analysis was more effective than PCA is because in my thinking I thought
nurses are trained and flexible that was not possible with a machine/ device. I also had a
perception that machines cannot better than a human being. The errors that occur in PCA can be
avoided by adhering to safety and quality standards as detailed in the National Safety and
Quality Health Service Standards (NSQHS) 2nd Edition (Boyd & Sheen, 2014). Before starting
the PCA practice, it important to assess the patient’s capacity to use the device, double check the
PCA settings and connect to verify proper functioning, regular monitoring of the patient,
education of the patient and adhering to medical safety standards. According to NSQHS standard
2 of partnering with consumers, patients’ are partners to their care in designing, planning, and
delivering to the extent that they choose. The NSQHS medication safety standard require health
practitioners to be competent to safely prescribe, dispense and administer drugs and be able to
monitor their use. Health centres need to describe, implement and have a monitoring system to
minimize the medication errors incidents and guarantee safety and quality of medicines used
(Australian Commission on Safety and Quality in Health Care, 2012).
PCA has been used for more than three decades in pain management. The practice was
adopted to effectively and quickly relieve pain (Dewhirst, Zhao, MacKenzie, Cwinn, &
Vaillancourt, 2017). Giving the patient control to the analgesic medicine administration enables
one to self administers when in need. This makes PCA practice more effective than a nurse
controlled analgesia where the nurse has to attend to the patient. The PCA has a programmable
computerized pump that enables the patient to press and administer drug that the nurse has
connected with the device. The drug dose is set on the device and minimum time set that the
patient cannot overdose (Hatherley, Jennings, & Cross, 2016). These two features enable the
PCA practice to quick in administering analgesia drug and minimise the risk of overdose. The
PCA practice errors are therefore on the technology and human errors. The patient can lack
ability or capacity to press the button for the PCA device. This can either be physical or mental
inability of the patient to decide or press the button to initiate the drug administration process.

Britt et al (2014) in their study noted that patient risk factors need to be considered as they
contributed to 70% PCA adverse occurrences due to mistakes associated with the pump use.
These errors include installation of the wrong medicine or concentration, misprogrammed
concentrations and doses. They recommended double checking to verify the PCA connectivity
and settings. Melson et al (2014) noted that patients’ from hospitals that provided information
about PCA were safer as compared to hospitals that do not educate their patients. Logtenberg et
al (2017) also found that hospitals that provided monitoring of patients when practicing PCA
experienced 65% positive results. Therefore it can be concluded that PCA practice safety can be
enhanced by educating the patients, monitoring patients, verifying proper PCA settings and
connection, and considering patients risk factors.
In my future career as a nurse, I want to effectively use PCA to quickly and effectively
manage pain. To ensure the patient safety, I will double check the PCA connection and settings,
assess the patient risks in terms of capacity and ability to press the button, and monitor the
patient regularly. I will also revise the National Safety and Quality Health Services Standards as
they provide important guidelines to providing and delivering safe and quality care. Therefore, I
will prefer to safely use PCA practice instead of nursing controlled analgesia in my future
practice of nursing.

References
Australian Commission on Safety and Quality in Health Care. (2012). National safety and
quality health service standards. Australian Commission on Safety and Quality in
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Britt, H., Miller, G. C., Henderson, J., Bayram, C., Harrison, C., Valenti, L., ... & Charles, J.
(2014). General practice activity in Australia 2013–14. Sydney University Press.
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Dewhirst, S., Zhao, Y., MacKenzie, T., Cwinn, A., & Vaillancourt, C. (2017). Evaluating a
medical directive for nurse-initiated analgesia in the Emergency
Department. International emergency nursing, 35, 13-18.
Hatherley, C., Jennings, N., & Cross, R. (2016). Time to analgesia and pain score documentation
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Logtenberg, S. L., Oude Rengerink, K., Verhoeven, C. J., Freeman, L. M., van den Akker, E. S.,
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Melson, T. I., Boyer, D. L., Minkowitz, H. S., Turan, A., Chiang, Y. K., Evashenk, M. A., &
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Van de Velde, M., & Carvalho, B. (2016). Remifentanil for labor analgesia: an evidence-based
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