Download Critical Care Delirium Management Orders

PLACE LABEL HERE
CRITICAL CARE
DELIRIUM MANAGEMENT ORDERS
(Not to be used as monotherapy for patients in substance withdrawal)
Diagnosis: ___________________________________________________
Orders with a “” are choices and are
NOT ordered unless checked. All may
be altered at physician’s discretion.
1. ICU-CAM positive per nursing assessment.
2. Verify patient’s Home Medication Reconciliation form is completed.
3. Review the patient’s current medications with the physician to identify possible pharmacologic causes
of delirium.
4. Reinforce environmental prevention therapies.
5.  Consult Hospitalist for management.
6. Medications:
If patients are receiving medications known to cause QT prolongation, Haldol® and Geodon® are
contraindicated. (Some common medications known to cause QT prolongations are Amiodarone, Cipro,
Avelox, Difulcan, Erythromycin, Geodon, Haldol, Risperdal and Mellaril).
Geodon and Haldol require a baseline QTc and monitoring of QTc q 24 hours while on therapy.
For baseline QTc greater than 500, Geodon and Haldol are contraindicated.
For 24-hour monitoring of QTc, a QTc interval greater than 500 requires discontinuation of
Geodon and Haldol orders.
Choose One: Initial starting doses will be individualized based on clinical response



Zyprexa (olanzapine) 10 mg IM now and repeat q 2-4 hours prn delirium. Max 30 mg/day.
Zyprexa Zydis (olanzapine) 10 mg po/per tube now and daily at HS
Zyprexa Zydis (olanzapine) 5 mg po/per tube now and daily at HS (for patients >65 yrs)


Geodon (ziprasidone) 10 mg IM now and repeat q 2 hours prn delirium. Max 40 mg/day.
Geodon (ziprasidone) 20 mg po/per tube BID


Haldol (haloperidol) 5 mg slow IV Push and q 6 hours prn delirium. Max 20 mg/day.
Haldol (haloperidol) 2 mg slow IV Push and q 6 hours prn delirium (for patients >65 yrs).
Max 20 mg/day.

Precedex(dexmedetomidine) drip by continuous infusion titrated 0.2-0.7 mcg/kg/hr
Other orders:_________________________________________________________________
_________________________________________________________________
__________
Date
______________
Time
*2-24341*
_____________________________________
Physician Signature
FORM 2-24341 INITIATED: 07/2008
___________
MD Number
Send copy to pharmacy _______ (initials)
Physician’s Delirium Reference
1. Evaluate change in clinical status
a. Fluid and electrolyte disturbances
b. Infection
c. Withdrawal from alcohol and sedatives
d. Rule out cardiovascular events
2. Evaluate all medications, especially medications added over the past 24-48 hours
(including drug levels where appropriate)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Anticholinergics
Sedatives/hypnotics
Analgesics –especially meperidine
Digoxin
Antiepileptic drugs
Histamine 2 Receptor Antagonists--famotidine
Corticosteroids
Fluoroquinolones—ciprofloxacin, moxifloxacin
Dopamine
Recently added medications
3. Environmental therapy
a. Encourage day time wakefulness
b. Encourage night time sleep
c. Try to keep the same staff members with patient
d. Have family member sit with patient
e. “Busy work”—Baby dolls and folding towels
f. Identify yourself to patient and give slow, clear, simple, repetititive instructions
g. Discontinue foley catheter as soon as possible
REFERENCE ONLY