A person may not be able to push the analgesia button for PCA because of:
(1) paralysis
(2) other physical impairment
(3) cognitive impairment
Control of analgesia by someone other than the patient may be appropriate if:
(1) the person is authorized (designated) to provide that function (authorized agent)
(2) the person does not activate the button when it is not indicated (patient asleep, presence of abnormal breathing, etc)
(3) the person has been instructed properly to handle problems that may occur (breakthrough pain, pump malfunction, etc)
(4) the person observes the patient for signs of undertreatment or toxicity
(5) the person carefully documents the situation
There should be an official policy outlining the steps involved and the assignment of responsibility.
If the authorized person is a nurse, then it is called nurse controlled analgesia (NCA).
If the authorized person is the caregiver, then it is called caregiver controlled analgesia (CCA).
Anyone not meeting all of the above criteria should not provide analgesia. They should not try to adjust the pump to provide more or less analgesia.
