ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked

DRUG AND TREATMENT ORDERS

ANES Obstructive Sleep Apnea Precautions (OSA)

PHYSICIAN SIGNATURE _____________________________________ DATE __________ TIME _______

DRUG ALLERGIES WT: KG

ORDERS

REV:

Page 1 of 2

A pharmaceutical equivalent or pharmaceutical alternative may be substituted. Therapeutic alternatives may be substituted as determined by the Pharmacy and Therapeutics Committee.

LABEL

PERMANENT COPY

ANES Obstructive Sleep Apnea Precautions (OSA) PACU Phase Nursing Orders

Elevate Head of Bed Other: See Special Instructions, GREATER THAN 30 degrees unless otherwise ordered

Cardiac Monitor Include continuous pulse oximetry in phase 1 PACU or equivalent for no less than 4 hours or as per

anesthesiologist or attending physician.

Pulse Oximetry (Continuous) Special Instructions: See Order Comments

Comments: Q8H sensor site must be inspected; IF circulatory condition or skin integrity has changed, the sensor should be applied to a different site.

Communication Order IF ordered, non-invasive respiratory device (i.e. Auto-Pap, Bi-Pap, etc) to be used at all hours of sleep

including naps. Comments: ** With any of the witnessed respiratory events listed below, the attending physician and respiratory therapist will be contacted for possible interventions.Respiratory Events defined as: --Bradypnea LESS THAN 8 respirations / min (3 Episodes in 30 minutes)--Apnea GREATER THAN 10 seconds (1 Episode in 30 minutes)--Desaturation LESS THAN 90% on pulse oximeter (3 Episodes in 30 minutes) on Nasal Cannula--Ramsay Score GREATER THAN 3 and Pain Scale Score GREATER THAN 5

Post PACU Phase Condition/Status

***(NOTE)*** IF patient is to be admitted, admit to monitor bed. Patient Status Patient Status Inpatient

Patient Status: Inpatient, Level of Care: Med/Surg with Telemetry (3) (DEF)*

Patient Status: Inpatient, Level of Care: Progressive Care (4), Monitored bed with telemetry

Patient Status: Inpatient, Level of Care: Intensive Care (8) Place in Observation

Patient Status: Outpatient- Refer for Observation Status, Level of Care: Med/Surg with Telemetry (3) (DEF)*

Patient Status: Outpatient- Refer for Observation Status, Level of Care: Progressive Care (4), Monitored bed with telemetry

Patient Status: Outpatient- Refer for Observation Status, Level of Care: Intensive Care (8) Vital Signs

Vital Signs ASDIR, Every 15 mins x 4, then every 30 mins X 2 then every 2H X4 then Q4H

Nursing Orders

Cardiac Monitor Include continuous pulse oximetry in phase 1 PACU or equivalent for no less than 4 hours or as per

anesthesiologist or attending physician.

ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked

DRUG AND TREATMENT ORDERS

ANES Obstructive Sleep Apnea Precautions (OSA)

PHYSICIAN SIGNATURE _____________________________________ DATE __________ TIME _______

DRUG ALLERGIES WT: KG

ORDERS

REV:

Page 2 of 2

A pharmaceutical equivalent or pharmaceutical alternative may be substituted. Therapeutic alternatives may be substituted as determined by the Pharmacy and Therapeutics Committee.

LABEL

PERMANENT COPY

Pulse Oximetry (Continuous) Special Instructions: In phase 1 PACU or equivalent for no less than 4 hours or as per anesthesiologist or

attending physician. Comments: Q8H sensor site must be inspected; IF circulatory condition or skin integrity has changed, the sensor should be applied to a different site.

Elevate Head of Bed Other: See Special Instructions, GREATER THAN 30 degrees unless otherwise ordered

Communication Order "OSA Precautions" signage to be placed in patient folder and outside of patient door

Communication Order IF ordered, non-invasive respiratory device (i.e. Auto-Pap, Bi-Pap, etc) to be used at all hours of sleep

including naps. Comments: ** With any of the witnessed respiratory events listed below, the attending physician and respiratory therapist will be contacted for possible interventions.Respiratory Events defined as: --Bradypnea LESS THAN 8 respirations / min (3 Episodes in 30 minutes)--Apnea GREATER THAN 10 seconds (1 Episode in 30 minutes)--Desaturation LESS THAN 90% on pulse oximeter (3 Episodes in 30 minutes) on Nasal Cannula--Ramsay Score GREATER THAN 3 and Pain Scale Score GREATER THAN 5

Patient Education Provide patient with education regarding OSA

Medications ***(NOTE)*** Please consider modified pain management plan which could include ANES Patient Controlled Analgesia (PCA) power plan.

Respiratory

BIPAP Comments: For Patient with diagnosed or suspected Obstrutive Sleep Apnea

CPAP

Auto-PAP

Endtidal CO2 Monitoring Consults

Consult Physician