Unique Plan Description: PCA Fentanyl Protocol (JE)
Plan Selection Display: PCA Fentanyl Protocol (JE)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-20 16:22:25
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 15:17:30
Available at all facilities: No

PCA Fentanyl Protocol (JE)
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, 20 ml/hr
			Comment:  If no current IV fluid order.
Medications
		Standard PCA dosing(NOTE)*
	fentaNYL 50 mcg/mL 20 mL PCA IV
		Loading Dose (mcg) 50, Patient Admin Bolus (mcg) 25, Lockout Interval (min) = 15, 4-hour limit (mcg) 400, 20 mL, PCA IV, PCA
		1,000 mcg, EVERY BAG
	End Tidal CO2 (ETCO2) Monitoring
		T;N, Q6H-Sch
			Comment: while on continuous dose
		High Risk dosing (OSA > 65 years old, respiratory problems, lung disease, heart failure)(NOTE)*
	fentaNYL 50 mcg/mL 20 mL PCA IV
		Loading Dose (mcg) 20, Patient Admin Bolus (mcg) 10, Lockout Interval (min) = 15, 4-hour limit (mcg) 400, 20 mL, PCA IV, PCA
		1,000 mcg, EVERY BAG
		Opioid Tolerant dosing(NOTE)*
		Loading Dose (mcg) 100, Continuous Dose (mcg/hr) 25, Patient Admin Bolus (mcg) 40, Lockout Interval (min) = 10, 4-hour limit (mcg) 800, 20 mL, PCA IV
		1,000 mcg, EVERY BAG, 25 mcg/hr
	End Tidal CO2 (ETCO2) Monitoring
		T;N, Q6H-Sch
			Comment: while on continuous dose
	Narcan
		0.4 mg, Injection, IV Push, Q5MIN, PRN, see comment
			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 9/minute, notify physician while on PCA.
Patient Care
	PCA Assessment
		T;N, Q15MIN, 4, Dose(s)/Time(s)
			Comment: Assessment to include vital signs, pain, RASS, resp rate,resp pattern, pump settings and ETCO2 if appropriate.  Discontinue PCA & protocol if patient somnolent with minimal or no response to stimuli or respiratory rate < 8 or systolic BP < 90
		T;N+60, Q1H, 4, hr
			Comment: Assessment to include vital signs, pain, RASS, resp rate, resp pattern, pump settings and ETCO2 if appropriate. Discontinue PCA & protocol if patient somnolent with minimal or no response to stimuli or respiratory rate < 8 or systolic BP < 90
		T;N+420, Q2H-Sch
			Comment: Assessment to include vital signs, pain, RASS, resp rate, resp pattern, pump settings and ETCO2 if appropriate. Discontinue PCA & protocol if patient somnolent with minimal or no response to stimuli or respiratory rate < 8 or systolic BP < 90
		T;N
			Comment: ongoing, with any patient controlled dose, basal rate change or nurse administered bolus. Assessment to include vital signs, pain, RASS, resp rate, resp pattern and pump settings and ETCO2 if appropriate. If resp rate <8, RASS <-2 or SBP <90 reassess patient q15min x4, then q1h x4, then q2h.  Discontinue PCA & protocol if patient somnolent with minimal or no response to stimuli or respiratory rate < 8 or systolic BP < 90
	Notify MD
		T;N, if patient is on Benzodiazepines (lorazepam, midazolam, diazepam etc). PCA protocol
		T;N, if respirations ? 8, or  systolic BP < 90. PCA protocol.
		T;N, if ETCO2 greater than 50
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
			Comment: while on continuous dose.

*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