Epidural Monitoring - Frequency of Assessment/Dermatone Levels

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    We are currently in the process of revising our epidural standards of practice and procedures. Current practice is to monitor VS/Pain/Sedation/Motor Strength/Site Q 4 hrs. There is a wide variation in literature and in our surrounding areas of how often these are done. We are also exploring assessment of dermatone levels, do your hospitals include that? How often are you assessing epidurals? Do you have patients on continuous oxygen saturation monitoring and for how long? Any help would be appreciated, thanks!
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    We assess vital signs, motor strength, site every 4 hours, everything you do. We don't assess dermatone levels. We document respiratory rate every hour for the first 15 hours. We also have them on continuous oximetry for the first 15 hours and then discontinue it if they are stable.
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    For the first 12 hrs we monitor rr SaO2 and pain score and bromage hourly.

    We do routine post op observations, then 4 hrly, dermatome and site check each shift. If we bolus the pt we do 5 min obs for 20 min with dermatome and bromage score as well as a pre bolus site check.
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    After the first 12 hr we do 2 hr resp and pain score with a count on the volume infused from the bag.
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    After post op vs are done than Q4 vs/dermatomes and site check Q 8. Cont pulse ox and foley can't be d/c'd until 12 hrs after epi line has been pulled. Thankfully we don't have too many epidurals as we use to, alot of extra monitoring/charting. A lot of our pts do receive intrathecals + PCAs nowadays though.


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