Looking for EBP re: non-OB epidural management

[qaqueen]

Hello All,I am looking for current EBP on epidural nursing management in the non-laboring patient. I have found several articles with insertion guidelines, i.e., vitals/dermatomes Q15min X 4, Q30min X 2, then Q2hours X12, with a final goal of Q4hours.What I am most curious about management after a rate change OR a bolus. At this time, we re-start from the beginning regardless of if it is an increase, decrease, or one time bolus. This is obviously time consuming but also requires waking the patient up through the night. The most common med combo we use for epidurals is fent/bup, these each have a duration of about 4 hours (with normal renal function, etc..). It seems that Q2hour assessments for over a 24 hour period would be disproportionate to the effect of a bolus.Any suggestions, or references would be greatly appreciated.