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TSC - Anesthesiology - Adult - Recovery/PACU [4782]

TSC - Anesthesiology - Adult - Recovery/PACU [4782] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Transformations Surgery Center


TSC - Anesthesiology - Adult - Recovery/PACU [4782]
Intended for Adult Patients Only
Patient Care Orders
Non Categorized Patient Care Orders [134246]
Urinary Catheterization-Intermittent [NURELM0018] PRN, Starting today For Until specified, Routine, Perform a
urinary bladder drainage straight cath, if bladder volume via
bladder scan meets PACU criteria, PACU
Physiologic Parameters to Notify Anesthesiologist
[NURCOM0022]
CONTINUOUS, Starting today For Until specified, SBP < 85
or >175 mmHg by either arterial line or cuff for 15 minutes or
longer.
HR < 42 or >105 bpm for 15 minutes or longer.
RR < 8 or >18 breaths per minute for 10 minutes or longer.
O2 sat < 91 % for 5 minutes or longer.
ETCO2 > 60 mmHg for 10 minutes or longer. (if CO2
measured)
Any critical laboratory value, PACU
Glucose, POC - Immediately Postoperatively
[HCMGLUC]
ONCE, Routine
If Conditional, What Condition?
PACU
Glucose, POC - Prior to Discharge from PACU
[HCMGLUC]
ONCE, Routine
If Conditional, What Condition?
PACU
Respiratory [134247]
CPAP Continuous [RT0009] CONTINUOUS, Starting today, Routine
PEEP (cmH2O):
FiO2 (%):
Titrate oxygen to maintain O2 sat at (%):
Self Administered (Only RT may document in this box after
patient assessment):
PACU
Medications
Parenteral Opioid Analgesic - First Line Rescue Therapy (Single Response) [124159]
MORPHine PF injection RANGE [750057] 1-4 mg, Intravenous, EVERY 6 MINUTES PRN, pain
First Line Parenteral Analgesic Agent - Give if unable to
tolerate oral opioids or rapid response required (if for rapid
response, may give parenteral and oral pain meds
concurrently). Administer up to *** mg. If insufficient pain
relief, give Second Line Parenteral Therapy or notify provider
if no second line therapy is ordered.
for 4 Minutes, PACU
HYDROmorphone PF (DILAUDID) injection RANGE
[750050]
0.2-0.4 mg, Intravenous, EVERY 6 MINUTES PRN, pain
First Line Parenteral Analgesic Agent - Give if unable to
tolerate oral opioids or rapid response required (if for rapid
response, may give parenteral and oral pain meds
concurrently). Administer up to *** mg. If insufficient pain
relief, give Second Line Parenteral Therapy or notify provider
if no second line therapy is ordered.
for 3 Minutes, PACU
FENTanyl (SUBLIMAZE) injection RANGE [750047] 25-50 mcg, Intravenous, EVERY 6 MINUTES PRN, pain
First Line Parenteral Analgesic Agent - Give if unable to
tolerate oral opioids or rapid response required (if for rapid
response, may give parenteral and oral pain meds
concurrently). Administer up to *** mcg. If insufficient pain
relief, give Second Line Parenteral Therapy or notify provider
if no second line therapy is ordered.
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

