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Treatment of Nausea in Pregnancy – Adult/Pediatric – Ambulatory [157]

Treatment of Nausea in Pregnancy – Adult/Pediatric – Ambulatory [157] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols



Delegation Protocol Number: 157

Delegation Protocol Title:
Treatment of Nausea in Pregnancy – Adult/Pediatric – Ambulatory

Delegation Protocol Applies To:
UW Health OB/GYN Clinics and Family Medicine Clinics with OB/Gyn services

Target Patient Population:
Pregnant Women

Delegation Protocol Champions:
Makeba Williams, MD – Department of Obstetrics and Gynecology (OB/GYN)
Jacqueline Gerhart, MD – Department of Family Medicine

Delegation Protocol Reviewers:
Jenny Accola, BSN, RN – Clinic Operations Manager - UW OB/GYN
Linda Kiefer, RN – Clinical Supervisor – Deforest-Windsor Clinic
Cheryl DeVault, BSN, RN, OCN – Clinic Operations Manager – Yahara Clinic
Matthew Swedlund, MD – Department of Family Medicine
Nancy Foulk, RN – Family Medicine – Yahara Clinic

Responsible Department:
Department of Obstetrics and Gynecology
Department of Family Medicine

Purpose Statement:
To delegate authority from the patient’s OB/GYN or Family Medicine provider to Registered Nurses
(RNs) to initiate treatment of nausea and vomiting in pregnant patients.

Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) trained in the use of this delegation protocol.

Guidelines for Implementation:
1. This delegation protocol is initiated when a pregnant patient contacts their OB/GYN or Family
Medicine clinic with OB/Gyn services with complaints of nausea that prevent the patient from
performing their normal daily activities.
2. If the patient has any contraindications to this protocol, no orders will be placed and the RN will
notify the provider. Contraindications to the use of this protocol:
2.1. Allergies or drug interactions with all of the medications in this protocol
2.2. Signs of dehydration (decreased urine output, dry mouth, headaches) or has no oral intake for
24 hours
3. The RN will provide education to patients regarding ways to cope with nausea and vomiting during
pregnancy and order appropriate medication for treatment. Patient handout Health Facts for You
(HFFY #5457) will be provided to patient prior to any treatments below.
4. The RN will manage the patient’s nausea following the treatments below in the sequence listed.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

2
4.1. 1
st
Line of Treatment – Non-pharmacologic therapy will be offered to all patients. The RN will
advise patient of supportive care treatments (hydration, small frequent meals/snacks, etc.) as
defined in the UW Health Handout “Early Pregnancy” and/or “Health Facts for You: Coping with
Nausea and Vomiting in Pregnancy.”
4.1.1. If patient does not improve within 2 days the RN will add the 2
nd
line of treatment.
4.2. 2
nd
Line of Treatment - To be offered if patient has already tried first line treatment without
success.
4.2.1. The RN will order the following:
• Vitamin B6 25-50mg by mouth, 3 times per day PRN nausea and vomiting; not to exceed
200mg per day. Order quantity #100, no refills.
AND
• Doxylamine 12.5mg, 4 times per day PRN nausea and vomiting. Order quantity #30, no
refills.
4.2.2. The patient will be instructed to follow up with the RN in 2 days.
4.2.3. If symptoms do not improve within 2 days the RN will add the 3
rd
line of treatment.
4.3. 3
rd
Line of Treatment – To be offered if patient has already tried first and second line
treatments without success. The RN will order one of the medications below and instruct the
patient to take it in combination with existing first and second line therapy line therapy.
4.3.1. The RN will order the following:
• Promethazine, 12.5-25mg, every 4 hours PRN nausea and vomiting. Order quantity #30, no
refills.
OR
• If the patient is unable to tolerate drowsiness then the RN will order Dimenhydrinate, 50-
100 mg, every 6 hours PRN nausea and vomiting. Order quantity 30, no refills.
4.3.2. The RN will instruct the patient that if there is no improvement within 2 days, to
discontinue 2
nd
and 3
rd
lines of treatment and call RN. RN should then instruct patient to
move to 4
th
line of treatment.
4.4. 4
th
Line of Treatment – To be offered if patient has already tried 1st, 2nd and 3rd line without
success. The RN will instruct the patient to discontinue the 2nd and 3rd line treatment and will
order:
4.4.1. Metoclopramide, 5-10mg every 8 hours PRN nausea and vomiting. Order quantity #30, no
refills.
5. If at any point the patient experiences signs of dehydration (decreased urine output, dry mouth,
headaches) or has no oral intake for 24 hours, the delegation protocol will be discontinued and the
RN will notify the provider.

Order Mode: Meds: Protocol/Policy, Without Cosign


References:
1. ACOG Practice Bulletin; Clinical Management Guidelines for OB/GYN, number 153, September 2015.
Collateral Documents/Tools: NA
1. Coping with Nausea and Vomiting in Pregnancy (HFFY #5457)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

3
Approved By:
UW Health Ambulatory Protocol Committee: November 2016
UWHC Pharmacy and Therapeutics Committee: March 2017
UWHC Medical Board: May 2017
UW Health Chief Clinical Officer: May 2017

Effective Date: May 2017

Scheduled for Review: May 2020
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org