I am interested in whether other medical centers require 4-hr max dose for opioid PCAs. We use BD Alaris PCA module and have had this configured for many years. There have been increasing requests to remove it due to errors in calculating on the ordering side and forgetting to increase it when increasing dose/decreasing lock out duration leading to the PCA module locking out prematurely. The frequency of calculation errors have led to desensitization/workarounds to adjust the 4 hr max based on "what the provider meant" which has led to errors when the other dose fields were wrong/unsafe. An at-risk behavior to be sure, since most of the time this corrects the issue without error.
Anecdotally, we've had serious errors prevented by the 4 hour max field. Like a 10 fold error in PCA dose that doesn't match the 4 hour max leading to a question. I'm having a hard time finding evidence or best practices to support keeping it, other than a few anecdotal "good catches" when compared to the cons.
Any insight from other hospitals who use or decided not to enable the 4 hour max feature for PCA would be appreciated!