PLACE LABEL HERE
POST ANESTHESIA CARE
ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
The following orders are for use in PACU setting only. DC upon transfer out of PACU setting.
Phase I Orders:
1.  Patient with General or MAC Anesthesia
Immediate Post Op Nursing Care
Monitoring per Care for Patients in Phase I (6604-01)
If patient had General Ansethesia apply oxygen via face shield or non rebreather mask at 100% and titrate
down to maintain O2 sat ≥ 90%
If patient had MAC anesthesia apply 2-4 L/min via nasal cannula or may go to RA if O2 sat maintained ≥ 90%
Call Anesthesia for pain uncontrolled by narcotics.
Patient to remain in Phase I for 15 min after last narcotic dose.
Discontinue arterial line prior to discharge from Phase I if Level of Care on transfer is not Critical Care.
When Phase I discharge criteria met, transfer Outpatients with Physician Discharge Orders to Phase II or
Observation/Inpatients to floor, may hold in Phase II if necessary.
MEDICATION ORDERS:
Severe Pain: Morphine 1 - 2 mg IV q 5 min prn up to 10 mg, then if needed
Dilaudid (hydromorPHONE) 0.5 mg IV q 5 min prn up to 2 mg
If CrCl < 30, DC Morphine and give Dilaudid (hydromorPHONE) 0.25 IV q 15 min prn x 3 doses
Moderate Pain:  Toradol (ketorolac) 30 mg IV x 1 dose prn (15 mg if CrCl 31-50, > 65 y/o or < 50 kg), DC if CrCl < 30
Mild pain: Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325 mg po x 1 dose prn or may give Hycet
elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po x 1 dose prn instead of Norco.
OR  oxyCODONE 5 mg po prn x 1 dose or may give Roxicodone (oxyCODONE) elixir (5 mg/ 5 ml) 5
ml po x 1 dose prn instead of tablet. Discontinue Norco and Hycet elixir.
Shivering: Demerol (meperidine) 12.5 mg IV q 5 min prn up to 25 mg
Nausea/Vomiting: Zofran (ondansetron) 4 mg IV x 1 dose prn or  DC Zofran, give: _______________
2.  Bypass Phase I and implement these order in Phase II (MAC Anesthesia ONLY)
Immediate Post Op Nursing Care
Monitoring per Care for Patients in Phase II (6604-02)
Apply 2-4 L/min via nasal cannula or may go to RA if O2 sat maintained ≥ 90%
Call Anesthesia for pain uncontrolled by narcotics.
Patient to remain in Phase II for 30 min after last narcotic dose.
When discharge criteria met, Outpatients may discharge per physician orders or Observation/Inpatients may
transfer to floor.
MEDICATION ORDERS:
Severe Pain: Morphine 1 - 2 mg IV q 5 min prn up to 10 mg, then if needed
Dilaudid (hydromorPHONE) 0.5 mg IV q 5 min prn up to 2 mg
If CrCl < 30, DC Morphine and give Dilaudid (hydromorPHONE) 0.25 IV q 15 min prn x 3 doses
Moderate Pain:  Toradol (ketorolac) 30 mg IV x 1 dose prn (15 mg if CrCl 31-50, > 65 y/o or < 50 kg), DC if CrCl < 30
Mild pain: Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325 mg po x 1 dose prn or may give Hycet
elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po x 1 dose prn instead of Norco.
OR  oxyCODONE 5 mg po prn x 1 dose or may give Roxicodone (oxyCODONE) elixir (5 mg/ 5 ml) 5
ml po x 1 dose prn instead of tablet. Discontinue Norco and Hycet elixir.
Shivering: Demerol (meperidine) 12.5 mg IV q 5 min prn up to 25 mg
Nausea/Vomiting: Zofran (ondansetron) 4 mg IV x 1 dose prn or  DC Zofran, give: __________________
Order writer’s initials _______
Copy to pharmacy
*3-21677*
FORM 3-21677 REV. 11/2015
Page 1 of 3
PLACE LABEL HERE
POST ANESTHESIA CARE
ORDERS
Order writer’s initials _______
Copy to pharmacy
*3-21677*
FORM 3-21677 REV. 11/2015
Page 2 of 3
PLACE LABEL HERE
POST ANESTHESIA CARE
ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
3.  OSA Patient with General Anesthesia or MAC Anesthesia:
MAC OSA patients may bypass Phase I as deemed appropriate by the anesthesia provider.
Monitoring and discharge of the MAC OSA patient per Care of the Patient with Obstructive Sleep Apnea (500-57).
Immediate Post Op Nursing Care
Monitoring per Care for Patients in Phase I (6604-01)
Observe patient a minimum of 2 hrs in PACU setting
Notify Respiratory Care to place CPAP/BiPAP or CPAP at 8 – 10 cm initially at 100% FiO2, if indicated
May be titrated to room air keeping O2 saturation ≥ 90% (Note exceptions for ENT surgeries)
Keep patient in inclined position at 45° (unless contraindicated by surgery/surgeon orders)
If PCA ordered, may start PCA after 1 hour in Phase I and observe in PACU setting for 1 hr after PCA initiated
prior to transferring out of perioperative area.
