UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Lidocaine (EMLA) Cream Prescription
Effective Date: June, 2009 Contact: Transformations Clinic
Reviewed August 2010 February 2012
PURPOSE: To provide guidelines for the ordering Lidocaine cream for patients at the UWMF Transformations Clinic.
POLICY: The clinical staff will utilize the following guidelines to properly place an order for Lidocaine cream in
Healthlink for patients who are scheduled for laser or any other procedure requiring pre-numbing of the treatment area at
UWMF Transformations clinic.
1. Prior to placing order for topical Lidocaine, clinical staff is to review patient allergies by:
Reviewing patient’s record in Healthlink, and
Verifying allergies directly with patient
NOTE: If patient is allergic to Lidocaine contact MD for alternate therapy.
2. The Lidocaine prescription will be ordered at the time the patient is set up for their laser or skin procedure. This is an
optional choice for each patient. Some may not feel they need numbing cream prior to treatment.
3. An order will be placed in Healthlink once it is determined the patient will need Lidocaine cream by the clinical staff
4. Check provider’s order and clarify any inconsistencies.
5. The order will be set up under order entry as EMLA or Lidocaine cream 2.5%. Directions will read to apply thin layer
to area to be treated one hour prior to procedure. A 30gm tube will be dispensed with no additional refills.
6. A generic option is allowed based on patient preference and insurance coverage.
7. Once order is set up and a pharmacy is listed the order can be accepted and the order signed allowing for the
prescription to be faxed to the appropriate pharmacy.
WRITTEN BY: Lisa Gretebeck, R.N., UW Transformations Clinic
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: Michael Bentz, M.D., UW Transformations Clinic, 2009
Lisa Gretebeck, RN, UW Transformations Clinic, 2011
Medical Director, Transformations Clinic Date
UWM Medical Director Date