Provider Orders
(Provider must sign all orders-check and/or fill in appropriate blanks)
Date__________Time___________________
VPH CNS Depressant Protocol Orders
Last modified: 2007-09-13 09:29:25.0
Use CNSDP Protocol for Hypnosedative, Benzodiazepine or Barbiturate Withdrawal
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NURSING: cns1) criteria for initiation of CNSDP protocol is based on pt's report &/or
documented history of recent or long term use of CNS Depressants &/or verification of + UDS of
same substances
NURSING: cns2) initiate the Central Nervous System Depressant Protocol if patient meets
criteria
NURSING: cns3) assess pt. & record v/s & signs/symptoms q 4 hours (observe for objective signs)
NURSING: cns4) at 1st sign of progression from mild to moderate/severe withdrawal signs, begin
q1h assessment & v/s schedule & document on CNSDP flowsheet; if all signs return to mild
status, resume q4h assessment & v/s schedule
NURSING: cns5) if patient does not display signs/symptoms of cns depressant withdrawal within
72 hours, discontinue the protocol
NURSING: cns6) initiate phenobarbital load when pt. displays at least 2 moderate to severe signs
from the list on the CNSDP Flowsheet
NURSING: cns7) continue to assess pt. and record v/s hourly prior to the administration of each
phenobarbital dose
NURSING: cns8) discontinue phenobarbital load when pt. displays 2 or more of the following
signs indicating intoxication: pt. asleep and difficult to arouse, ataxic (unsteady gait), dysarthric
(thick tongue), nystagmus, labile mood
SEIZURE PRECAUTIONS
Phenobarbital Load (CAUTION: Phenobarbital is not recommended for use in pregnancy)
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PHENOBARBITAL (PHV PROTOCOL) (e 2000mg; if baseline bp =/< 100/70, hold for bp =/< 80/50,
if baseline bp > 100/70, hold for bp < 90/60; p < 60, r < 12begin 120mg q1h when cnsdp scoring
criteria met & d/c when pt displays min of 2 signs of intox per prot; max cum dose nt)
Date/ Time ___________________
Provider Signature _________________________ Print Name_____________________Beeper#_______