PACU orders

[nrsman1]

I was recently assigned the responsibility of revamping our PACU anesthesia orders, because our accrediting body says ours are written poorly. Ours currently read like 2-10mg morphine, titrate for relieve, 10-50mg morphine, and so on. They say we need to be more specific about the amounts, but each patient is different, and there is no way of knowing how much or little they will need. Any suggestions about how to write "more specicifc" doses?

[meandragonbrett]

We have : Dilaudid ____mg IV q___Min PRN pain. Max dose ___mg.

Most of our docs and CRNAs write for 0.5mg or 1mg IV q5min with usually an initial max dose of 5mg.

We also have standing orders for demerol, benadryl, droperidol, zofran, phenergan, nubain, etc.

[Perpetual Student]

Ours are like the above poster's, "Dilaudid ____mg IV q ___ Min PRN pain. Max dose ___mg" with the only significant difference being that the minute interval on ours is filled in as 5. Sometimes the anesthesiologist will cross out the 5 and replace it with a different number (e.g. they ordered a small dose like 2mg of morphine and want it given q3min.) Also, in front of each pain med is a blank for numbering it from 1-x (where x= the number of different pain meds ordered), and we are supposed to start with 1 and try them in sequence.

A similar format is used for IVP antihypertensives and pressors. (labetalol _____ mg IV q ____ up to total dose of ____ mg). The BP parameters are listed above the choices.

Our whole system uses the same order set and several of our hospitals just passed Joint Commission surveys. I imagine that means our orders are kosher.

[RN-LOGIC]

pain 1-5, 0.5 mg diluadid

pain 5-10, 1 mg diluadid every 5 minutes for a max dose of 4 mg.

FYI: we've been using ofirmev iv 1000mg ivpb which is Tylenol and it really cuts down in the usage of narcotics.

[pacuvanessa]

Ours are Morphine 10mg IM (up to 1/3 may be given IV), then if not successful, may give dilaudid 0.5 mg IV every 10 minutes up to total 2mg

Demerol 12.5 mg IV (for shivering ONLY!!!) and may repeat x 1

All these orders are stated to be for adults over the age of 12 and only if not allergic, also have orders for Zofran, Atropine, Narcan.

Hope this helps!