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 ___Other:_________________________________________________________________ 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 hours OR 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
Haloperidol (Haldol) 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): i. Risperdone (Risperdal) (recommended dosing is 0.25 – 0.5 mg daily at bedtime):
___Risperdone (Risperdal) _____mg by mouth daily at bedtime or ____________________________________ ii. Olanzapine (Zyprexa) (recommended starting dose is 2.5 – 5 mg daily at bedtime):
___Olanzapine (Zyprexa) _____mg by mouth daily at bedtime or _____________________________________ iii. Quetiapine (Seroquel) (recommended starting dose is 25 mg daily at bedtime or twice a day)
___Quetiapine (Seroquel)_____mg by mouth daily at bedtime or ______________________________________
iv. Other:
b. PRN dosing: Haloperidol (Haldol) is recommended – see 3c or___________________________________________. Time:_________ Physician Signature:__________________________________________________________ 934 08/09
ORDERS FOR TREATMENT
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Source: http://www.aahpm.org/pdf/delirium3.pdf