/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/pain-management/,

/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-123243-en.cckm

201712341

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Pain Management

IP - Ketamine Infusion - Adult - Supplemental [5981]

IP - Ketamine Infusion - Adult - Supplemental [5981] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


IP - Ketamine Infusion - Adult - Supplemental [5981]
Patient Care Orders
Vital Signs [200900]
Vital Signs [NURMON0013] EVERY 4 HOURS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Measure Respiratory Rate, Depth And Regularity
[NURMON0092]
EVERY 4 HOURS, Routine, Measure for 1 full minute
Patient Monitoring [200901]
Assess Sedation Level [NURCOM0022] EVERY 4 HOURS
Assess Patient's Pain Rating [NURCOM0022] EVERY 4 HOURS
Respiratory [200902]
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Contingency Parameters [200903]
Notify Acute Pain Service [NURCOM0001] Provider to Notify: Provider
Notify based on: Heart Rate,Respiratory Rate,Other
Other: Adult Sedation Score (Ramsay) = 4 or greater.
If intolerable psychonimetric effects occur.
If respiratory rate >:
If respiratory rate <: 8
If heart rate > (bpm): 120
If heart rate < (bpm):
All pain questions and analgesic side effect issues,
sedation score greater than or equal to 4 (Ramsay),
pager #7246 or "PAIN" (for patients at CSC). If there
is no response after page #7246, call paging or the
anesthesiology on-call resident (or faculty); or call the
Inpatient Operating Room at 263-8595.
If patient located at the American Center, page the
TAC Anesthesiologist on-call in U-Connect
(WebXchange) using the on-call schedule search for
"TAC Anesthesiologist".
Medications
General [206368]
Note: Note: NO other opioids, sedatives or CNS
depressants unless approved by the
Anesthesiology Acute Pain Service. If patient is
located at The American Center, obtain approval
from the On-Call Anesthesiologist [950018]
4 X DAILY (NOTE ACKNOWLEDGE)
Note: NO other opioids, sedatives or CNS
depressants unless approved by the Anesthesiology
Acute Pain Service. If patient is located at The
American Center, obtain approval from the On-Call
Anesthesiologist
Analgesics [201087]
ketAMINE (KETALAR) 100 mg in sodium chloride
0.9 % 50 mL infusion syringe [700932]
Intravenous, CONTINUOUS
Basal infusion only. No titration. No patient initiated
dose/lockout interval/RN initiated bolus
NOTE: No titrate to effect orders or doses with ranges
will be deemed acceptable. Suggested dosing: 0.1
mg to 0.15mg/kg/hr for 48 hours.
All dose adjustments must be ordered and managed
by Acute Pain Service.
Page 1 of 2
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:35:50 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

TENS [EQP0080] CONTINUOUS, Routine
Mode to initiate therapy:
If mode does not provide benefit for the patient, allow
provider/ patient to try other modes:
Titrate up channels 1 & 2 to a level that may cause
discomfort, but is tolerable:
celecoxib (CELEBREX) cap [60834] 400 mg, Oral, 2 X DAILY PRN, pain
See Pain management Algorithm for the Selection of
As-needed Analgesics
Analgesics - Scheduled [16703]
acetaMINOPHEN (TYLENOL) tab - NOTE: Do
NOT order if patient had hepatic resection [34149]
650 mg, Oral, 4 X DAILY
NOTE: Do NOT order if patient had hepatic resection
acetaMINOPHEN (TYLENOL) tab - NOTE: Do
NOT order if patient had hepatic resection [34150]
1,000 mg, Oral, 4 X DAILY
NOTE: Do NOT order if patient had hepatic resection
Post-Op/Phase II
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Do NOT order if patient had
hepatic resection [800005]
650 mg, Nasogastric Tube, 4 X DAILY
NOTE: Do NOT order if patient had hepatic resection
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Do NOT order if patient had
hepatic resection [800005]
1,000 mg, Nasogastric Tube, 4 X DAILY
NOTE: Do NOT order if patient had hepatic resection
gabapentin (NEURONTIN) cap [54257] 400 mg, Oral, 3 X DAILY
MORPHine (MS CONTIN, ORAMORPH) ER tab
[156572]
15 mg, Oral, 2 X DAILY
Analgesics - As Needed for Incident Pain [202287]
oxycodone tab [750032] 5-15 mg, Oral, EVERY 3 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
acetaMINOPHEN (TYLENOL) tab - NOTE: Do
NOT order if patient had hepatic resection [34149]
650 mg, Oral, EVERY 6 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg
NOTE: Do NOT order if patient had hepatic resection
ketOROLAC (TORADOL) injection [800050] 15-30 mg, Intravenous, EVERY 6 HOURS PRN For
48 Hours, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
If ordered IV: push over 15-30 seconds
Analgesics - As Needed For Uncontrolled Incident Pain (Single Response) [16712]
MORPHine PF injection [750057] Intravenous, EVERY 1 HOUR PRN, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
for 4 Minutes
HYDROmorphone PF (DILAUDID) injection
[750050]
0.2-0.5 mg, Intravenous, EVERY 1 HOUR PRN, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
for 3 Minutes
FENTanyl PF injection RANGE [750047] Intravenous, EVERY 1 HOUR PRN, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
for 1 Minutes
Side Effect Management [202288]
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN, opioid overdose
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting
Page 2 of 2
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:35:50 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org