continuous opioid infusion chart – adult education slide presentation a presentation prepared by...
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Continuous Opioid Infusion Chart – adult
Education Slide Presentation
A presentation prepared by the Pain Interest Group Nursing Issues
in association with the Agency of Clinical Innovation Pain Management Network
Please direct comments to:
APRIL 15, 2015
Emily EdmondsCoordinator State Pain Forms
Pain Interest Group Nursing IssuesCNC Acute Pain Service Blacktown Hospital
Phone: 9881 7649 Email: [email protected]
Jenni JohnsonManager
Pain Management NetworkAgency for Clinical Innovation (ACI)
Phone: 9464 4636Email: [email protected]
OR
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Continuous Opioid Infusion Chart - adult
The Continuous Opioid Infusion prescription and observation chart for adult patients has been developed by a team of experts in the field of acute pain including clinical nurse consultants, anaesthetists and pharmacy representatives.
This chart has been designed for a patient receiving a continuous opioid infusion in a ward environment. This chart is not suitable for paediatric patients.
Standardisation of this chart promotes best practice in prescribing, pain assessment and management of adverse effects in those patients receiving a continuous opioid infusion via an infusion modality.
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Aim of this presentation:
This presentation aims to explain how to use the chart for prescribing a continuous
opioid infusion how to record the administration and discard of
drugs used for a continuous opioid infusion how to complete the clinical observations guidelines on the management of patients receiving
an a continuous opioid infusion including the management of adverse effects
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Continuous Opioid Infusion Chart - adultBooklet format
Prescription valid for 4 daysObservation pages for 4 days
Page 1Management guidelines
Yellow and Red Zone Instructions
Page 1 Page 2
Page 3
Page 2Continuous opioid
prescription, naloxone prescription, oxygen therapy,
ceasing
Page 3Administration and discardOpioid administration, drug discard, record of naloxone
administration
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Continuous Opioid Infusion Chart - adult
Observation pages:for up to 4 days
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Managing adverse effects
For detailed information regarding continuous opioid infusion
prescribing and management refer to local hospital continuous opioid
infusion policy or procedure
Instructions for managing patients whose observations fall into the
Yellow or Red Zone
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Prescription (Page 2)
Patient label and allergy and
adverse reactions
Private patients: pain specialist referral, name and signature of the doctor making the referral
Opioid prescription:• Primary opioid drug• Option for additional drugs• Continuous infusion range• Start rate• Additional bolus dose
Oxygen therapy
Ceasing instruction
Naloxone prescription
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Continuous opioid infusion prescription:
SMITH 3/3/15PSmith
Prescriber to complete patient allergy and ADR
section in fullHandwrite patient details OR affix patient label
(First prescriber to check patient label is correct)
PRIVATE PATIENTS: A pain specialist referral from the referring doctor
(name), signature and date
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Continuous opioid prescription:Below is an EXAMPLE prescription
Refer to hospital policy for local guidelines on prescribing a continuous opioid infusion
5 1 mg
NIL
Morphine
1 mg/mL
3/5/15 SMITHTSmith
Space provided for pharmacist
reconciliation
100
7511
NIL
1 3 mg
1 mg 1
3 mg 3
IV
15 2
100 mg
3
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Naloxone prescription:
10/5/15 naloxone IV 100 microgram x4 2 – 3 Tsmith SMITH minutes
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Oxygen therapy and cessation of epidural:
Administration of oxygen therapy default as stated OR space is
provided for individual patient instructions for oxygen delivery
Give oxygen to maintain Sa02 above 95% Smith(SMITH) 3/515
CEASE continuous opioid infusion as per Acute Pain Service or equivalent medical officer
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Administration and discard of epidural solution:
Opioid infusion
commenced
Discard of any remaining opioid
solution
Page 3
6/4/15 10:00 SLee SRose 6/4/15 21:00 10mL THall GLamb
5/4/15 10:00 Thall SRose 5/4/15 20:00 5mL ALoh JLucas
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The Continuous Opioid Infusion Chart provides
observations for a maximum of 4 days.
If the infusion continues beyond 4 days, a new chart must be started and a new
prescription written.
Observation pages
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Observations:
Pain score
Sedation score and
Respiratory rate
Opioid infusion delivery
- Infusion rate- Total dose- Bolus dose- Program check
Oxygen therapy and oxygen
device mode
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Documenting observations: Pain Assessment: ‘R’ for rest ‘M’ for movement
R R
R R
R
M M R
M
M
1100 120
0130
0150
01400
05/4/15
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Documenting observations:Sedation, respiratory rate, oxygen therapy,Infusion delivery
Observations in the ‘Red Zone’ requires a Rapid
Response to be initiated AND
contact the Acute Pain Service (or equivalent medical officer)
Observations in the ‘Yellow Zone’ requires a
Clinical Review by the Acute Pain Service
(or equivalent medical officer)
2L 2L 2L 2LNP NP NP NP
2 2 2 2mg mg mg mg
TS TS TS TS
TS
3mg
TS BJ
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The next 2 slides detail:
• Continuous opioid management guidelines
• Yellow and Red Zone Instructions
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The standardisation of this chart promotes best practice in prescribing, pain assessment and management of adverse effects in those patients receiving a
continuous opioid infusion
Comments or questions can be directed to your implementation officer or the project leaders Emily Edmonds or Jenni Johnson
(for contact details see introduction slide)
The feedback register can be located on the ACI website:
http://www.aci.health.nsw.gov.au/networks/pain-management/acute-pain-forms