Unique Plan Description: PCA NON-Titratable Morphine
Plan Selection Display: PCA NON-Titratable Morphine
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2100-12-31 00:00:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-04-13 16:25:05
Available at all facilities: No

PCA NON-Titratable Morphine
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, 20 ml/hr
			Comment: If there is no current IV fluid order.
Medications
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	morphine  IV
		2 mg, Syringe, IV Push, Once, PRN see comment, Routine, duration: 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		mg, Syringe, IV Push, Q1H, PRN pain-breakthrough
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	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) 30 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 50 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.  Reassess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
	morphine 100mg/NS 100mL IV
		50 mg, EVERY BAG, mg/hr
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	morphine  IV
		2 mg, Syringe, IV Push, Once, PRN see comment, Routine, duration: 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
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	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) 30 mg, Nurse Admin Bolus (mg) __ mg breakthrough pain, Nurse Admin Bolus Freq 1 hr, 50 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.  Reassess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
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	morphine  IV
		1 mg, Syringe, IV Push, Once, PRN see comment, Routine, duration: 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
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	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, 0 mg/hr
			Comment: HIGH RISK PROTOCOL. No basal rate. Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Reassess 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, duration: 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		mg, Syringe, IV Push, Q1H, PRN pain-breakthrough
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	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, 0 mg/hr
			Comment: OPIATE TOLERANT PROTOCOL.  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Reassess 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, 0 mg/hr
		250 mg, EVERY BAG
	morphine 100mg/NS 100mL IV
		50 mg, EVERY BAG, mg/hr
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	morphine  IV
		4 mg, Syringe, IV Push, Once, PRN see comment, Routine, duration: 2 hr
			Comment: May give as loading dose or if PCA pump not immediately available.
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
	morphine 5 mg/mL PCA 50 mL IV
		250 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, 0 mg/hr
			Comment: HIGH DOSE PROTOCOL  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Reassess pain, respiratory rate, respiratory pattern and sedation level 15 minutes after any dose change or nurse bolus.
	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, 0 mg/hr
			Comment: HIGH DOSE Protocol:  Notify provider for any concerns about dosing.  Do not adjust dose without a provider order.  Reassess 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

PCA Comfort Care Patient Care Orders Subphase
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, or 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.

PCA Comfort Care Patient Care Orders Subphase
	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, or 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.

PCA Routine Patient Care Orders Subphase
	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

PCA Routine Patient Care Orders Subphase
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