Unique Plan Description: Pain Service Hydromorphone Routine Continuous Infusion
Plan Selection Display: Pain Service Hydromorphone Routine Continuous Infusion
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-10-06 09:00:18
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 10:38:10
Available at all facilities: No

Pain Service Hydromorphone Routine Continuous Infu
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, 20 ml/hr
			Comment: If no current IV fluid order.
Medications
		Standard protocol w/basal(NOTE)*
	Dilaudid Injectable
		0.5 mg, Injection, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		mg, Injection, IV Push, Q1H, PRN for pain-breakthrough
	HYDROmorphone 0.2 mg/mL PCA 30mL Standard IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 3 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, 0 mg/hr
			Comment: STANDARD W/BASAL.  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order. Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		6 mg, EVERY BAG
	HYDROmorphone 10mg/NS 50mL IV
		50 mL, IV, T;N
			Comment: Notify provider for any concerns about dosing.  Do not adjust dose without a provider order
		10 mg, EVERY BAG, mg/hr
		Standard protocol NO basal(NOTE)*
	Dilaudid Injectable
		0.5 mg, Injection, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
	HYDROmorphone 0.2 mg/mL PCA 30mL Standard IV
		Continuous Dose (mg/hr) No basal rate, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 3 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, 0 mg/hr
			Comment: STANDARD-NO BASAL. Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		6 mg, EVERY BAG
		High risk (Elderly >65 yr old, OSA, Respiratory problems, lung disease, Heart Failure etc)(NOTE)*
	Dilaudid Injectable
		0.3 mg, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
	HYDROmorphone 0.2 mg/mL PCA 30mL Standard IV
		Continuous Dose (mg/hr) No basal rate, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 2 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, 0 mg/hr
			Comment: HIGH RISK PROTOCOL.  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order. Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		6 mg, EVERY BAG
		Opiate tolerant(NOTE)*
	Dilaudid Injectable
		1 mg, Injection, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		mg, Injection, IV Push, Q1H, PRN for pain-breakthrough
	HYDROmorphone 0.2 mg/mL PCA 30mL Standard IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 4 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, 0 mg/hr
			Comment: OPIATE TOLERANT PROTOCOL:  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		6 mg, EVERY BAG
	HYDROmorphone 1 mg/mL PCA 30 mL High Dose IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 4 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, 0 mg/hr
			Comment: OPIATE TOLERANT PROTOCOL:  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		30 mg, EVERY BAG
	HYDROmorphone 10mg/NS 50mL IV
		50 mL, IV, T;N
			Comment: Notify provider for any concerns about dosing.  Do not adjust dose without a provider order
		10 mg, EVERY BAG, mg/hr
	HYDROmorphone 50mg/NS 100mL IV
		50 mg, EVERY BAG, mg/hr
		High Dose(NOTE)*
	Dilaudid Injectable
		1 mg, Injection, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		mg, Injection, IV Push, Q1H, PRN for pain-breakthrough
	HYDROmorphone 1 mg/mL PCA 30 mL High Dose IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 4 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, 0 mg/hr
			Comment: HIGH DOSE PROTOCOL:  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order. Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		30 mg, EVERY BAG
	HYDROmorphone 5 mg/mL PCA 30mL IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 4 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 30 mL, PCA IV, 0 mg/hr
			Comment: HIGH DOSE PROTOCOL:  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order. Re-assess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
		150 mg, EVERY BAG
	HYDROmorphone 50mg/NS 100mL IV
		50 mg, EVERY BAG, mg/hr
	HYDROmorphone 250mg/NS 100mL IV
		250 mg, EVERY BAG, mg/hr
	Narcan
		0.1 mg, Injection, IV Push, Q5MIN, PRN, see comment
			Comment: Until desired response.  Follow with 10 mL NaCl Flush, for patients who are somnolent with minimal or no response to stimuli, RASS -3 to -5, or for respiratory rate less than or equal to 10/minute, notify provider while on PCA protocol.
Patient Care
	PCA Assessment
		T;N, Q15MIN, 4, Dose(s)/Time(s)
			Comment: Assessment to include vital signs, pain, RASS, resp rate, resp pattern and pump settings.  Stop PCA if patient somnolent with minimal or no response to stimuli or respiratory rate < 10 or systolic BP < 90 and immediately notify provider.
		T;N+60, Q1H, 4, Dose(s)/Time(s)
			Comment: Assessment to include vital signs, pain, RASS, resp rate, resp pattern and pump settings.  Stop PCA if patient somnolent with minimal or no response to stimuli or respiratory rate < 10 or systolic BP < 90 and immediately notify provider.
		T;N+420, Q2H-Sch
			Comment: Assessment to include vital signs, pain, RASS, resp rate, resp pattern and pump settings.  Stop PCA if patient somnolent with minimal or no response to stimuli or respiratory rate < 10 or systolic BP < 90 and immediately notify provider.
		T;N
			Comment: ongoing, with any patient controlled dose, or basal rate change or nurse administered bolus. Assessment to include vital signs, pain, RASS, resp rate, resp pattern and pump settings. If resp rate <10, or SBP <90 reassess patient q15min x4, then q1h x4, then q2h.  Stop PCA if patient somnolent with minimal or no response to stimuli or respiratory rate < 10 or systolic BP < 90 and immediately notify provider.
	Notify MD
		T;N, if respirations </= 10, or  systolic BP < 90.
	PCA Parameters
		T;N
			Comment: Notify provider for any concerns about dosing.  Do not titrate dose without a provider order.Notify provider if patient develops respiratory depression (respiratory quality is shallow, respiratory rate is < 12 bpm), RASS -2, patient is lethargic, frequently drowsy or drifts off to sleep during conversation and consider oxygen protocol.  Stop PCA if patient somnolent with minimal or no response to stimuli or respiratory rate < or = 10 or RASS -3 to -5  and/or systolic blood pressure < 90mm Hg.  Notify provider immediately if PCA is stopped.  Do not resume PCA without provider order.
		T;N
			Comment: Do not initiate any PCA (continuous or patient administered doses) in patients with sleep apnea (OSA) without verbal verification from physician.  Basal (continuous) PCA dosing should not be used for patients with history of sleep apnea (OSA), or respiratory problems (lung disease, heart failure). Do not use patient controlled doses of PCA unless patient is fully able to understand and comply with instruction -this includes restricting use for patients with dementia, delirium, confusion.
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
			Comment: RT, while on PCA

*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