The Benefits of Authorized Agent Controlled Analgesia (AACA) to Control Pain and Other Symptoms at the End of Life.

CONTEXT: Eliza Coffee Memorial Hospital is a community hospital with a palliative care unit providing inpatient symptom management and end-of-life care. The palliative care unit provides authorized agent controlled analgesia (AACA).

OBJECTIVES

The objective of this study was to determine if an AACA system improves control of pain and other end-of-life symptoms adequately and if it provides families with satisfactory involvement in the care of their loved ones.

METHODS

Data on demographics, pain assessments, length of stay before and after consult, drugs used, mortality, discharge disposition, and family and staff satisfaction were collected by chart review of all 2013 consultations.

RESULTS

There was a total of 318 consults in 2013. Of the 118 patients (37% of total) who used the AACA system, 112 (95%) died in hospital; morphine was used by 77% and the others used hydromorphone. Following the patient's death, of the 70 AACA families contacted, 100% were satisfied with the pain/symptom control. Staff also were overwhelmingly pleased with the system.

CONCLUSION

An AACA system has been highly satisfactory for patients, families, and staff, meeting the goals of 1) allowing patients with a terminal condition to die peacefully and 2) enabling families to share in the patients' care, providing them with a more favorable memory at the end of life.