Mr Form 1c - Sickle Cell Pain Crisis Hospital Orders Page 3
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4PHYSICIAN ORDERS
DIAGNOSIS:
DRUG SENSITIVITY:
Patient Identification
ADULT PATIENT CONTROLLED ANALGESIA (PCA) ORDERS
FOR SICKLE CELL PATIENTS
Discontinue PRN opioid analgesics while patient is using PCA
G
Continue previous chronic opioid analgesics
G
ALL PCA THERAPY IS TO BE ADMINISTERED IV UNLESS OTHERWISE ORDERED
CONSIDER LOADING DOSE (BOLUS) IF PATIENT IS IN MODERATE OR SEVERE PAIN AT TIME OF ORDERS
Nursing: Program Alaris pump by selecting the “Sickle Cell” library menu
Analgesia:
Morphine
Suggested Dosing
G
________ mg Loading Dose
Use patient’s previous hospitalization records to guide
opioid dose
________ mg PCA Dose
G
Opioid Tolerant Patient - Loading Dose: 6-10mg PCA
________ Minute Lockout Interval
G
Dose/Interval: 3-4mg every 15 minutes, 1 Hour Limit:
________ mg/hr Continuous IV infusion Basal Rate
G
12-16 mg/hr
________ mg/hr One Hour Limit
G
Pharmacy to send morphine 6 mg/mL concentrated syringe for sickle cell patients
HYDROmorphone (DILAUDID) - use in renal insufficiency
________ mg Loading Dose
G
Suggested Dosing
________ mg PCA Dose
G
Use patient’s previous hospitalization records to guide
________ Minute Lockout Interval
G
opioid dose
________ mg/hr Continuous IV infusion Basal Rate
G
Opioid Tolerant Patient - Loading Dose: 1-1.5mg
________ mg/hr One Hour Limit
PCA Dose/Interval: 0.25-0.5mg every 10 minutes,
G
1 Hour Limit: 1.5-3 mg/hr
Pharmacy to send hydromorphone 2 mg/mL concentrated syringe for sickle cell patients
Fentanyl
Suggested Dosing
Use patient’s previous hospitalization records to guide
________ mg Loading Dose
G
opioid dose
________ mg PCA Dose
G
Opioid Tolerant Patient - Loading Dose: 100-150mcg
G
________ Minute Lockout Interval
PCA Dose/Interval: 25-50mcg every 10 minutes,
________ mg/hr Continuous IV infusion Basal Rate
G
1 Hour Limit: 150-300 mcg/hr
________ mg/hr One Hour Limit
G
Pharmacy to send fentanyl 50 mcg/mL concentrated syringe for sickle cell patients
Management of Side Effects
Itching: Initiate selected interventions one at a time starting with first checked
Apply lotion or cold wet towel to itchy areas
G
Naloxone (NARCAN) 2mg/1000mL NS, 50mL per hr PRN if pruritis not responsive to diphenhydramine
G
Diphenhydramine 25 mg PO every 4 hours PRN itching.
G
GI Medications:
Ondansetron (ZOFRAN) 4mg IV q6hr prn N/V
G
___________
Initials
Rev. 4/13
JH 4/4/13
Page 3 of 4
MR FORM 1C
8/96
Distribution: White - Chart Copy
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