for 1 Minutes, PACU
Parenteral Opioid Analgesic - Second Line Rescue Therapy (Single Response) [124160]
MORPHine PF injection RANGE [750057] 1-4 mg, Intravenous, EVERY 6 MINUTES PRN, pain
Second Line Parenteral Analgesic Agent - Give if
unresponsive to maximum First Line Parenteral Therapy.
Give if unable to tolerate oral opioids or rapid response
required (if for rapid response, may give parenteral and oral
pain meds concurrently). Administer up to *** mg
for 4 Minutes, PACU
HYDROmorphone PF (DILAUDID) injection RANGE
[750050]
0.2-0.4 mg, Intravenous, EVERY 6 MINUTES PRN, pain
Second Line Parenteral Analgesic Agent - Give if
unresponsive to maximum First Line Parenteral Therapy.
Give if unable to tolerate oral opioids or rapid response
required (if for rapid response, may give parenteral and oral
pain meds concurrently). Administer up to *** mg
for 3 Minutes, PACU
FENTanyl (SUBLIMAZE) injection RANGE [750047] 25-50 mcg, Intravenous, EVERY 6 MINUTES PRN, pain
Second Line Parenteral Analgesic Agent - Give if
unresponsive to maximum First Line Parenteral Therapy.
Give if unable to tolerate oral opioids or rapid response
required (if for rapid response, may give parenteral and oral
pain meds concurrently). Administer up to *** mcg
for 1 Minutes, PACU
Parenteral Opioid Antishivering - Meperidine [124161]
meperidine (DEMEROL) injection RANGE [750055] 12.5-25 mg, Intravenous, ONCE PRN For 1 Doses, shivering,
for 4 Minutes, PACU
Oral Opioid Analgesic (Single Response) [133541]
Hyperlink to Pain Fast Fact - Multimodal Analgesia URL: https://uconnect.wisc.edu/clinical/references/pain-
management/references-guidelines/resources/name-
29968-en.file
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 1 HOUR PRN For 2 Doses, pain
Give parenteral opioid if patient unable to tolerate oral meds
or if rapid response required, may give parenteral and oral
pain meds concurrently. If giving oral med, and patient does
not have relief in 1 hour, titrate dose up to maximum dose. If
no benefit after 2 doses, call provider.
PACU
hydrocodone-acetaMINOPHEN (NORCO) 5-325 MG per
tab RANGE [750021]
1-2 tab, Oral, ONCE PRN For 1 Doses, pain
Give parenteral opioid if patient unable to tolerate oral meds
or if rapid response required, may give parenteral and oral
pain meds concurrently. If giving oral med, and patient does
not have relief in 1 hour, call provider. No more than 4 grams
acetaminophen per 24 hours for adults or 15mg/kg per dose
for peds <40kg.
PACU
oxycodone-acetaMINOPHEN (PERCOCET) 5-325 MG
per tab RANGE [750033]
1-2 tab, Oral, ONCE PRN For 1 Doses, pain
Give parenteral opioid if patient unable to tolerate oral meds
or if rapid response required, may give parenteral and oral
pain meds concurrently. If giving oral med, and patient does
not have relief in 1 hour, call provider. No more than 4 grams
acetaminophen per 24 hours for adults or 15mg/kg per dose
for peds <40kg.
PACU
Sedation / Muscle Relaxation [133542]
Hyperlink to Pain Fast Fact - Multimodal Analgesia URL: https://uconnect.wisc.edu/clinical/references/pain-
management/references-guidelines/resources/name-
29968-en.file
diazepam (VALIUM) injection RANGE [750043] 1-2.5 mg, Intravenous, EVERY 10 MINUTES PRN, Muscle
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

Pain
For painful muscle spasms/tightness unrelieved by opioids
IV push rate 5mg/minute. MAX 5 mg
PACU
NSAID Analgesics - Note: May only select one NSAID Analgesic (Single Response) (Single Response) [129716]
URL:
ketOROLAC (TORADOL) injection [58693] Intravenous, ONCE For 1 Doses
IV push over 15-30 seconds.
PACU
ibuprofen (MOTRIN) tab [38353] 600 mg, Oral, ONCE For 1 Doses, PACU
Other Analgesics - Note: Do not order if within 6 hours of parenteral acetaminophen administration [133540]
URL:
acetaMINOPHEN (TYLENOL) tab - NOTE: Do not order
if within 6 hours of parenteral acetaminophen
administration [34149]
Oral, ONCE For 1 Doses
No more than 4 grams acetaminophen per 24 hours for adults
or 15 mg/kg per dose for peds <40 kg
PACU
Hypotensives [129717]
sodium chloride 0.9% BOLUS [730003] 500 mL, Intravenous, ONCE PRN For 1 Doses, hypotension -
see Admin Instructions
Systolic blood pressure less than *** mmHg
PACU
lactated ringers BOLUS [730001] 500 mL, Intravenous, ONCE PRN For 1 Doses, hypotension -
see Admin Instructions
Systolic blood pressure less than *** mmHg
PACU
Antiemetics - First Line Rescue Therapy [129718]
If the patient received a single prophylactic antiemetic agent during the procedure, select an agent with a different
mechanism of action for rescue therapy in the anesthesia recovery period (e.g., if ondansetron was given prophylactically,
rescue with prochlorperazine). If two - three agents are ordered within a 1st, 2nd, or 3rd Line Panel, these should be
considered as concurrent administration orders.
promethazine (PHENERGAN) injection [41412] Intravenous, ONCE PRN For 1 Doses, nausea/vomiting
First Line Agent. Administer dose in a free flowing IV. If two -
three first line agents are ordered, these should be
considered as concurrent administration orders.
PACU
metoclopramide (REGLAN) injection [39626] 10 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
First Line Agent. If two - three first line agents are ordered,
these should be considered as concurrent administration
orders.
If ordered IV: Administer over 2 minutes
PACU
ondansetron (ZOFRAN) injection [132824] 4 mg, Intravenous, ONCE PRN For 1 Doses
First Line Agent. If two - three first line agents are ordered,
these should be considered as concurrent administration
orders.
for 3 Minutes, PACU
diphenhydramine (BENADRYL) injection [36790] 12.5 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
First Line Agent. If two - three first line agents are ordered,
these should be considered as concurrent administration
orders.
for 1 Minutes, PACU
haloperidol lactate (HALDOL) injection [800108] Intravenous, ONCE PRN For 1 Doses, agitation,
Nausea/Vomiting
First Line Agent. If two - three first ilne agents are ordered,
these should be considered as concurrent administration
orders.
PACU
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Pr i nt ed by GUETZLAFF, SCOTT F [SFG091] at 10/7/2015 8:22:26 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

