7/14/2014 RE: Sedation scale discrepancies - Davis, Aurora

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RE: Sedation scale discrepancies
Hi, all.

I talked with Rob today, and I can take on the job of updating the order sets. However, first things first. I
need to finish updating the policy and clarify exactly what our sedation levels for calling the
team/administering narcan will be.

Speaking of which, educator people: can you tell me the details of the instructions given to RNs when the
new sedation scale rolled out? What were the parameters they were given for calling providers and
administering narcan?

Thanks,
Aurora

Aurora Davis, RN, BA, BSN, OCN
Relief Charge Nurse
Oncology and Bone Marrow Transplant Unit
University of Colorado Hospital
Aurora.Davis@uchealth.org
From: Montgomery, Robert <Robert.Montgomery@ucdenver.edu>
Sent: Sunday, April 27, 2014 12:53 PM
To: Davis, Aurora
Cc: Swedhin, Amanda M; Hammond, Kyle R; Krumbach, Barbara; Buffington, Annsley J
Subject: RE: Sedation scale discrepancies

Aurora
No, nothing in the works for the order sets. However this sounds like a good time to get it done. I originally
worked with Epic to create the PCA and PCEA order sets. I can submit the changes, but am also happy to let
someone else have the responsibility if they wish?

-Rob

Robert Montgomery, ND, RN-BC, ACNS-BC
Associate Prof essor of Anesthesiology
Davis, Aurora
Thu 5/1/2014 1:51 PM
Sent Items
To:Montgomery, Robert <Robert.Montgomery@ucdenver.edu>;
Cc:Swedhin, Amanda M <Amanda.Swedhin@uchealth.org>; Hammond, Kyle R <Kyle.Hammond@uchealth.org>; Krumbach,
Barbara <Barbara.Krumbach@uchealth.org>; Buffington, Annsley J <Annsley.Buffington@uchealth.org>;
7/14/2014 RE: Sedation scale discrepancies - Davis, Aurora
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Clinical Coordinator Acute Pain Service
720-848-6706 of f ice
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From: Davis, Aurora [mailto:Aurora.Davis@uchealth.org]
Sent: Friday, April 25, 2014 6:38 PM
To: Montgomery, Robert
Cc: Swedhin, Amanda M; Hammond, Kyle R; Krumbach, Barbara; Buffington, Annsley J
Subject: FW: Sedation scale discrepancies

Rob,

I'm updating the sedation scale in the PCA policy, but do you know if anyone is updating the physician
order sets, too? They still say to call the MD if the sedation level is 2 and to administer narcan if the
sedation level is 1.

Thanks,
Aurora
Aurora Davis, RN, BA, BSN, OCN
Relief Charge Nurse
Oncology and Bone Marrow Transplant Unit
University of Colorado Hospital
Aurora.Davis@uchealth.org
From: Hammond, Kyle R
Sent: Thursday, April 3, 2014 5:13 PM
To: Swedhin, Amanda M; Krumbach, Barbara; Buffington, Annsley J
Cc: Hutches, Karee A; Davis, Aurora
Subject: RE: Sedation scale discrepancies

Great. THANK YOU!

Curios if you are you looking into Physician order sets for PCA as well or should we be contacting somebody else
for that portion?

Kyle Rose Hammond, RN, BSN, OCN
Clinical Nurse Educator
Bone Marrow Transplant and Oncology Units
Kyle.Hammond@UCHealth.org
720-848-0422

The Department of Professional Resources improves lives by empowering healthcare professionals
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From: Swedhin, Amanda M
Sent: Thursday, April 03, 2014 4:45 PM
To: Krumbach, Barbara; Buffington, Annsley J
Cc: Hammond, Kyle R; Hutches, Karee A; Davis, Aurora
Subject: RE: Sedation scale discrepancies

Thank you for letting us know! We have several policies to look at revamping related to painAurora is planning
on working on this policy next, so I have ccd her in on this as well.

From: Krumbach, Barbara
Sent: Thursday, April 03, 2014 3:16 PM
To: Buffington, Annsley J; Swedhin, Amanda M
Cc: Hammond, Kyle R; Hutches, Karee A
Subject: RE: Sedation scale discrepancies

Thanks. I do not think the PCA Policy has been updated. I know Rob is aware of this and has not had time to do
it. We need to look at several policies here in the month for April and get updated.

Barb.

From: Buffington, Annsley J
Sent: Thursday, April 03, 2014 3:13 PM
To: Swedhin, Amanda M; Krumbach, Barbara
Cc: Hammond, Kyle R; Hutches, Karee A
Subject: FW: Sedation scale discrepancies

Hi Max and Barb,

Kyle and I were alerted to this today!! Were wondering if you are aware that the Moline Roberts Scale indicates
reverse order of sedation as indicated in policy and PCA order sets. Moline Roberts score of 1 indicates wide
awake whereas policy and PCA order set states turn off PCA with a sedation level of 1 = unarousable. Just
wanted to make you aware. Thanks!!

Annsley J Buffington RN, BSN, OCN
Clinical Nurse Educator
Oncology/BMT
Annsley.Buffington@uchealth.org
720-848-4940
7/14/2014 RE: Sedation scale discrepancies - Davis, Aurora
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We Improve Lives by Empowering Healthcare Professionals to Influence Quality Care
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From: Hutches, Karee A
Sent: Thursday, April 03, 2014 2:54 PM
To: Buffington, Annsley J; Hammond, Kyle R
Subject: Sedation scale discrepancies


On EPIC Moline roberts scale: 1 for sedation states; none to minimal BUT the UCH policy and PCA order
set has this:



University of Colorado Hospital Policy and Procedure
Patient Controlled Analgesia (PCA): Adult and Pediatric



Sedation scale
5 = wide awake 3 = sleeping arousable 1 = not able to arouse
4 = drowsy 2 = difficult to arouse


Just noticed this while taking the PCA quiz.

Karee, Ellen B., and Barb