Unique Plan Description: Palliative Care Subcutaneous PCA
Plan Selection Display: Palliative Care Subcutaneous PCA
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2016-03-22 09:15:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-09-15 15:15:14
Available at all facilities: No

Palliative Care Subcutaneous PCA
IV Solutions
	Morphine sulfate PCA SUBQ Infusion
		Lockout Interval (min) = 30, Nurse Admin Bolus Freq 1, 50 mL, SUBCUTANEOUS INFUSION, T;N, PCA
			Comment: Notify the provider for any concerns about dosing. Re-assess pain, respiratory rate, respiratory pattern in 30-60minutes after any dose change.  Pharmacist to review dosing, product concentration, and modify order such that total rate does not exceed 3ml/hr .  With any rate change calculate maximum times patient could administer bolus + nurse administer bolus + basal. If this amount exceeds 3mL notify pharmacy for change in concentration.
		250 mg
	Hydromorphone PCA SUBQ Infusion
		Lockout Interval (min) = 30, Nurse Admin Bolus Freq 1, 50 mL, SUBCUTANEOUS INFUSION, T;N, PCA
			Comment: Notify the provider for any concerns about dosing. Re-assess pain, respiratory rate, respiratory pattern in 30-60minutes after any dose change.  Pharmacist to review dosing, product concentration, and modify order such that total rate does not exceed 3ml/hr .  With any rate change calculate maximum times patient could administer bolus + nurse administer bolus + basal. If this amount exceeds 3mL notify pharmacy for change in concentration.
		50 mg
Medications
	Narcan
		0.1 mg, Injection, SUBCUTANEOUS, Q5MIN, PRN, see comment, Routine
			Comment: Until desired response.  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 if administered.
Patient Care
	PCA Assessment
		T;N, Q30MIN, 4, Dose(s)/Time(s)
			Comment: Assessment to include pain, respiratory rate, respiratory pattern and pump settings.  Notify the provider for any concerns about dosing.
		T;N+120, Q1H, 4, Dose(s)/Time(s)
			Comment: Assessment to include pain, respiratory rate, respiratory pattern and pump settings.  Notify the provider for any concerns about dosing.
		T;N+360, Q2H-Sch
			Comment: Assessment to include pain, respiratory rate, respiratory pattern and pump settings.  Notify the provider for any concerns about dosing.
	Notify Methodist IV Team
		to start subcutaneous line (0700-2300) or 6 South Core (2300-0600) and for restart If needed.
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
			Comment: 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