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Motion Sickness - Adult - Ambulatory [162]

Motion Sickness - Adult - Ambulatory [162] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols




Delegation Protocol Number: 162

Delegation Protocol Title:
Motion Sickness - Adult - Ambulatory

Delegation Protocol Applies To:
UW Health Primary Care Clinics

Target Patient Population:
Adult patients requesting medications for the prevention of motion sickness

Delegation Protocol Champions:
Mark Anderson, MD – Department of Family Medicine
Anne Schmidt, MD – Department of Medicine – Internal Medicine

Delegation Protocol Reviewer:
Stephanie North, RN – General Internal Medicine – West Towne Clinic
Kelly Case, RN – Family Medicine – Yahara Clinic

Responsible Department:
Department of Internal Medicine
Department of Family Medicine

Purpose Statement:
This protocol delegates authority from the patient’s UW Health Primary Care Provider (PCP) to
Registered Nurses (RNs) and Pharmacists (RPhs) to place orders for medications requested by
patients for the prevention of motion sickness for travel related purposes.

Who May Carry Out This Delegation Protocol:
RNs and RPhs trained in the use of this delegation protocol.

Guidelines for Implementation:
1. This protocol is initiated when a patient requests medications for the prevention of motion
sickness for travel related purposes and the patient has a UW Health PCP.
2. Exclusions to this protocol are age 65 years or older or known allergies to the included
medications or known history of vertigo or new onset of vertigo. If the patient is excluded from
the protocol, the RN/RPh will consult the provider for additional direction.
3. Prior to placing any order the RN/RPh will review the medical record including medications,
allergies, problem list and past medical history to determine the appropriate action.
4. The RN/RPh will inform patients traveling outside of the US to contact the UW Health Travel
Clinic.
5. The RN/RPh will order one of the following medications based on patient preference and
pertinent medical history.
5.1. Meclizine (Dramamine) 25 mg by mouth taken one hour prior to travel and repeated every
24 hours as needed. Quantity: Sufficient to cover the duration of travel plus 2 additional
tablets. Maximum of 30 tablets.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org



• Prior to ordering meclizine the RN/RPh will confirm the patient does not have any
known allergies to antihistamines.
• RN/RPh will discuss potential adverse reactions to medication including but not limited
to fatigue, dry mouth, dizziness, and risk of falls.
5.2. Scopolamine (Transderm Scop) 1.5 mg transdermal Apply one patch every 72 hours starting
at least 4 hours prior to travel. Quantity: Sufficient to cover the duration of travel plus 2
additional patches. Maximum 10 patches.
• Prior to ordering scopolamine the RN/RPh will confirm the patient does not have (1) a
known allergy to scopolamine or belladonna alkaloids or (2) a known history of narrow
angle glaucoma, benign prostatic hypertrophy or urinary retention, (3) a known
adhesive allergy, (4) history of seizures or psychosis.
• RN/RPh will discuss potential adverse reactions to medication including but not limited
to fatigue, dry mouth, dizziness, and risk of falls.

Order Mode: Protocol/Policy, Without Cosign

References:
1. Priesol AJ. Motion sickness. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on
February 7, 2017).

Collateral Documents/Tools: N/A

Approved By:
UW Health Ambulatory Protocol Committee: March 2017
UW Health Pharmacy & Therapeutics Committee: August 2017
UWHC Medical Board: September 2017
UW Health Chief Medical Officer: October 2017

Effective Date: October 2017

Scheduled for Review: October 2020

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