Palliative Care Order Set - Stratis Health

Palliative Care
Annotations Committee on Evidence-Based Practice/May 6, 2008
(Miller, 2004a [R])
Medications
• Lorazepam 0.5-2 mg by mouth, sublingual or IV at bedtime and every 2 hours as needed
• Zolpidem 5-10 mg by mouth at bedtime as needed
• Temazepam 15 mg at bedtime as needed, may repeat 1 dose as needed
For elderly
• Trazadone 25-100 mg by mouth at bedtime, may repeat 1 dose as needed
(Center for Advancement of Palliative Care, 2007b [R]; Kaye, 1999 [R]; Miller, 2004b [R]; Palliative Care
Pocket Consultant, 2001 [R])
22. Urinary Incontinence and Retention Management
Because indwelling urinary catheters can lead to infection and trauma to the urethra and bladder, their use
is generally discouraged. In palliative care, however, the clinician and patient must balance the potential
risks of catheter use against benefits. Indwelling catheters can help to prevent moisture in the perineal area,
allowing an environment more conducive to healing pressure ulcers and other challenging skin problems.
Patients too weak to use a commode may appreciate the ability to remain dry and free of distressing odor.
Patients with urinary retention need catheters in order to drain urine. Before using, however, assess for
treatable causes of retention, including medication side effects and constipation.
Use the smallest diameter catheter with smallest balloon possible, to reduce leakage around the catheter as
well as bladder spasm. Bladder spasms may respond to anticholinergic medications; use with caution in
older patients because of the risk of delirium.
Orders
• Rectal examination to rule out impaction
• Use smallest diameter catheter with smallest balloon available
• For cramps or bladder spasms
- Belladonna/opium suppositories, 1 twice daily to 4 times daily
- Oxybutynin 2.5 to 5 mg by mouth twice daily to 4 times daily
(Center for Advancement of Palliative Care, 2007a [R]; Reuben, 2007 [R])
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