Call Anesthesia for pain uncontrolled by narcotics.
Patient to remain in PACU setting for 30 min after last narcotic dose.
Discontinue arterial line prior to discharge from Phase I if Level of Care on transfer is not Critical Care.
When Phase I discharge criteria met, transfer Outpatients with Physician Discharge Orders to Phase II or
Observation/Inpatients to floor, may hold in Phase II if necessary.
MEDICATION ORDERS:
Severe Pain: Morphine 2 mg IV q 10 min prn x 3 doses, then if needed
Morphine 1 mg IV q 10 min prn x 4 doses, then if needed
Dilaudid (hydromorPHONE) 0.5 IV q 15 min prn x 3 doses
If CrCl < 30, DC Morphine and give Dilaudid (hydromorPHONE) 0.25 IV q 15 min prn x 3 doses
Moderate Pain:  Toradol (ketorolac) 30 mg IV x 1 dose prn (15 mg if CrCl 31-50, > 65 y/o or < 50 kg), DC if CrCl < 30
Mild pain: Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325 mg po x 1 dose prn or may give Hycet
elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po x 1 dose prn instead of Norco.
OR  oxyCODONE 5 mg po prn x 1 dose or may give Roxicodone (oxyCODONE) elixir (5 mg/ 5 ml) 5
ml po x 1 dose prn instead of tablet. Discontinue Norco and Hycet elixir.
Nausea/Vomiting: Zofran (ondansetron) 4 mg IV x 1 dose prn or  DC Zofran, give: ________________
4.  UPPP Patient with General Anesthesia
Immediate Post Op Nursing Care
Monitoring per Care for Patients in Phase I (6604-01)
Apply oxygen via humidified face shield and titrate oxygen down to maintain O2 sat ≥ 90%
Maintain humidified face shield
Call Anesthesia for pain uncontrolled by non narcotic medications.
If narcotics are ordered by Anesthesia patient to remain in PACU setting for 1 hr after last narcotic dose.
Discontinue arterial line prior to discharge from Phase I if Level of Care on transfer is not Critical Care.
When Phase I discharge criteria met, transfer Observation/Inpatients to floor.
MEDICATION ORDERS:
Moderate Pain: Xylocaine (lidocaine) 4% nebulizer x 1 dose
and Toradol (ketorolac) 30 mg IV x 1 dose prn (15 mg if CrCl 31-50, > 65 y/o or < 50 kg), DC if CrCl < 30
5.  Critical Care Patient with General Anesthesia
No recovery needed.
Transfer to ICU for routine critical care monitoring.
Copy to pharmacy
FORM 3-21677 REV. 11/2015
Order writer’s initials _______
Page 3 of 3
PLACE LABEL HERE
POST ANESTHESIA CARE
ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
6. STAT Diagnositcs:

 Portable CXR in PACU for central line placement
  EKG Reason: _____________________ Read by: _________________________
7. Hypertension:
 Labetalol 5 mg IV slowly over 2 min, may repeat in 10 min x ______ dose in Phase I
and/or  Apresoline (hyDRALazine) 5 mg IV slowly, may repeat q 10 min x 2 doses in Phase I
and/or  Other: _______________________________________________________________
Phase II Orders:
8.  Outpatient with physician discharge orders
Phase II Nursing Care Orders (Discontinue Phase I orders)
Monitoring per Care for Patients in Phase II (6604-02)
If on O2 upon arrival to Phase II titrate oxygen down to RA or home O2 amount maintaining O2 sat ≥ 90%
May have oral intake
Patient to remain in PACU setting for 30 min after last narcotic dose.
Call anesthesia for uncontrolled pain/nausea or Phase II discharge criteria is not met.
MEDICATION ORDERS:
Mild Pain:
Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325 mg po x 1 dose prn or may give Hycet elixir
(HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po x 1 dose prn instead of Norco.
Nausea/Vomiting: Zofran (ondansetron) 4 mg IV x 1 dose prn
9.  Observation or Inpatient Hold in Phase II
Phase II Nursing Care Orders (Discontinue Phase I orders)
Monitoring per Care for Patients in Phase II (6604-02)
If on O2 upon arrival to Phase II titrate oxygen down to RA or home O2 amount maintaining O2 sat ≥ 90%
Patient to remain in PACU setting for 30 min after last narcotic dose.
Call anesthesia for uncontrolled pain/nausea.
When discharge criteria met transfer to floor and discontinue Phase II orders.
MEDICATION ORDERS:
Mild Pain:
Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325 mg po x 1 dose prn or may give Hycet elixir
(HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po x 1 dose prn instead of Norco.
Nausea/Vomiting: Zofran (ondansetron) 4 mg IV x 1 dose prn
ADDITIONAL ORDERS:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
______________
____________
_______________________________
__________
Date
Time
Physician Signature
PID Number
Copy to pharmacy
FORM 3-21677 REV. 11/2015
Page 4 of 3