Available at: BMC-B BMC-D BMC-N BMC-S Activity Activity Bedrest with BRP, with assistance at nurse's discretion (DEF)* Ambulate with Assistance Diet Communication Order Patient to remain NPO while in PACU or until directed by Anesthesiologist Nursing Orders ***(NOTE)***Order Blood Glucose POC if patient is on oral hypoglycemic agents or insulin Blood Glucose Monitor POC On arrival to PACU Notify Provider Routine, Notify Anesthesiologist if blood sugar LESS than 90 mg/dl or GREATER than 200 mg/dl Notify Provider Notify pacemaker-icd service to interrogate/restore device pacemaker and/or ICD function unless interrogation of Pacemaker-ICD deferred per manufacturer's recommendation Discontinue PACU Orders PACU staff to discontinue all Anesthesia Post Op Power Plan when patient leaves PACU PACU Discontinue IV Access When tolerating PO fluids. PACU Discontinue Arterial Line When blood pressure and pulmonary status are stable Release from PACU When PACU discharge criteria is met Medications GEN Correction Insulin (Sliding Scale)(SUB)* ***Reminder: Order GEN Correction Insulin (Sliding Scale) (SUB) on a separate form*** Analgesics ***(NOTE)***Reduce Toradol dose to 15 mg for patients over 65 years old or for estimated CrCl of 60 ml/minute. HOLD Toradol for patients with significant intra-op hemorrhage or who are at risk of post-op hemorrhage. ketorolac (PACU Toradol) 30 mg inj IV PUSH ONCE, PRN Pain Moderate/Severe, Duration: 6 hour, Clinical Instructions: Give ONCE only (DEF)* Comments: If patient is over 65 years old or has an estimated CrCl of 60 ml/minute or less, reduce the dose to 15 mg 15 mg inj IV PUSH ONCE, PRN Pain Moderate/Severe, Duration: 6 hour Page 1 of 7
acetaminophen (PACU Ofirmev) Available only at BMCB 1 g bottle IVPB ONCE, PRN Pain Moderate/Severe, Duration: 6 hour (DEF)* Comments: Weight based recommendation: For adults GREATER than or EQUAL to 50 kg administer 1 g IVPB 15 mg/kg bottle IVPB ONCE, PRN Pain Moderate/Severe, Duration: 6 hour Comments: Weight based recommendation: For adults LESS than 50 kg, give 15 mg/kg IVPB PACU fentanyl 12.5 mcg inj IV PUSH Q5MINS Int, PRN Pain Moderate/Severe, Duration: 6 hour (DEF)* Comments: Only if respirations are GREATER than or equal to 12 per minute. MAXIMUM of 125 mcg. If Fentanyl not effective after maximum dose, administer morphine if ordered or call Anesthesiologist 25 mcg inj IV PUSH Q5MINS Int, PRN Pain Moderate/Severe, Duration: 6 hour Comments: Only if respirations are GREATER than or equal to 12 per minute. MAXIMIUM of 250 mcg. If Fentanyl not effective after maximum dose, administer morphine if ordered or call Anesthesiologist 50 mcg inj IV PUSH Q5MINS Int, PRN Pain Moderate/Severe, Duration: 6 hour Comments: Only if respirations are GREATER than or equal to 12 per minute. MAXIMUM of 250 mcg. If Fentanyl not effective after maximum dose, administer morphine if ordered or call Anesthesiologist. PACU morphine 2 mg inj IV PUSH Q5MINS Int, PRN Pain Moderate/Severe, Duration: 6 hour (DEF)* Comments: Only if respirations are GREATER than or equal to 12 per minute. MAXIMUM of 20 mg. 1 mg inj IV PUSH Q5MINS Int, PRN Pain Moderate/Severe, Duration: 6 hour Comments: Only if respirations are GREATER than or equal to 12 per minute. MAXIMUM of 10 mg. 4 mg inj IV PUSH Q5MINS Int, PRN Pain Moderate/Severe, Duration: 6 hour Comments: Only if respirations are GREATER than or equal to 12 per minute. MAXIMUM of 20 mg. hydromorphone (PACU Dilaudid) 0.25 mg inj IV PUSH Q5MINS Int, PRN Pain Moderate/Severe, Duration: 6 hour (DEF)* Comments: Only if respirations are GREATER than or equal to 12 per minute. MAXIMUM 2 mg. 0.5 mg inj IV PUSH Q5MINS Int, PRN Pain Moderate/Severe, Duration: 6 hour Comments: Only if respirations are GREATER than or equal to 12 per minute. MAXIMUM 2 mg. 0.2 mg inj IV PUSH Q5MINS Int, PRN Pain Moderate/Severe, Duration: 6 hour Comments: Only if respirations are GREATER than or equal to 12 per minute. MAXIMUM 2 mg. meperidine (PACU Demerol) 6.25 mg inj IV PUSH Q5MINS Int, PRN Rigors, Duration: 6 hour (DEF)* Comments: May repeat 1 time to a MAXIMUM dose of 12.5 mg 12.5 mg inj IV PUSH Q5MINS Int, PRN Rigors, Duration: 6 hour Comments: May repeat 1 time to a MAXIMUM dose of 25 mg Antiemetics/Antacids metoclopramide (PACU Reglan) 10 mg inj IV Q15MINS Int, PRN Nausea/Vomiting, Duration: 6 hour (DEF)* 10 mg inj IV ONCE, PRN Nausea/Vomiting Page 2 of 7
