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/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-98094-en.cckm

201712341

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IP - Floor - Perineural Regional Analgesia Therapy - Adult - Supplemental [4854]

IP - Floor - Perineural Regional Analgesia Therapy - Adult - Supplemental [4854] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


IP - Floor - Perineural Regional Analgesia Therapy - Adult - Supplemental [4854]
Patient Care Orders
Vital Signs [146539]
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 perineural
infusion, then every 4 hours.
Measure Respiratory Rate, Depth And Regularity
[NURMON0092]
SEE COMMENTS, Starting today, Routine, EVERY 2
HOURS times 12 HOURS, Then every 4 HOURS.
Measure for 1 full minute.
Patient Monitoring [146540]
Assess Sedation Level [NURMON0060] SEE COMMENTS, Starting today, EVERY 2 HOURS
times 12 HOURS, Then every 4 HOURS. (Note:
Awaken only if unable to distinguish between normal
sleep and sedation, or if change in respiratory pattern
(regularity) or depth of respiration.)
Assess for Changes in Sensation and Strength of
Lower Extremities [NURMON0060]
SEE COMMENTS, Starting today, Every 4 hours
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.
Respiratory [146541]
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today For 24 Hours, Routine
Procedure Site Care [146542]
Assess Perineural Catheter Insertion Site
[NURWND0015]
CONTINUOUS For Until specified, Routine
Wound Type: Other (Comment) (Catheter insertion
site)
Wound Site:
Wound Location:
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:
Contingency Parameters [146543]
Page 1 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:11:03 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Notify Acute Pain Service. If patient is located at
The American Center, notify On-Call
Anesthesiologist [NURCOM0001]
Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
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 Anesthesia Therapy
Regional Anesthesia Therapy [147514]
Perineural Infusion [242108]
sodium chloride 0.9 % 275 mL PERIPHERAL
NERVE BLOCK infusion [700948]
Peripheral Nerve, CONTINUOUS
{Type of Therapy:2000952}
Site: ***
sodium chloride 0.9 % 275 mL PERIPHERAL
NERVE BLOCK infusion [700948]
Peripheral Nerve, CONTINUOUS
{Type of Therapy:2000952}
Site: ***
Maintain Regional Analgesia Catheter
[NURVAD0054]
CONTINUOUS, Routine
Type of catheter:
Location:
Note: Send Medications To: [950055] ONCE For 1 Doses, IntraOp
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: 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)
Note: May give first dose of warfarin if ordered by
the primary service [950018]
ONCE (HS) For 1 Doses
Note: May give first dose of warfarin if ordered by
the primary service
Page 2 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:11:03 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Note: Stop regional analgesia infusion at 0600 on
Post Operative Day#1 [950018]
ONCE Starting tomorrow For 1 Doses
Note: Stop regional analgesia infusion at 0600 on
POD#1
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 30 mg) 6 - 8 hours
postoperatively. Second dose (enoxaparin 40
mg) 24 hours after first dose was administered
post-operatively. [NURCOM0022]
ONCE For 1 Occurrences, 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 30 mg) 6 - 8 hours postoperatively.
Second dose (enoxaparin 40 mg) 24 hours after first
dose was administered post-operatively.
Medications - Adjunct Opioids/Analgesics
General [147711]
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, notify 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, notify the On-Call Anesthesiologist
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 [16708]
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 15 mg/kg per dose for peds <40 kg.
NOTE: Do NOT order if patient had hepatic resection
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
Page 3 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:11:03 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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
Medication - Non-categorized
Medications - Uncategorized [16726]
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN, opioid overdose
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 1 Minutes
NOTE: Do NOT order if patients 65 years or older
For second line therapy
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 8 HOURS PRN, nausea,
nausea/vomiting
Page 4 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:11:03 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org