DOCTOR’S ORDER SHEET
DRUG ALLERGIES:PATIENT IDENTIFICATION ROOM NO.
POST ANESTHESIA CARE UNIT- CLINICAL PATHWAY
DATE
/TIME
/ ORDERS FOR MEDICATION, DIET AND TREATMENTS1. Admit to: PACU
2. For SpO2 less than 94%, place on O2 at 3L/NC or 40% O2 per face mask to maintain SpO2 greater than
or equal to 94%.
3. May insert/remove oral or nasal airway as needed.
4. Apply mechanical body warmer for temperature less than 96°F oral degrees or if patient complains of
being uncomfortably cold. Check temp every 15 minutes and discontinue mechanical warmer when
temperature is 96.8 tympanic or 96.4 oral degrees or greater.
5. General Surgery: IV as ordered or IV of RL at 125 ml/hr.
Day Surgery: May convert IV to saline lock if stable, no N/V and less than 100 ml TBA.
If temp greater than 100o maintain present IV or IV of D5RL at 125 ml/hr.
6. If second IV in place to infuse pre-op antibiotics, discontinue prior to discharge from PACU.
7. Administer IV bolus of 500 ml RL for sudden decreases in blood pressure (notify Anesthesiologist) and/or
urinary output less than 30 ml for first hour (notify attending MD if urinary output less than 30 ml for
second hour).
8. Notify Anesthesiologist for increased blood pressure of greater than 180 systolic and /or greater than
100 diastolic.
9. Initiate pain therapy as follows:
Mild pain – Fentanyl (Sublimaze) 25 mcg IV Push every 3 minutes to max dose of 100 mcg prn pain.
Moderate or severe pain – Fentanyl (Sublimaze) 50 mcg IV Push every 5 minutes to max dose of
100 mcg prn
- If unrelieved, after 100mcg Fentanyl, give
- Hydromorphone (Dilaudid) 0.5 mg IV Push every 5 minutes to max dose of 2 mg prn pain.
10. PCA as ordered if applicable. Pain therapy as ordered above may be used until PCA pump is available
or until pain relief obtained. If patient being transferred to post-op unit with PCA ordered by Anesthesia,
initiate Oxygen Weaning and pulse Oximetry Monitoring Orders.
11.Midazolam (Versed) 0.5 mg IV Push every 3 minutes prn restlessness or agitation (max dose 2 mg).
(Do not give if SpO2 less than 90%.)
12.Ondansetron (Zofran) 4 mg IV Push every 4 hours prn N/V for a max of 2 doses. If Zofran not effective
in 15 minutes, give Promethazine (Phenergan) 25 mg IM every 4 hrs. prn N/V. If N/V still unrelieved after 1
hour give Metoclopramide (Reglan) 10 mg slow IV push or po every 2 hrs. X 2 doses prn N/V.
13.Diphenhydramine (Benadryl) 25 mg IV Push prn itching (Max dose of 25 mg x 1) If Benadryl not
effective in 15 minutes, give Nalbuphine (Nubain) 10mg slow IV push X 1 dose. If Nubain not available,
repeat Benadryl 25mg (Max dose of 50 Mg).
14.Straight cath prn if unable to void.
15.Accucheck for patients on either hypoglycemic agents, insulin, or diet control diabetes. (Notify
Anesthesiologist if greater than 180 mg/dL or less than 70 mg/dL.)
16.May release from PACU 15 minutes after last dose of medication, has obtained a Post Anesthesia score
of 11 or above (with no score of 0 in any individual category), can bend both knees (if received epidural),
and SpO2 greater than or equal to 94% on room air or 3L/NC. OK to discharge patient if blood pressure is
within normal limits and within 20% of baseline.
17.If unable to maintain SpO2 of 94% on room air, transport to Nursing Unit with O2 at 3L/NC and initiate
Oxygen Weaning and pulse Oximetry Monitoring orders. Notify anesthesia if patient being transported to
Surgical Care Unit with O2 in use.
18.Notify RT if patient being transported with O2 in use.
19.If beta blocker is taken daily, verify that the patient received the medication within 24 hours prior to arrival to
PACU. If not given, notify Anesthesiologist prior to patient discharge from PACU.
09/2016 POST ANESTHESIA CARE UNIT - CLINICAL PATHWAY