Unique Plan Description: PCA order set (FH)
Plan Selection Display: PCA order set (FH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2020-03-24 10:06:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-12-20 08:28:16
Available at all facilities: No

PCA order set (FH)
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, 20 ml/hr
Medications
	HYDROmorphone 0.2 mg/mL PCA 50mL IV
		50 mL, PCA IV, 0 mg/hr
		10 mg, EVERY BAG
	HYDROmorphone 1 mg/mL PCA 50mL IV
		50 mL, PCA IV, 0 mg/hr
		50 mg, EVERY BAG
	nalbuphine 1 mg/ml 40 mL PCA IV
		40 mL, PCA IV, 0 mg/hr
		40 mg, EVERY BAG
		PCA Dilaudid Intolerance(NOTE)*
	morphine 1mg/1mL 50 mL PCA IV
		50 mL, PCA IV, 0 mg/hr
		50 mg, EVERY BAG
	Narcan
		0.4 mg, Injection, IV Push, Q5MIN, PRN respirations < (see comment)
			Comment: If respiratory rate < 8/min, stop infusion and notify ordering service
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Mild Pain
	Tylenol
		650 mg, Tab, By Mouth, Q4H, PRN pain-mild
Moderate Pain
	ketorolac injectable
		15 mg, Injection, IV Push, Q6H, PRN pain-moderate, duration: 5 Day(s)
		30 mg, Injection, IM-Intramuscular, Q6H, PRN pain-moderate, T;N, duration: 5 Day(s)
Pruritis
	Benadryl
		25 mg, Injection, IV Push, Q4H, PRN for itching-severe
Nausea Vomiting
	Reglan
		10 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
	ondansetron (MH/WH)
		4 mg, Injection, IV Push, Q4H, PRN nausea and/or vomiting
	ondansetron
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN nausea and/or vomiting
	Phenergan 25 mg/mL injectable solution
		25 mg, INT, IVPB, Q4H, PRN nausea and/or vomiting
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 < 10 or systolic BP < 90
		T;N+60, Q1H, 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 < 10 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 < 10 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. If resp rate <10, 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 < 10 or systolic BP < 90
		T;N
	Notify MD
		T;N, if patient is on benzodiazepines (lorazepam, midazolam, diazepam etc.)
		T;N, if respirations </= 10, or  systolic BP < 90.
		T;N, if pain increases or unable to wean in 12 hr
		T;N, if ETCO2 greater than 50
	PCA Parameters
		T;N
			Comment: Stop PCA for 1 hour if patient develops respiratory depression (respiratory quality is shallow, respiratory rate is < or = 12 bpm), RASS -2, patient is lethargic, frequently drowsy or drifts off to sleep during conversation.  Do not resume PCA unless RASS 0 to -1, RR < or = 12bpm and normal depth, alert.  Consider oxygen protocol.  Discontinue PCA & protocol if patient somnolent with minimal or no response to stimuli or respiratory rate < or = 10 or RASS -3 to -5  and/or systolic blood pressure < 90mm Hg.  Do not resume PCA without MD order.
		T;N
			Comment: Do not initiate any PCA (continuous or patient administered doses) in patients with sleep apnea (OSA) without verbal verification from physician.  Basal (continuous) PCA dosing should not be used for patients with history of sleep apnea (OSA), or respiratory problems (lung disease, heart failure). 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. Start dosing at the lowest range possible for continuous and patient administered doses (exceptions comfort care patients, oncology patients routinely receiving opiates, chronic pain patient routinely receiving opiates), including starting with no basal rate
	PCA weaning parameters
		T;N
			Comment: 1.  Administer oral opiate 2. Provide patient education on weaning process 3. If a basal (continuous) rate is running, turn it off upon administration of oral opiate 4. Begin demand (patient controlled dose) wean 4hr after initial opiate dose.  Every 4hr decrease demand dose by 50% until adequate pain control is achieved (defined as a pain scale of <4 or meeting patient's goal for pain control).  Do not decrease demand below minimum dose in PCA protocol for patient controlled dosing (0.5mg morphine, 0.1mg hydromorphone) 5. If patient does not use demand dose in at least 4hr after receiving oral medication, discontinue PCA.6.  Notify MD if pain increases or unable to wean in 12hr.
	Continuous Pulse Oximetry by Nurse
		T;N, Q6H-Sch
			Comment: RT, while on PCA
Therapies
	End Tidal CO2 (ETCO2) Monitoring
		T;N, Q6H-Sch
			Comment: while on PCA

*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