2. Ordered parameters and notify thresholds
The following are this patient’s pain goal and opioid-safety notify thresholds. They are written to be acted on without prior knowledge of the patient. Confirm each against the current physician orders and plan of care at every visit and update if the order changes; where a specific order differs from a figure here, the order governs.
Ordered parameters — notify thresholds (self-contained) A nurse covering this patient acts on the values below without prior knowledge of the patient. Confirm against the current physician orders and plan of care each visit; the figures here are the standing thresholds unless the order states otherwise. Functional pain goal: the individualized goal is pain controlled enough to meet the ordered functional target (state it — for example, able to transfer, sleep, or participate in therapy), not a single number for everyone. Notify the provider for pain persistently above the goal despite the ordered regimen. Sedation and respiratory rate (the opioid-safety vitals): assess sedation (using the ordered sedation scale) and respiratory rate before and after opioid doses. Hold the opioid and notify for increasing sedation (difficult to rouse) or a respiratory rate below the ordered threshold (commonly <10–12 breaths per minute — confirm the order). Increasing sedation precedes respiratory depression. Naloxone: naloxone must be present, not expired, and the caregiver trained in its use for any patient on opioids. Notify if naloxone is unavailable or expired. Opioid-induced constipation: a bowel regimen accompanies scheduled opioids. Notify for no bowel movement within the ordered interval (commonly >3 days), or for abdominal distension, pain, or vomiting suggesting obstruction (cross-reference Gastrointestinal). Breakthrough and escalation: use breakthrough medication within the ordered limit; notify for breakthrough use exceeding the ordered frequency or a request to escalate beyond the ordered regimen. Emergency signs (give naloxone per order, then activate EMS): unarousable or minimally responsive, respiratory rate below the threshold or shallow or absent breathing, or pinpoint pupils with depressed consciousness — opioid-induced respiratory depression. Central-nervous-system depressant caution: notify for concurrent alcohol or other sedating agents (for example benzodiazepines) with opioids, which raises the respiratory-depression risk. |
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