I would appreciate your response to the following:
1. Does your institution limit use of PCAs with basal rates on opioid-tolerant patients only?
2. Does your institutions limit the location where PCA​ with basal rate may be used (ICU, Step-Down, etc.?)
3. Any limits on prescribing authority of PCA with a basal rate (i.e. only a specific service(s) may initiate)?
4. Is EtCO2 monitoring required for patients on PCA, with or without basal rate?
5. Any other safety measures in place?
Thank you.

Good morning! There are numerous organizations that recommend assessing a patient's status as opioid naïve or tolerant prior to opioid administration. (ex: WAKE UP Campaign, HRET ADE Prevention Change Package, ISMP TMSBP 12, TJC SEA 49, Opioid ADE Prevention Gap Analysis Minnesota Hospital Association.) We also know that performing an assessment of opioid naïve or tolerant status is complex and prone to knowledge based error by multiple disciplines.