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/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-98095-en.cckm

201712341

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IP - Floor - Neuraxial/Paravertebral Block Regional Analgesia Therapy - Adult - Supplemental [4892]

IP - Floor - Neuraxial/Paravertebral Block Regional Analgesia Therapy - Adult - Supplemental [4892] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


IP - Floor - Neuraxial/Paravertebral Block Regional Analgesia Therapy - Adult -
Supplemental [4892]
Patient Care Orders
Vital Signs [146507]
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.
Measure Respiratory Rate, Depth And Regularity
[NURMON0092]
SEE COMMENTS, Starting today, Routine, EVERY 2
HOURS for duration of therapy. Measure for 1 full
minute.
Assess for Orthostatic Changes in Blood
Pressure and Heart Rate [NURMON0060]
SEE COMMENTS, Starting today with First
Occurrence As Scheduled, Assess if patient is
symptomatic. Symptoms could include syncope,
nausea, lightheadedness, or vision changes.
Patient Monitoring [146508]
Assess Sedation Level [NURMON0060] SEE COMMENTS, Starting today, EVERY 2 HOURS
for duration of therapy. (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.
Activity - Lumbar Epidural [147274]
Reposition Patient [NURACT0005] Type:
Routine, SEE COMMENTS, Starting today with First
Occurrence As Scheduled, Every 2 hours and assure
that there is no pressure on bony prominences if
patient has motor block.
Lower Extremity Strength Assessment
[NURCOM0022]
SEE COMMENTS, Patient has a lumbar epidural.
Please access lower extremity strength before
ambulation. Ambulation requires assistance at all
times.
Respiratory [19793]
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today For 24 Hours, Routine
Procedure Site Care [148442]
Page 1 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:30:46 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Assess Perineural Catheter Insertion Site
[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:
Contingency Parameters [146509]
Notify Anesthesiology Acute Pain Service. If
patient 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): 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 Anesthesia Therapy [147504]
Epidural Adult Infusion [242119]
sodium chloride 0.9 % 275 mL EPIDURAL
NERVE BLOCK infusion [700945]
Epidural, CONTINUOUS
sodium chloride 0.9 % 275 mL EPIDURAL
NERVE BLOCK infusion [700945]
Epidural, CONTINUOUS
Maintain Regional Analgesia Catheter
[NURVAD0054]
CONTINUOUS, Routine
Type of catheter:
Location:
Page 2 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:30:46 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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)
Note: May give first dose of warfarin [950018] ONCE (HS) For 1 Doses
Note: May give first dose of warfarin
Note: Stop regional analgesia infusion at 0600 on
POD#1 [950018]
ONCE Starting tomorrow at 6:00 AM For 1 Doses
Note: Stop regional analgesia infusion at 0600 on
POD#1
Perineural Infusion [238454]
sodium chloride 0.9 % 275 mL PERIPHERAL
NERVE BLOCK infusion [700948]
Peripheral Nerve, CONTINUOUS
sodium chloride 0.9 % 275 mL PERIPHERAL
NERVE BLOCK infusion [700948]
Peripheral Nerve, CONTINUOUS
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 [950018] ONCE
Note: May give first dose of warfarin
Note: Stop regional analgesia infusion at 0600 on
Post Operative Day#1 [950018]
ONCE
Note: Stop regional analgesia infusion at 0600 on
Post Operative Day#1
Medications - Adjunct Opioids/Analgesics
General [28300]
Note: NO other opioids, sedatives or CNS
depressants unless approved by the
Anesthesiology Acute Pain Service If patient is
located at The American Center, call 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, call 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
Page 3 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:30:46 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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
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
Medications - Non-categorized
Medications - Side Effect Management [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 11:30:46 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org