Ketamine Infusion Prescription and Observation 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:

Emily EdmondsCoordinator State Pain Forms

Pain Interest Group Nursing IssuesCNC Acute Pain Service Blacktown Hospital

Phone: 9881 7649 Email: emily.edmonds@swahs.health.nsw.gov.au

Jenni JohnsonManager

Pain Management NetworkAgency for Clinical Innovation (ACI)

Phone: 9464 4636Email: jenni.johnsons@aci.health.nsw.gov.au

OR

March 21, 2013

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Ketamine infusion Prescription and observation- adultThe ketamine 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 the administration of subcutaneous or intravenous ketamine infusions for patients who may have acute or chronic pain. The chart may not be appropriate for ketamine infusion administration in palliative care.

Standardisation of this chart promotes best practice in pain assessment and management of adverse effects in those patients who are receiving a ketamine infusion for pain management.

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Aim of this presentation:

This presentation aims to explain how to use the chart to record the prescription,

administration and discarding of ketamine as a continuous infusion.

how to complete the clinical observations. guidelines on the management of patients who are

receiving ketamine as a continuous infusion including the management of adverse effects.

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Ketamine infusion Prescription and observation chart - adult

Page 2 and Page 3: Left side: prescription (valid for 4 days)Right side: administration & discard

Front page: - Ketamine Infusion

- Management Guidelines & Clinical Review Criteria

Inside pages: Observation space for up to

4 days

Page 1 Page 2 Page 3

Inside pages

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Prescription page:

Patient allergy status and patient label

Two revised prescription options

for alterations to ketamine prescription

Ketamine prescription:- Route- Amount- Additional drug & amount (if used)

- Diluent- Total volume- Concentration- Infusion rate- Infusion range (if used)

- Date, prescriber, pharmacy

Page 2

6

Prescription: Patient identificationHandwrite patient details

or affix patient label

(First prescriber to check patient label is correct)

Prescriber to complete patient allergy and ADR section in full

Prescription is valid for a maximum of 4 days unless

ceased earlierThe frequency of observations (2 hourly or 4 hourly)

must be determined by the medical officer

Private patients: require a

signature from the referring

Doctor to the Pain Service

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Ketamine prescription: Options: set rate OR infusion range

Two further prescription boxes are provided for when alterations are indicated for the ketamine dose, concentration or infusion rate.

PLEASE REFER TO YOUR LOCAL HOSPITAL POLICY OR PROCEDURE FOR PREFERRED KETAMINE DELIVERY OPTIONS

Ketamine 200 mgIV

15/04/13 SMITHTSmith

50mL0.9% sodium chlorideNIL

4 mg41

4

1

8

2

8

Administration and discard of ketamine:

IF a ketamine syringe or bag is empty when the next is

commenced, document ‘NIL’ discarded

There are 12 more rows provided for more than

one syringe or bag of ketamine that is

commenced

Any ketamine remaining from a syringe or bag

MUST be recorded on the corresponding row from

its administration

10:0015/04/13 THal

l SRose 20:0015/04/13 BLo

hJLu

casNIL

20:00 BLoh JLucas 09:0017/04/13PLa

mbert

TBuckl

ey5 mL16/04/13

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Clinical Review Criteria and Management Guidelines:

Ketamine Infusion

Management Guidelines

Clinical Review Criteria

Ketamine infusion

cessation prompt

(check local policy for use

of this prompt)

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Observations

The ketamine chart can provide 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.

Inside pages

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0900

1100

1300

1500

1700

01/03/2013

M M M

M M

R R R

R R

6mg

6mg

8mg

8mg

8mg

SH KL

SH KL

1000

1400

1800

2200

0200

15/04/13

A patient label must be affixed or details written

on each page that has recorded observations

Pain assessment:R = Rest

M = movement(If a PCA chart is in use – record

pain score on the PCA chart)

Dysphoric adverse effects assessment

(A score in the Yellow Zone requires a Clinical Review by the pain service)

Infusion rate (in mg or mL)

Ketamine pump program check

Subcutaneous or IV site check

Comments for free text

SHKL/AT

SH KLSH

NH

NH

Initial prompt

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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 ketamine infusion.

Comments or questions can be directed to your implementation officer or the project leaders Emily Edmonds or Jenni Johnson.

(contact details 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