ondansetron (PACU Zofran) 4 mg inj IV PUSH ONCE, PRN Nausea/Vomiting, Duration: 6 hour promethazine (PACU Phenergan) 6.25 mg inj IV PUSH Q15MINS Int, PRN Nausea/Vomiting, Duration: 6 hour (DEF)* Comments: If ineffective within 15 minutes, may give additional 6.25 mg IV. MAX dose is 12.5 mg. If the patient has an IV running, the promethazine (PHENERGAN) should be mixed in 10 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the promethazine (PHENERGAN) 6.25 mg inj IV PUSH ONCE, PRN Nausea/Vomiting, Duration: 6 hour Comments: If the patient has an IV running, the promethazine (PHENERGAN) should be mixed in 10 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the promethazine (PHENERGAN) 2.5 mg inj IV PUSH Q15MINS Int, PRN Nausea/Vomiting, Duration: 6 hour Comments: If ineffective within 15 minutes, may give additional 2.5 mg IV. MAX dose is 5 mg. If the patient has an IV running, the promethazine (PHENERGAN) should be mixed in 10 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the promethazine (PHENERGAN). 2.5 mg inj IV PUSH ONCE, PRN Nausea/Vomiting, Duration: 6 hour Comments: If the patient has an IV running, the promethazine (PHENERGAN) should be mixed in 10 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the promethazine (PHENERGAN) 12.5 mg inj IV PUSH Q15MINS Int, PRN Nausea/Vomiting, Duration: 6 hour Comments: If ineffective within 15 minutes, may give additional 12.5 mg IV. MAX dose is 25 mg. If the patient has an IV running, the promethazine (PHENERGAN) should be mixed in 10 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the promethazine (PHENERGAN) 12.5 mg inj IV PUSH ONCE, PRN Nausea/Vomiting, Duration: 6 hour Comments: If the patient has an IV running, the promethazine (PHENERGAN) should be mixed in 10 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the promethazine (PHENERGAN) droperidol (PACU Inapsine) 0.625 mg inj IV PUSH Q15MINS Int, PRN Nausea/Vomiting, Duration: 6 hour (DEF)* Comments: If ineffective after 2 doses, notify physician 0.625 mg inj IV PUSH ONCE, Nausea/Vomiting, Duration: 6 hour Page 3 of 7
Antihypertensives labetalol (PACU Trandate) 5 mg inj IV PUSH Q15MINS Int, PRN Blood Pressure, Duration: 6 hour (DEF)* pressure GREATER than 100 mmhg and heart rate GREATER than 60 beats per minute. HOLD for heart rate LESS than 60 beats per minute 5 mg inj IV PUSH Q15MINS Int, PRN Blood Pressure, Duration: 6 hour pressure GREATER than 90 mmhg and heart rate GREATER than 60 beats per minute. HOLD for heart rate LESS than 60 per minute pressure GREATER than 100 mmhg and heart rate GREATER than 60 beats per minute. HOLD for heart rate LESS than 60 beats per minute pressure GREATER than 90 mmhg and heart rate GREATER than 60 beats per minute. HOLD for heart rate LESS than 60 beats per minute enalapril (PACU Vasotec) 1.25 mg inj IV PUSH ONCE, PRN Blood Pressure, Duration: 6 hour (DEF)* pressure GREATER than 100 mmhg. If 1.25 mg inj IV PUSH ONCE, PRN Blood Pressure, Duration: 6 hour pressure GREATER than 90 mmhg. If hydralazine (PACU Apresoline) 5 mg inj IV PUSH Q15MINS Int, PRN Blood Pressure, Duration: 6 hour (DEF)* Comments: Up to a MAX dose of 20 mg total. For systolic blood pressure GREATER than 160 mmhg and/or diastolic blood pressure GREATER than 100 mmhg. HOLD for heart rate GREATER than 100 beats per minute. If 5 mg inj IV PUSH Q15MINS Int, PRN Blood Pressure, Duration: 6 hour pressure GREATER than 90 mmhg. HOLD for heart rate GREATER than 100 beats per minute.. If Comments: Up to a MAX dose of 20 mg total. For systolic blood pressure GREATER than 160 mmhg and/or diastolic blood pressure GREATER than 100 mmhg. HOLD for heart rate GREATER than 100 beats per minute. If pressure GREATER than 90 mmhg HOLD for heart rate GREATER than 100 beats per minute. If Page 4 of 7
