Unconventional use of a PCA pump: nurse-activated dosing.

Creative approaches, such as NAD, can be taken to manage pain in patients who would be candidates for PCA therapy if they were physically and cognitively able to manage their own pain. NAD authorizes the patient's primary nurse to administer bolus doses with or without a basal rate via the PCA infusion pump. Doses are administered for breakthrough pain with a basal rate or in scheduled doses to maintain analgesia without a basal rate. It is also used to administer bolus doses before and during painful procedures.