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PACU – Neuraxial/Paravertebral Block Regional Anesthesia Therapy – Adult – Supplemental [5327]

PACU – Neuraxial/Paravertebral Block Regional Anesthesia Therapy – Adult – Supplemental [5327] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


PACU - Neuraxial/Paravertebral Block Regional Anesthesia Therapy - Adult
-Supplemental [5327]
for Adult Patients OnlyIntended
Regional Analgeisa -. Use the FLOOR in the ORstarted Use this order set for regional analgesia being
Supplemental order set to order epidurals to be started on the floor. -Adult -Therapy
Only Anesthesiology Acute Pain Service (APS) or Anesthesiology staff may initiate, modify or discontinue
epidural therapy. Refer to policy number: 8.92
Patient Care Orders
Vital Signs [145822]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 4 with initiation of
epidural/paravertebral infusion, then every 4 hours.,
Post-Op/Phase II
Measure Respiratory Rate, Depth And Regularity
[NURMON0092]
EVERY 2 HOURS, Starting today, Routine, Measure
for 1 full minute., Post-Op/Phase II
Assess for Orthostatic Changes in Blood
Pressure and Heart Rate [NURMON0060]
SEE COMMENTS, Starting today, Assess if patient is
symptomatic. Symptoms could include syncope,
nausea, lightheadedness, or vision changes., Post-
Op/Phase II
Patient Monitoring [145823]
Assess Sedation Level [NURMON0060] SEE COMMENTS, Starting today, EVERY 2 HOURS.
(Note: Awaken only if unable to distinguish between
normal sleep and sedation, or if change in respiratory
pattern (regularity) or depth of respiration)., Post-
Op/Phase II
Assess for Changes in Sensation and Strength of
Lower Extremities [NURMON0060]
SEE COMMENTS, Starting today, Every 4 hours,
Post-Op/Phase II
Assess Patient's Pain Rating [NURMON0060] SEE COMMENTS, Starting today, Every 4 hours and
as needed if patient develops pain at insertion site,
diffuse back pain, spinal headache, or if inadequate
pain control., Post-Op/Phase II
Activity: Lumbar Epidural [145824]
Reposition Patient [NURACT0005] Type:
Routine, SEE COMMENTS, Starting today, Every 2
hours and assure that there is no pressure on bony
prominences if patient has motor block., Post-
Op/Phase II
Lower Extremity Strength Assessment
[NURMON0045]
SEE COMMENTS, Routine
Location:
Patient has a lumbar epidural. Please access lower
extremity strength before ambulation. Ambulation
requires assistance at all times.
Respiratory [145832]
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today For 24 Hours, Routine,
Post-Op/Phase II
Procedure Site Care [145833]
Page 1 of 4
Printed by BENNETT, SARA J [SJB008] at 12/8/2017 9:22:18 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Wound Care [NURWND0015] CONTINUOUS, Starting today, Routine
Wound Type: Other (Comment) (Catheter insertion
site)
Wound Site: Back
Wound Location: Posterior
Assess Frequency: EVERY 8 HOURS (And as
needed)
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing:
Secondary Dressing:
Post-Op/Phase II
Contingency Parameters [145834]
Notify Anesthesiology Acute Pain Service. If
patient is located at The American Center, notify
the On-Call Anesthesiologist [NURCOM0001]
Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <: 8
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: All pain questions and analgesic side effect
issues,Sedation score greater than or equal to
4,Unable to perform plantar and dorsi
flexion,Inadequate analgesia,Naloxone given,Greater
than 20% orthostatic changes,Pain at epidural site
"Pager #: 7246 or "PAIN" (for patients at CSC)
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".
If there is no response after paging #7246, call paging
or the anesthesiology on-call resident (or faculty); or
call the Inpatient Operating Room at 263-8595.
Regional Analgesia Therapy
Regional Analgesia Therapy [145820]
Epidural Adult Infusion [242116]
sodium chloride 0.9 % 275 mL EPIDURAL
NERVE BLOCK infusion [700945]
Epidural, CONTINUOUS, Post-Op/Phase II
sodium chloride 0.9 % 275 mL EPIDURAL
NERVE BLOCK infusion [700945]
Epidural, CONTINUOUS, Post-Op/Phase II
Page 2 of 4
Printed by BENNETT, SARA J [SJB008] at 12/8/2017 9:22:18 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Maintain Regional Analgesia Catheter
[NURVAD0054]
CONTINUOUS, Routine
Type of catheter:
Location:
Post-Op/Phase II
NOTE: RPh Release a Regional Analgesia
Infusion(s) and Maintain Regional Analgesia
Catheter Orders. Send Regional Analgesia
Infusions to location specified in order. [950018]
ONCE For 1 Doses, IntraOp
Note: Send Medications To: [950055] ONCE For 1 Doses, IntraOp
NOTE: NO anticoagulants unless approved by
Anesthesiology Acute Pain Service. If patient is
located at The American Center, obtain approval
from On-Call Anesthesiologist [950051]
4 X DAILY (NOTE ACKNOWLEDGE), Post-
Op/Phase II
Note: May give first dose of warfarin [950018] ONCE (HS) For 1 Doses
Note: May give first dose of warfarin
Post-Op/Phase II
Note: Stop regional analgesia infusion at 0600 on
POD#1 [950018]
ONCE Starting tomorrow at 6:00 AM
Note: Stop regional analgesia infusion at 0600 on
POD#1
Post-Op/Phase II
Neuraxial Injection [221023]
Single Shot Neuraxial Regional Analgesia
Administered [NURTRT0059]
ONCE, Routine
Low Molecular Weight Heparin (LMWH)
Thromboprophylaxis dosing after Combined
Spinal Epidural or Spinal Only. Twice Daily
Dosing: First dose can be administered 24 hours
post-operatively. Delay next LMWH dose for 4
hours after catheter removal. Daily Dosing: First
dose (enoxaparin 30mg) 6 - 8 hours
postoperatively. Second dose (enoxaprin 40mg)
24 hours after first dose was administered post-
operatively. [NURCOM0022]
ONCE, Low Molecular Weight Heparin (LMWH)
Thromboprophylaxis dosing after Combined Spinal
Epidural or Spinal Only. Twice Daily Dosing: First
dose can be administered 24 hours post-operatively.
Delay next LMWH dose for 4 hours after catheter
removal. Daily Dosing: First dose (enoxaparin 30mg)
6 - 8 hours postoperatively. Second dose (enoxaprin
40mg) 24 hours after first dose was administered post-
operatively.
Medications - Adjunct Opioids/Analgesics
General [92505]
Note: NO other opioids, sedatives or CNS
depressants unless approved by the
Anesthesiology Acute Pain Service. If the 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 the patient is located at The American Center, obtain
approved from the On-Call Anesthesiologist.
Post-Op/Phase II
Analgesics - Scheduled [92506]
acetaMINOPHEN (TYLENOL) tab - NOTE: Do
NOT order if patient had hepatic resection [34149]
650 mg, Oral, EVERY 6 HOURS
NOTE: Do NOT order if patient had hepatic resection
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab - NOTE: Do
NOT order if patient had hepatic resection [34149]
1,000 mg, Oral, EVERY 8 HOURS
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
Post-Op/Phase II
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
Post-Op/Phase II
gabapentin (NEURONTIN) cap [54256] 400 mg, Oral, 3 X DAILY, Post-Op/Phase II
Page 3 of 4
Printed by BENNETT, SARA J [SJB008] at 12/8/2017 9:22:18 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

