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General Operational Topics

Next Reply: Re:Ketamine PO or infusion
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Post Ketamine PO or infusion
Author: TerrellVanAkenMD
Date: Feb 13, 2012 5:51 pm
I occasionally have patients in our hospital system on Inpatient Hospice or palliative care that are on progressively higher and higher doses of narcotics by PCA. In those cases where the dose keeps climbing I have wanted to start ketamine orally (for those patients alert enough)or otherwise by infusion. Unfortunately, there is considerable concern - inspite of referencing EPERC and San Diego Hospice - that this is a high risk treatment and anesthesia and pharmacy want monitoring,etc., etc. I have pointed out the much lower doses of ketamine used for analgesic properties rather than anesthetic but everyone still seems unnerved. Can anyone cite their experience in their facilities that I can mention? I realize I will probably need to push through a formal policy but want to get moving before the "next time." Unfortunately, by the way, we do not have a PCU. (Yet!)
Replies: order by [Date] [Author] [Subject]
+ Re:Ketamine PO or infusion (by JGordon84 on 02/14/2012)
I am an RN in the Surgical Trauma ICU at Brooke Army Medical Center/SAMMC in San Antonio. We routinely care for soldiers who require extremely large doses of narcotics and still have no relief. We had a long history of trouble with ketamine infusions for those particular reasons you mentioned (treatment use- anesthesia vs. pain adjunct, provider administration availability, monitoring parameters, dose range, etc.). We finally came up with a policy and now patients are able to receive ketamine infusions in our ICUs. If you'd like, I can send you a copy of our policy so you can see what works in our facility. The biggest hurdle was making sure RNs are comfortable with infusing the medication to non-intubated patients for analgesia purposes and understanding it's unique side effect profile (and making sure they understand that it is NOT for anesthesia). Lots of teaching/training for the end users actually administering the medication.
+ Re:Ketamine PO or infusion (by Eva on 02/14/2012)
I would also be grateful to receive any policies regarding this. ezivitz@rrmc.org
Many thanks in advance.
Eva
Re:Ketamine PO or infusion (by RobWebb on 02/14/2012)
We have been using ketamine both in the hospital and at home w/ hospice, w/ good success. If anyone would like a copy of the protocol we use, you can access it at my website, comfortcarechoices.com, under 'articles', scroll down to the two ketamine articles. You can copy them and print them from there.
Re:Ketamine PO or infusion (by RobWebb on 02/14/2012)
We have been using ketamine both in the hospital and at home w/ hospice, w/ good success. If anyone would like a copy of the protocol we use, you can access it at my website, comfortcarechoices.com, under 'articles', scroll down to the two ketamine articles. You can copy them and print them from there.
CAPC NEW TOOL: Ketamine Orders for Refractory Pain (by PCaines on 02/15/2012)
CAPC has posted a new tool, "Ketamine Orders for Refractory Pain" from Froedtert Hospital for your guidance and use:

To download the file, copy and paste this link into your browser's address bar:

http://www.capc.org/tools-for-palliative-care-programs/clinical-tools/

Under the section entitled, "Templated Order Forms"

Download the file entitled:
Ketamine Order Form (Froedtert)

Thank you,
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