Preprocedure with Moderate Sedation Standing Orders

PLACE LABEL HERE PRE-PROCEDURE with MODERATE SEDATION STANDING ORDERS

Nurse initiated standing order based on medical staff approved policy (520-29).

1. Start IV with LR, 1,000 ml at KVO rate. If patient has a history of dialysis, start IV with NS, 500 ml at KVO rate.

2. May use Xylocaine 0.5 % intradermal or topical refrigerant spray prior to starting IV.

3. Urine hCG for any menstruating female ≥ 12 years of age.

4. POC blood glucose pre-procedure for insulin-dependent diabetics or diabetics reporting signs/symptoms.  If blood glucose > 400 notify physician.  < 70 Implement Hypoglycemia Treatment Standing Orders (#2513).

______Date Time Nurse Signature Physician Signature PID Number

Copy to pharmacy

*1-33183* FORM 1-33183 REV. 08/2016 Page 1 of 1