Unique Plan Description: Dexmedetomidine (Precedex) MultiModal Post-op protocol
Plan Selection Display: Dexmedetomidine (Precedex) MultiModal Post-op protocol
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-03-01 13:49:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 09:59:26
Available at all facilities: Yes

Dexmedetomidine (Precedex) MultiModal Post-op prot
Vital Signs
	Vital Signs
		Q 15min upon initiation until RASS target achieved, or when titrating medication until RASS target achieved; then every 1hr and PRN
IV Solutions
	dexmedetomidine 400 mcg/NS 100 mL
		400 mcg, 0.2 mcg/kg/hr, T;N
		100 mL, drug form: IV Large Volume, route of administration: IV, pharmacy order priority: Routine, requested start date/time T;N, duration: 48 hr, RASS Sedation Goal: 0 to -1, incremental dose increase 0.1 mcg/kg/hr, incremental dose decrease 0.1 mcg/kg/h
			Comment: This infusion is meant to be part of a multimodal treatment approach for surgery, not meant for extended sedation for anxiolysis or to interfere with any routine post-op cares. Okay to target moderate to alert and calm sedation (RASS -3 -0) during PACU intubation phase per the dosing rate ordered by provider or anesthesia. Once the patient is extubated, target RASS Goal 0 - -1. If sedation occurs with a RASS score of -2, hold dose for 30 minutes; may resume by decreasing previous rate by 0.1mcg/kg/hr. If RASS < -2, discontinue the order and do not resume. Discontinue if RASS < -2,  HR<50, SBP<100mmHg or MAP<50 and notify MD;  Use with caution if patient on vasopressors or inotropic agents; duration of use should not exceed 48 hours.
	dexmedetomidine 400 mcg/NS 100 mL Premix IV
		100 mL, drug form: IV Large Volume, route of administration: IV, pharmacy order priority: Routine, requested start date/time T;N, duration: 48 hr, RASS Sedation Goal: 0 to -1, incremental dose increase 0.1 mcg/kg/hr, incremental dose decrease 0.1 mcg/kg/h
			Comment: This infusion is meant to be part of a multimodal treatment approach for surgery, not meant for extended sedation for anxiolysis or to interfere with any routine post-op cares. Okay to target moderate to alert and calm sedation (RASS -3 -0) during PACU intubation phase per the dosing rate ordered by provider or anesthesia. Once the patient is extubated, target RASS Goal 0 - -1. If sedation occurs with a RASS score of -2, hold dose for 30 minutes; may resume by decreasing previous rate by 0.1mcg/kg/hr. If RASS < -2, discontinue the order and do not resume. Discontinue if RASS < -2,  HR<50, SBP<100mmHg or MAP<50 and notify MD;  Use with caution if patient on vasopressors or inotropic agents; duration of use should not exceed 48 hours.
		400 mcg, EVERY BAG, 0.2 mcg/kg/hr
Medications
		Contraindications to use include: Left ventricular ejection fraction <30%, Heart rate <50, Systolic blood pressure <100mmHg despite use of vasopressors and/or fluids, Heart block. Use with caution if patient on vasopressors or inotropic agents(NOTE)*
Patient Care
	Notify MD
		If HR<50, SBP<100mmHg, MAP<50 or if RASS < -2, and hold dexmedotomidine infusion.

*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