Content analysis of nurses\' responses to the open-ended items revealed themes associated with annoyance about operating the device, nursing time, and patient safety. Nurses commented that the device was a “nuisance to deal with,” “hard to set up,” “not reliable,” and that it R-406
is “easier to dispense meds personally.” Eight nurses commented that the set up or use of the machine was difficult because of limited computers for programming, previous patients not being discontinued from the machine properly, or the machine not being plugged in and charged. Nurses\' comments also reflected concerns for medication
safety when patients self-administer opioids, as well as the potential for opioid diversion. Nurses said that not being able to actually see patients take the medication could be a safety issue, citing the possibility of patients “stashing or saving pills” or that visitors might take the medication instead of the patient. One nurse commented that the training provided to nursing staff and patients was insufficient, adding that more instruction would be helpful to better educate patients about using the device. Nurses also offered positive comments about the device, indicating that they liked it, enjoyed using it, and believed it could be a “valuable time saver for nurses.” They noted that the device worked well when it worked and was easy to manage.
Patients\' Perceptions and Attitudes Using the Oral PCA Device
Forty-six orthopedic patients undergoing a total hip or knee replacement during the time of the study were eligible to participate, with 35 actually using the oral PCA device. On the women\'s health unit, 58 women scheduled for a Caesarean section were eligible to use the device, but only 16 had orders
placed. Of the 51 patients who actually used the device during their hospital stay, only 21 (41%) patients evaluated use of the device; 10 from women\'s health and 11 from orthopedics.