Antiemetics - Second Line Rescue Therapy [129719]
If the patient received a single prophylactic antiemetic agent during the procedure, select an agent with a different
mechanism of action for rescue therapy in the anesthesia recovery period (e.g., if ondansetron was given prophylactically,
rescue with prochlorperazine). If two - three agents are ordered within a 1st, 2nd, or 3rd Line Panel, these should be
considered as concurrent administration orders.
promethazine (PHENERGAN) injection [41412] Intravenous, ONCE PRN For 1 Doses, nausea/vomiting
Second Line Agent - Give if patient fails to respond to first line
agent after 30 minutes. Administer dose in a free flowing IV.
If two - three second line agents are ordered, these should
be considered as concurrent administration orders.
PACU
metoclopramide (REGLAN) injection [39626] 10 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Second Line Agent - Give if patient fails to respond to first line
agent after 30 minutes. If two - three second line agents are
ordered, these should be considered as concurrent
administration orders.
If ordered IV: Administer over 2 minutes
PACU
ondansetron (ZOFRAN) injection [132824] 4 mg, Intravenous, ONCE PRN For 1 Doses
Second Line Agent - Give if patient fails to respond to first line
agent after 30 minutes. If two - three second line agents are
ordered, these should be considered as concurrent
administration orders.
for 3 Minutes, PACU
diphenhydramine (BENADRYL) injection [36790] 12.5 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Second Line Agent - Give if patient fails to respond to first line
agent after 30 minutes. If two - three second line agents are
ordered, these should be considered as concurrent
administration orders.
for 1 Minutes, PACU
haloperidol lactate (HALDOL) injection [800108] Intravenous, ONCE PRN For 1 Doses, agitation,
Nausea/Vomiting
Second Line Agent. Give if patient fails to respond to first line
agent after 30 minutes. If two - three second linie agents are
ordered, these should be considered as concurrent
administration orders.
PACU
Insulin [129721]
insulin regular (human) 100 UNIT/ML Injection [760284] Subcutaneous, ONCE For 1 Doses, PACU
IV Fluids (Single Response) [129722]
lactated ringers infusion [38890] Intravenous, CONTINUOUS
Titrate rate to keep up with fluid loss
PACU
Respiratory/Airway [129723]
albuterol 2.5 mg/3 mL neb soln [34314] 2.5 mg, Nebulization, ONCE For 1 Doses, PACU
Self-administered Medications [24893]
Note: Self Administered Medication Program
Documentation [950000]
ONCE For 1 Doses
Patient may self-administer and use own supply of the
following medications: ***
Laboratory
Labs - Immediately Postoperatively [128926]
HEMOGLOBIN, POC [HCHGBPOC] ONCE, Starting today For 1 Occurrences, Routine
If Conditional, What Condition?
PACU
PROTHROMBIN TIME/INR, POC [HCINRPOC] ONCE, Starting today For 1 Occurrences, Routine
If Conditional, What Condition?
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Pr i nt ed by GUETZLAFF, SCOTT F [SFG091] at 10/7/2015 8:22:26 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

PACU
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [134248]
ECG - 12 Lead [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam:
PACU
Page 5 of 5
Pr i nt ed by GUETZLAFF, SCOTT F [SFG091] at 10/7/2015 8:22:26 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison