Reducing pages to clarify ‘duplicate orders’

Hierarchies being added to common anxiety medications

To reduce the number of times nurses need to page providers to clarify “duplicate orders” for PRN medications for anxiety and agitation, hierarchies will be added to commonly used medications for anxiety and agitation, starting Jan. 20.

These hierarchies will function just like the ones for pain, nausea and fever, and will protect the organization from Joint Commission citations and nurses from practicing outside of their scope.

PRN Agitation Medication Hierarchy
Not a protocol; provider has individually ordered pain medication

1. Second generation (atypical) antipsychotic (i.e. quetiapine, risperidone, olanzapine, aripiprazole, ziprasidone, paliperidone, etc.)
2. First generation antipsychotic (i.e. haloperidol, perphenazine, etc.)
3. Benzodiazepine (lorazepam, diazepam, midazolam, clonazepam, chlordiazepoxide, etc.)
4. Other agents ordered for agitation

Start with #1 (if ordered), move in descending order for continued or escalating agitation after 30 minutes. If there are ANY questions, clarify intent with provider.

PRN Anxiety Medication Hierarchy
Not a protocol; provider has individually ordered pain medication

1. Hydroxyzine
2. Benzodiazepines (lorazepam, diazepam, midazolam, clonazepam, chlordiazepoxide, etc.)
3. Second generation (atypical) antipsychotic (i.e. quetiapine, risperidone, olanzapine, aripiprazole, ziprasidone, paliperidone, etc.)
4. Other agents ordered for anxiety

Start with #1 (if ordered), move in descending order for continued or escalating agitation after 30 minutes. If there are ANY questions, clarify intent with provider.

If you have questions or concerns about this, please contact Matt Tanner in pharmacy: 4-9960 or matthew.tanner@salemhealth.org.