MORPHine (MS CONTIN, ORAMORPH) ER tab
[156572]
15 mg, Oral, 2 X DAILY, Post-Op/Phase II
Analgesics - As Needed For Incident Pain [92507]
oxycodone tab [750032] 5-15 mg, Oral, EVERY 3 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
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 of acetaminophen per 24 hours
for adults or 15 mg/kg per dose for peds <40 kg
NOTE: Do NOT order if patient had hepatic resection
Post-Op/Phase II
Analgesics - As Needed For Uncontrolled Incident Pain [92508]
MORPHine PF injection [750057] Intravenous, EVERY 1 HOUR PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 4 Minutes, Post-Op/Phase II
HYDROmorphone PF (DILAUDID) injection
[750050]
0.2-0.5 mg, Intravenous, EVERY 1 HOUR PRN
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 3 Minutes, Post-Op/Phase II
FENTanyl PF injection RANGE [750047] Intravenous, EVERY 1 HOUR PRN
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 1 Minutes, Post-Op/Phase II
Medications - Non-categorized
Medications - Side Effect Management [92510]
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN, opioid overdose, Post-
Op/Phase II
nalbuphine (NUBAIN) injection - Note: Do not
order for patients on chronic around-the-clock
chronic opioid therapy. [39994]
2.5-5 mg, Intravenous, EVERY 8 HOURS PRN,
itching
NOTE: First line therapy for itching. Do not order for
patients on chronic around-the-clock opioid therapy.
for 3 Minutes
diphenhydramine (BENADRYL) injection - NOTE:
Do NOT order if patients 65 years or older
[750044]
12.5-25 mg, Intravenous, EVERY 6 HOURS PRN,
itching
For second line therapy
for 1 Minutes
NOTE: Do NOT order if patients 65 years or older
Post-Op/Phase II
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting, Post-Op/Phase II
Page 4 of 4
Printed by BENNETT, SARA J [SJB008] at 12/8/2017 9:22:18 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org