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/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-98084-en.cckm

201708226

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UWHC,UWMF,

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

IP - Lidocaine Intermittent Intravenous Infusion - Adult - Supplemental [1373]

IP - Lidocaine Intermittent Intravenous Infusion - Adult - Supplemental [1373] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


IP - Lidocaine Intermittent Intravenous Infusion - Adult - Supplemental [1373]
Policy 3.5.5 Pain Management URL: https://uconnect.wisc.edu/policies/clinical/uw-
health-clinical/med-records/patient-
assessment/355.policy
Patient Care Orders
Vital Signs [18540]
Vital Signs (Temperature, Blood Pressure, Pulse
Rate, Respiratory Rate) [NURMON0013]
ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Prior to Infusion.
Vital Signs (Blood Pressure, Pulse Rate,
Respiratory Rate) [NURMON0013]
SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes and as needed if adverse effects
develop during infusion (temperature not needed).
Vital Signs (Blood Pressure, Pulse Rate,
Respiratory Rate) [NURMON0013]
SEE COMMENTS, Starting today For Until specified,
Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Once 30 minutes after completion of infusion
(temperature not needed)
Vital Signs [223722]
Vital Signs (Temperature, Blood Pressure, Pulse
Rate, Respiratory Rate) [NURMON0013]
ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Prior to Infusion., Pre-Op Day Of Procedure
Vital Signs (Blood Pressure, Pulse Rate,
Respiratory Rate) [NURMON0013]
SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes and as needed if adverse effects
develop during infusion (temperature not needed).,
Pre-Op Day Of Procedure
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 8/14/2017 9:46:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Vital Signs (Blood Pressure, Pulse Rate,
Respiratory Rate) [NURMON0013]
SEE COMMENTS, Starting today For Until specified,
Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Once 30 minutes after completion of infusion
(temperature not needed), Pre-Op Day Of Procedure
Patient Monitoring [18541]
Assess Pain Rating Prior to Infusion
[NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess pain rating once prior to infusion.
Assess pain rating every 15 minutes as as
needed if adverse effect develop during infusion
[NURMON0060]
SEE COMMENTS, Starting today, Assess pain rating
every 15 minutes as as needed if adverse effect
develop during infusion.
Assess Pain Rating 30 Minutes After Infusion
[NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess pain rating 30 minutes after completion of
infusion.
Assess for Lidocaine Side Effects Every 15
Minutes [NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess for Lidocaine adverse effects every 15 minutes
and as needed if adverse effects develop during
infusion.
Assess for Lidocaine Adverse Effects 30 Minutes
After Infusion [NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess for Lidocaine adverse effects 30 minutes after
completion of infusion.
Patient Monitoring [223723]
Assess Pain Rating Prior to Infusion
[NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess pain rating once prior to infusion., Pre-Op Day
Of Procedure
Assess pain rating every 15 minutes as as
needed if adverse effect develop during infusion
[NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess pain rating every 15 minutes as as needed if
adverse effect develop during infusion., Pre-Op Day
Of Procedure
Assess Pain Rating 30 Minutes After Infusion
[NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess pain rating 30 minutes after completion of
infusion., Pre-Op Day Of Procedure
Assess for Lidocaine Side Effects Every 15
Minutes [NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess for Lidocaine adverse effects every 15 minutes
and as needed if adverse effects develop during
infusion., Pre-Op Day Of Procedure
Assess for Lidocaine Adverse Effects 30 Minutes
After Infusion [NURMON0060]
SEE COMMENTS, Starting today For Until specified,
Assess for Lidocaine adverse effects 30 minutes after
completion of infusion., Pre-Op Day Of Procedure
Infusion Reaction [151892]
Infusion Reaction [NURCOM0022] ONCE, If mild or moderate adverse effects develop
hold infusion for 15 minutes or until resolved,
whichever is sooner. Resume infusion at 1/2 rate. If
adverse effects have not resolved in 10-15 minutes,
discontinue infusion. If adverse effects re-surface
when infusion restarted, discontinue infusion.
Document total dose infused, any adverse effects and
other pertinent information using the lidocaine test
dose note template.
Infusion Reaction [223724]
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 8/14/2017 9:46:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Infusion Reaction [NURCOM0022] ONCE, If mild or moderate adverse effects develop
hold infusion for 15 minutes or until resolved,
whichever is sooner. Resume infusion at 1/2 rate. If
adverse effects have not resolved in 10-15 minutes,
discontinue infusion. If adverse effects re-surface
when infusion restarted, discontinue infusion.
Document total dose infused, any adverse effects and
other pertinent information using the lidocaine test
dose note template., Pre-Op Day Of Procedure
Intravenous Therapy
IV Fluids [18793]
sodium chloride 0.9 % infusion [64367] at 10 mL/hr, Intravenous, CONTINUOUS
To keep vein open
IV Fluids [223725]
sodium chloride 0.9 % infusion [64367] at 10 mL/hr, Intravenous, CONTINUOUS
To keep vein open
Pre-Op Day Of Procedure
Medications
Infusion Agent - Maintenance [18794]
lidocaine PF in sodium chloride 0.9 % 100 mL
bag [700391]
5 mg/kg, Intravenous, ONCE For 1 Doses
Infusion Reaction: Document total dose infused, any
adverse effects and other pertinet information
Infusion Agent - Maintenance [223726]
lidocaine PF in sodium chloride 0.9 % 100 mL
bag [700391]
Intravenous, ONCE For 1 Doses
Infusion Reaction: If mild or moderate side effects
develop hold infusion for 15 minutes or until resolved,
whichever is sooner. Resume infusion at 1/2 rate. If
side effects have not resolved in 10-15 minutes,
discontinue infusion. If side effects re-surface when
infusion restarted, discontinue infusion.
Document total dose infused, any side effects and
other pertinent information.
Pre-Op Day Of Procedure
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 8/14/2017 9:46:00 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org