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PHYSICIAN ORDER SHEET

PCA INFUSER

GOOD SHEPHERD MC / MARSHALL - MARSHALL, TEXAS

MARSHALL ORTHOPAEDICS

 

 

1. Type and Strength of Medication: 

2. Loading Dose/ Abbott: 

3. Dose Volume/ Abbott : 

4. Lock out interval / Abbott : 

5. Four hour limit setting / Abbott : 

6. Maximum hourly dose in mg/ hr : 

7.  Do not convert IV to Saline Lock until PCA has been discontinued.

8.  If patient has a saline lock, change to IV Ringers' Lactate 50 mL/hour while PCA is running.

 

_____________________________    

___ D.  Waldman, MD     ___ A. Strahan, MD      date / time

PATIENT NAME :

 form number 6760294  revised 2/1/10