Unique Plan Description: Palliative Care Morphine CC Continuous Infusion
Plan Selection Display: Palliative Care Morphine CC Continuous Infusion
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2025-02-06 11:35:15
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-02-06 11:50:38
Available at all facilities: No

Palliative Care Morphine CC Continuous Infusion
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, 20 ml/hr
			Comment: If no current IV fluid order.
Medications
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	morphine  IV
		2 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		mg, Syringe, IV Push, Q1H, PRN for pain-breakthrough
	morphine 1 mg/mL PCA 50 mL IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 30 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 50 mL, PCA IV, PCA
			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.
		50 mg, EVERY BAG
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	morphine  IV
		2 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
	morphine 1 mg/mL PCA 50 mL IV
		Continuous Dose (mg/hr) No basal dosing, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 30 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 50 mL, PCA IV, PCA
			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.
		50 mg, EVERY BAG
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	morphine  IV
		1 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
	morphine 1 mg/mL PCA 50 mL IV
		50 mg, EVERY BAG
		Continuous Dose (mg/hr) No basal dosing, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 15 mg, Nurse Admin Bolus (mg) 1 mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 50 mL, PCA IV, PCA
			Comment: HIGH RISK PROTOCOL. No basal rate.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.
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	morphine  IV
		4 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		mg, Syringe, IV Push, Q1H, PRN for pain-breakthrough
	morphine 1 mg/mL PCA 50 mL IV
		50 mg, EVERY BAG
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 40 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 50 mL, PCA IV, PCA
			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.
	morphine 5 mg/mL PCA 50 mL IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 40 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 50 mL, PCA IV, PCA
			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.
		250 mg, EVERY BAG
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	morphine  IV
		4 mg, Syringe, IV Push, Once, PRN, see comment, Routine, 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
	morphine 5 mg/mL PCA 50 mL IV
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 40 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 50 mL, PCA IV, PCA
			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
		250 mg, EVERY BAG
	morphine 10 mg/mL PCA 50 mL IV
		500 mg, EVERY BAG
		Continuous Dose (mg/hr) __ mg/hr, Patient Admin Bolus (mg) __ mg, Lockout Interval (min) = 15, 4-hour Limit (mg) 40 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 50 mL, PCA IV, PCA
			Comment: HIGH DOSE PROTOCOLl:  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.
	Narcan
		0.1 mg, Injection, IV Push, Q5MIN, PRN, see comment, Routine
			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 physician while on PCA.
Patient Care
	PCA Assessment
		T;N, Q15MIN, 4, Dose(s)/Time(s)
			Comment: Assessment to include pain, resp rate, resp pattern and pump settings.  Notify provider of any concerns about dosing.  Do not adjust PCA dose without a provider order.
		T;N+60, Q1H, 4, Dose(s)/Time(s)
			Comment: Assessment to include pain, resp rate, resp pattern and pump settings.  Notify provider of any concerns about dosing.  Do not adjust PCA dose without a provider order.
		T;N+420, Q2H-Sch
			Comment: Assessment to include pain, resp rate, resp pattern and pump settings.  Notify provider of any concerns about dosing.  Do not adjust PCA dose without a provider order.
		T;N
			Comment: ongoing, with any patient controlled dose, basal rate change or nurse administered bolus. Reassess patient q15min x4, then q1h x4, then q2h
	PCA Parameters
		T;N
			Comment: Assessment to include pain, resp rate, resp pattern and pump settings.  Notify provider of any concerns about dosing.  Do not adjust PCA dose without a provider order.
		T;N
			Comment: 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.

*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