Pharmacy & Therapeutics- July 2008 - (Page 422) Pain Management and Medication Errors The Hospital of Central Connecticut ADULT ACUTE PAIN ORAL MEDICATION ORDERS NURSE INSTRUCTIONS: DISCONTINUE IV OPIOIDs when oral opioids begun. CALL MD/PA/APRN IF: 1. Patient has altered level of alertness, DO NOT ADMINISTER OPIOID; “C or D” (C=Confused/impaired or arousable only with stimulation, D=Disoriented) 2. Patient has a respiratory rate less than 8/min. 3. Consider Rapid Response or Dr. Quick for numbers 1 and 2 above. MD/PA/APRN ORDERS: Select the following orders by checking box: Senokot-S 2 tabs PO q HS (Do Not order in pt with diarrhea, ileostomy or fistula) Metoclopramide (Reglan®) 10 mg IV q 6 hrs PRN nausea Ondansetron (Zofran®) 4 mg IV q 6 hrs PRN refractory nausea For Acute Severe Respiratory Depression, call RRT/Dr.Quick Naloxone (Narcan®) IVP 0.4 mg diluted in 10 ml NS slow IVP x one PRN acute severe respiratory depression FOR MILD PAIN (Pain score 1-3) Acetaminophen or Ibuprofen may be ordered either PRN for mild pain or ATC to maintain analgesia Acetaminophen (Tylenol®) mg (325mg or 650 mg) PO q 4 hours (PRN or ATC) pain Caution with Acetaminophen: Do not exceed more than 650 mg of Acetaminophen or APAP containing opioid in 4 hours Omit or limit Acetaminophen to 2 grams/day if patient has hepatic insufficiency NSAID: Omit in patients with renal insufficiency/failure, PUD/UGI bleed, anticoagulation/coagulopathy, thrombocytopenia, severe asthma Ibuprofen mg (400 mg, 600 mg, or 800 mg) PO q hours (4, 6 or 8 hrs) (PRN or ATC) pain Maximum daily dose 2400 mg FOR MODERATE (Pain score 4-7) or SEVERE PAIN (Pain score 8-10) Select ONE box from table below: Severe Pain Pain score 8 – 10 Patient Category and Medication Normal Renal / Hepatic function (Choose Percocet® or Vicodin®, not both) Oxycodone/APAP 5mg/325mg (Percocet 5/325®) Hydrocodone/APAP 5mg/500mg (Vicodin 5/500®) Hepatic Insufficiency (or history of ethanol abuse) or Acetaminophen-free Option Oxycodone 5 mg Renal Insufficiency / Failure Hydromorphone (Dilaudid ®) 2 mg Elixir Formula (Choose Oxycodone or Morphine, not both) Oxycodone 5mg/5ml Elixir Morphine Sulfate 10mg/5ml Elixir Moderate Pain Pain score 4 – 7 1 tab PO q 4 hours PRN 1 tab PO q 4 hours PRN 2 tabs PO q 4 hours PRN 2 tabs PO q 6 hours PRN 1 tab PO q 3 hours PRN 2 tabs PO q 3 hours PRN 1 tab PO q 3 hours PRN 2 tabs PO q 3 hours PRN 5 mg (5 ml) PO or feeding tube q 3 hours PRN 10 mg (5 ml) PO or feeding tube q 3 hours PRN 10 mg (10 ml) PO or feeding tube q 3 hours PRN 20 mg (10 ml) PO or feeding tube q 3 hours PRN Signature/Print Name HCC Form # 1843 5/08 Date/Time ADULT ACUTE PAIN Oral Medication Orders Figure 1 Example of a pain-order set developed with input from University of Connecticut faculty at the Hospital of Central Connecticut, New Britain. 422 P&T® • July 2008 • Vol. 33 No. 7
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