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Microsoft word - so934 2009-08 pharmacologic tx of delirium - p&t.doc
DISPENSING BY NON-PROPRIETARY NAME IS AUTHORIZED IF NOT CHECKED IN THIS COLUMN
PHARMACOLOGIC TREATMENT OF DELIRIUM ORDER SET
Pharmacy and Therapeutics Committee
There is documentation of the diagnosis of delirium and the possible cause, if known, and any need for further diagnostic tests to meet the goals of care.
If appropriate, the cause of the delirium is being treated.
PRN medication is given for uncontrolled symptoms and suffering.
If an antipsychotic is not controlling the behavior and this is documented, or the delirium is caused by alcohol/benzodiazepine withdrawal, it is appropriate to use a benzodiazepine. If detoxification is indicated, there is an applicable order set (#026) available to the physician.
If irreversible or terminal delirium, there is an applicable order set (#935) available to the physician.
Symptom(s) which is/are causing suffering or distress are:
___Moaning ___Grimacing ___Hallucinations ___Restlessness
3. Antipsychotic Medication (first generation):
Haloperidol (Haldol) (1 mg by mouth is equivalent to 0.5 mg IV or subcutaneous). a. If administering Haloperidol (Haldol) intravenously or subcutaneously, verify that a recent electrocardiogram has
been performed to evaluate QTc. If QTc is greater than 440ms if male or greater than 470ms if female, transfer to telemetry bed – unless terminal care.
b. Scheduled Haloperidol (Haldol) dosing (recommended starting dose: Haloperidol (Haldol) 2 mg by mouth every 6
Haloperidol (Haldol) 1 mg IV or subcutaneous every 6 hours).
___ Haloperidol (Haldol) _____mg by mouth every _____ hours ___ Haloperidol (Haldol) _____mg IV every _____ hours (if unable to administer IV may give subcutaneously)
If symptoms are mild and primarily occur at bedtime (recommended starting dose: 0.5 – 1 mg): ___ Haloperidol (Haldol) _____ mg by mouth daily at bedtime ___ Haloperidol (Haldol) _____ mg IV daily at bedtime (if unable to administer IV may give subcutaneously)
c. PRN Haloperidol dosing (recommended starting dose: Haloperidol (Haldol) 2 mg by mouth every hour as needed OR
1 mg IV or subcutaneous every hour as needed).
___Haloperidol (Haldol) _____mg by mouth as needed every ______hours. ___Haloperidol (Haldol) _____mg IV every ______ hours as needed. (if unable to administer IV may give
If three PRN doses are not effective within ______ hours, call physician for further orders.
4. Antipsychotic Medication (Second generation):
(Risperdal) (recommended dosing is 0.25 – 0.5 mg daily at bedtime):
___Risperdone (Risperdal) _____mg by mouth daily at bedtime or ____________________________________
(Zyprexa) (recommended starting dose is 2.5 – 5 mg daily at bedtime):
___Olanzapine (Zyprexa) _____mg by mouth daily at bedtime or _____________________________________
(Seroquel) (recommended starting dose is 25 mg daily at bedtime or twice a day)
mg by mouth daily at bedtime or ______________________________________
b. PRN dosing: Haloperidol (Haldol) is recommended – see 3c or___________________________________________.
Time:_________ Physician Signature:__________________________________________________________
ORDERS FOR TREATMENT
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CURRICULUM VITAE Sandra “Sande” Gracia Jones, PhD, ARNP, ACRN, ACNS-BC, FAAN College of Nursing & Health Sciences Florida International University, Miami Florida February 2011 EDUCATION Degree Institution FULL-TIME ACADEMIC EXPERIENCE Institution Florida International University Associate Professor College of Nursing & Health Sciences Miami, Florida
WRONGFUL DEATH Medical Malpractice Lawsuit:
Delay in Diagnosis Results in Wrongful Death. Ms. Melanson had been a patient of Dr. William Damon. Prior to June 1995, Dr. Damon treated Ms. Melanson for a number of conditons. In June 1995, Ms. Melanson was treated at the Emergency Room for complaints of abdominal pain. When Ms. Melanson went to see Dr. Damon on June 26, 1995 to follow up