Directions for Completing Educational Requirements for ...



Directions for Completing Educational Requirements Administration of Epidural Analgesia

This education material is MANDATORY for all RNs who may care for patients receiving Epidural Infusions or Single Dose Epidural Analgesia (e.g: Duramorph).

The purpose of the education is to:

• provide information and rationales regarding changes to the care of patients receiving epidural analgesia therapy

• explain revisions to our two epidural physician order forms

-Epidural Infusion Order Form

-Epidural/Intrathecal Single Dose Analgesia Form

The entire program takes approximately 30 minutes to complete. 

• Read the pages that follow:

o Epidural Infusion Fact Sheet

o Epidural Infusion Physician Order Form (revised)

o Epidural Singe Dose Analgesia Fact Sheet

o Epidural Single Dose Physician Order Sheet (revised)

• Complete the posttest. 

• The posttest will be automatically submitted electronically. 

• A posttest score of 100% is required before caring for patients receiving epidural analgesia therapy. 

Contact:

Peter Deringer, RN, MA Nursing, NE-BC - Nursing Professional Practice Coordinator

Phone: 484 526-6123 or peter.deringer@

Epidural Infusion/PCEA

Fact Sheet

New Epidural Pump

• The Smiths Medical CADD®-Solis Pump will replace the Curlin Pump for epidural infusion and PCEA therapy.

• The Smiths Medical CADD®-Solis Pump is the same type of pump we currently use for PCA therapy. Staff has found it to be a very intuitive and easy to use pump.

• Standardization to one type of pump benefits patient safety because of increased user familiarity with this pump, along with its ease of use.

• Designated Smiths Medical CADD®-Solis Pumps will be used exclusively for epidural therapy.

• The designated epidural pumps have a bright yellow faceplate and will be loaded with only the Epidural drug library.

• Clear yellow locked boxes are available if the epidural solution contains a narcotic.

• Tubing will have a yellow stripe.

Process Changes

• Bottled epidural solutions will now come prepared in bags because of the compatibility of bags with the new pump.

• Epidural infusions will no longer be documented in IV Manage.

o Documentation will occur in AdminRx.

o The process will be the same as used for documenting peripheral PCA administration.

o You will enter “End of Shift” totals in AdminRx.

Changes to Order Form

• Epidural solutions have been standardized to 4 premixed solutions.

• Dosing orders match pump language and sequence.

• The age-related High Risk Screening criteria has been changed from:

> 65 years (old) to > 65 years with pertinent comorbidities (new).

This change takes into account that many of our senior adult patients are healthy

and do not require the additional capnography monitoring.

This change is also being made to the High Risk Criteria for our PCA order set!

The Epidural Infusion Order Form follows on page 3.

(Please be patient, it may take 15 seconds

for the document to load for viewing.)

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Epidural/Intrathecal Single Dose Analgesia

Fact Sheet

Process Changes

• For the first 24 hours post injection, single dose epidural narcotics, such as Duramorph, carry the same risks for respiratory depression and oversedation as do epidural infusions, PCEA and peripheral PCA. Therefore patient monitoring for this period will be standardized to include the same monitoring parameters currently in place for epidural infusions, PCEA and PCA.

(See order sheet below…monitoring section will look very familiar.)

• Exception:

An exception to this standardized monitoring occurs in OB where continuous pulseoximetry will be initiated if the patient falls into a high risk criteria or the physician otherwise orders it. The rationale behind this exception is that there is still an increased level of progesterone post delivery which reduces the potential for respiratory depression.

• Assessments will be documented in Horizon Clinicals (Care Manager) under Epidural-Single Dose

Changes to Order Form

• High Risk Screening criteria added

• New patient monitoring parameters defined

• Standardized and improved approach to treating side effects

The Epidural/Intrathecal Single Dose Analgesia Order Form follows on page 5.

(Please be patient, it may take 15 seconds

for the document to load for viewing.)

After reviewing the final document below, exit out of this portion of the program and complete the posttest “Take Test”.

Page 4

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