metoprolol (PACU Lopressor) 2.5 mg inj IV PUSH ONCE, PRN Other (see comment), Duration: 6 hour (DEF)* pressure GREATER than 100 mmhg and heart rate GREATER than 60 beats per minute. If 2.5 mg inj IV PUSH ONCE, PRN Other (see comment), Duration: 6 hour pressure GREATER than 90 mmhg and heart rate GREATER than 60 beats per minute. If 5 mg inj IV PUSH ONCE, PRN Other (see comment), Duration: 6 hour pressure GREATER than 100 mmhg and heart rate GREATER than 60 beats per minute. If 5 mg inj IV PUSH ONCE, PRN Other (see comment), Duration: 6 hour pressure GREATER than 90 mmhg and heart rate GREATER than 60 beats per minute. If Anti-pruritics nalbuphine (PACU Nubain) 2.5 mg inj IV PUSH Q2H Int, PRN Itching, Duration: 6 hour (DEF)* Comments: If not effective after 2 doses, Administer Benadryl if ordered OR call physician 2.5 mg inj SUBCUT Q2H Int, PRN Itching, Duration: 6 hour Comments: If not effective after 2 doses, Administer Benadryl if ordered OR call physician 5 mg inj IV PUSH Q2H Int, PRN Itching, Duration: 6 hour Comments: If not effective after 2 doses, Administer Benadryl if ordered OR call physician diphenhydramine (PACU Benadryl) 12.5 mg inj IV PUSH ONCE, PRN Itching, Duration: 6 hour (DEF)* 6.25 mg inj IV PUSH ONCE, PRN Itching, Duration: 6 hour Antiarrhythmics esmolol (PACU Brevibloc) 10 mg inj IV PUSH Q15MINS Int, PRN Heartrate, Duration: 6 hour Comments: For heart rate GREATER than 100 beats per minute. HOLD for a heart rate LESS than 100 beats per minute. Do NOT administer more than 2 doses Respiratory Medications albuterol (PACU Proventil Neb 0.083%) 2.5 mg neb inh INHALE ONCE, PRN Shortness of Breath, Duration: 6 hour albuterol (PACU Proventil MDI) 2 puff INHALE aerosol ONCE, PRN Shortness of Breath, Duration: 6 hour albuterol-ipratropium (PACU DuoNeb) 3 ml INHALE neb inh ONCE, PRN Shortness of Breath, Duration: 6 hour Page 5 of 7
Reversal Agents naloxone (PACU Narcan) 0.1 mg inj IV PUSH ASDIR, PRN Other (see comment), Duration: 24 hour Comments: For Respiratory Rate LESS than 6, patient cyanotic or Sedation Scale of 5. Administer 0.4 mg IV, stimulate patient, start oxygen at 2 liters/min via nasal cannula and STOP epidural infusion. If patient unresponsive CALL CODE BLUE STAT and call Anesthesiologist.For Respiratory Rate between 7 and 10, or Sedation Scale GREATER than or EQUAL to 4, Administer 0.2 mg IV, stimulate patient, start oxygen at 2 liters/min via nasal cannula and STOP epidural infusion. If patient unresponsive CALL CODE BLUE STAT and call Anesthesiologist.For Respiratory rate between 11 and 12, Administer 0.1 mg IV, stimulate patient, start oxygen at 2 liters/min via nasal cannula and STOP epidural infusion (dilute 1 ampule in 4 ml Normal Saline for a final concentration of 1mg/mL). Laboratory Complete Blood Count Hematocrit and Hemoglobin Basic Metabolic Panel Potassium Level Glucose Level PTT PT INR Radiology PACU Chest Xray (Portable) Central line placement, Stat, Pending Discharge - No, ONCE, Patient in PACU (DEF)* Pulmonary artery catheter placement, Stat, Pending Discharge - No, ONCE, Patient in PACU Respiratory PACU ABG/VBG Notification Stat, On arrival to PACU (DEF)* Stat, With Profile, On arrival to PACU Arterial Blood Gas Stat, On arrival to PACU Venous Blood Gas Stat, On arrival to PACU Page 6 of 7
PACU O2 Therapy. Nasal Cannula, 2, liters per minute. Titrate to maintain oxygen saturation GREATER than 92% Pulse Oximetry (Continuous) Special Instructions: PACU, Stat Comments: Q8H sensor site must be inspected; IF circulatory condition or skin integrity has changed, the sensor should be applied to a different site. Endtidal CO2 Monitoring Stat, Continuous CPAP For OSA Precautions please Initiate ANES Obstructive Sleep Apnea (OSA) PowerPlan(NOTE)* Consult MD Pulmonology, Ventilator Management Page 7 of 7