Unique Plan Description: Palliative Care Morphine CC Continuous Infusion
Plan Selection Display: Palliative Care Morphine CC Continuous Infusion
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2016-05-10 07:43:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-22 09:57:49
Available at all facilities: No

Palliative Care Morphine CC Continuous Infusion
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, 20 ml/hr
			Comment: If no current IV fluid order.
Medications
		Standard Protocol w/basal(NOTE)*
	morphine  IV
		2 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		mg, Syringe, IV Push, Q1H, PRN for pain-breakthrough
	morphine 1 mg/mL PCA 30 mL IV
		30 mg, EVERY BAG
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 30 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, PCA
			Comment: STANDARD W/BASAL. Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		Standard protocol NO basal(NOTE)*
	morphine  IV
		2 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
	morphine 1 mg/mL PCA 30 mL IV
		Continuous Dose (mg/hr) No basal dosing, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 30, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, PCA
			Comment: STANDARD-NO BASAL.  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		30 mg, EVERY BAG
		High risk (elderly > 65y/o, OSA, respiratory problems, lung disease, heart failure, etc)(NOTE)*
	morphine  IV
		1 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
	morphine 1 mg/mL PCA 30 mL IV
		Continuous Dose (mg/hr) No basal dosing, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 15, Nurse Admin Bolus (mg) 1 mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, PCA
			Comment: HIGH RISK PROTOCOL. No basal rate.Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		30 mg, EVERY BAG
		Opiate tolerant(NOTE)*
	morphine  IV
		4 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		mg, Syringe, IV Push, Q1H, PRN for pain-breakthrough
	morphine 1 mg/mL PCA 30 mL IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 40, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, PCA
			Comment: OPIATE TOLERANT PROTOCOL.  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		30 mg, EVERY BAG
	morphine 5 mg/mL PCA 30 mL IV
		150 mg, EVERY BAG
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 40, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, PCA
			Comment: OPIATE TOLERANT PROTOCOL.  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		High Dose(NOTE)*
	morphine  IV
		4 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
	morphine 5 mg/mL PCA 30 mL IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 40, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, PCA
			Comment: HIGH DOSE PROTOCOL  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		150 mg, EVERY BAG
	morphine 10mg/mL PCA 30mL IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 40, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, PCA
			Comment: HIGH DOSE PROTOCOLl:  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		300 mg, EVERY BAG
	Narcan
		0.1 mg, Injection, IV Push, Q5MIN, PRN, see comment, Routine
			Comment: Until desired response.  Follow with 10 mL NaCl Flush, for patients who are somnolent with minimal or no response to stimuli, RASS -3 to -5, or for respiratory rate less than or equal to 10/minute, notify physician while on PCA.
Patient Care
	PCA Assessment
		T;N, Q15MIN, 4, Dose(s)/Time(s)
			Comment: Assessment to include pain, resp rate, resp pattern and pump settings.  Notify provider of any concerns about dosing.  Do not adjust PCA dose without a provider order.
		T;N+60, Q1H, 4, Dose(s)/Time(s)
			Comment: Assessment to include pain, resp rate, resp pattern and pump settings.  Notify provider of any concerns about dosing.  Do not adjust PCA dose without a provider order.
		T;N+420, Q2H-Sch
			Comment: Assessment to include pain, resp rate, resp pattern and pump settings.  Notify provider of any concerns about dosing.  Do not adjust PCA dose without a provider order.
		T;N
			Comment: ongoing, with any patient controlled dose, basal rate change or nurse administered bolus. Reassess patient q15min x4, then q1h x4, then q2h
	PCA Parameters
		T;N
			Comment: Assessment to include pain, resp rate, resp pattern and pump settings.  Notify provider of any concerns about dosing.  Do not adjust PCA dose without a provider order.
		T;N
			Comment: Do not use patient controlled doses of PCA unless patient is fully able to understand and comply with instruction -this includes restricting use for patients with dementia, delirium, confusion.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase