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- Basil Rodgers
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1 DRUG AND TREATMENT Condition/Status Patient Status (WCH) Patient Status: Inpatient Update Resident Team C (DEF)* A B X Vital Signs Vital Signs Q4H, Do not wake for vitals (DEF)* DAILY Q4H Blood Pressure Measurement Activity Activity Up Ad Lib, ASDIR (DEF)* Lobby Privileges Bedrest, ASDIR Diet Diet Order (Pediatric) High Calorie/High Protein (DEF)* High Calorie/High Protein No Concentrated Sweets (NCS) Regular--peds menu No Concentrated Sweets (NCS) Diet Message 2 snacks a day Dietary Supplement / Tube Feeding (BMCW) PO, Additional Instructions: Boost Plus (DEF)* PO, Ensure Plus PO, Pediasure (Kid Approved) PO, Carnation Instant Breakfast G TUBE, TwoCal HN (RTH) G TUBE, Peptamen 1.5 G TUBE, Peptamen 1.5 G TUBE, Pediasure (Kid Approved) Nursing Orders Notify Resident Team C after arrival to floor Page 1 of 7
2 DRUG AND TREATMENT Notify Resident Team C after arrival to floor. Weigh Patient DAILY, By 9:00 AM Isolation Order Contact Strict I & O Pulse Oximetry (Continuous) Special Instructions: Routine until SPO2 above greater than 90% overnight on room air then d/c. Comments: Q8H reposition pulse oximeter probe and assess skin that has been in contact with the sensor. Notify Provider Vital Signs/Urine Output SpO2 < 90, Special Instructions: After max ordered oxygen administration IV/INT Start Access Central Line Port per sterile technique Medications ***(NOTE)*** Heparin For Port Use Only heparin flush 10 Units/mL (pediatric) 5 ml IV PUSH inj ASDIR, PRN, Clinical Instructions: after each use heparin flush portacath 100 units/ml 5 ml IV PUSH inj ASDIR, PRN Comments: for de-access tobramycin (tobramycin (pediatric)) 10 mg/kg ped_abx IVPB Q24H Int, Clinical Instructions: May consider once-daily dosing using previous total daily dose for greater than 6 years (DEF)* 3.3 mg/kg ped_abx IVPB Q8H, Clinical Instructions: for children less than 6 years Lab Order Entry per Previous CPOE Tobramycin level: 12 hour level for daily dosing. (DEF)* Tobramycin level Peak after 3rd dose 1 hour post for Q8 and Q12 frequency and trough 1 hour prior to fourth dose for Q8 and Q12 frequency Lab Order Entry per Previous CPOE Tobramycin level: Routine Q week trough for Q8 and Q12 dose Lab Order Entry per Previous CPOE Tobramycin Level QWEEK at hour 1 for Q24H dose. (DEF)* Tobramycin Level QWEEK at hour 2 for Q24H dose. Tobramycin Level QWEEK at hour 12 for Q24H dose. Tobramycin Level QWEEK at hour 18 for Q24H dose. ceftazidime (Fortaz (pediatric)) 50 mg/kg ped_abx IVPB Q8H Comments: Max 2g/dose ticaricillin-clavulanate (Timentin (pediatric)) 100 mg/kg ped_abx IVPB Q6H Comments: Max 4.5g/dose Page 2 of 7
3 DRUG AND TREATMENT piperacillin-tazobactam (Zosyn (pediatric)) 100 mg/kg ped_abx IVPB Q6H Comments: Max 4.5g/dose dosing per piperacillin component imipenem-cilastatin (Primaxin (pediatric)) 25 mg/kg ped_abx IVPB Q6H Comments: Max 1 g/dose ciprofloxacin (Cipro (pediatric)) 15 mg/kg liquid PO Q12H, Clinical Instructions: Max 750 mg/dose (DEF)* 20 mg/kg liquid PO Q12H, Clinical Instructions: Max 750 mg/dose 250 mg tab PO Q12H, Clinical Instructions: Max 750 mg/dose 500 mg tab PO Q12H, Clinical Instructions: Max 750 mg/dose 15 mg/kg ped_abx IVPB Q12H, Clinical Instructions: Max 400 mg/dose 10 mg/kg ped_abx IVPB Q8H, Clinical Instructions: Max 400 mg/dose levofloxacin (Levaquin (pediatric)) 10 mg/kg tab PO DAILY, Clinical Instructions: Max 750 mg/dose (DEF)* 10 mg/kg ped_abx IVPB DAILY, Clinical Instructions: Max 750 mg/dose sulfamethoxazole-trimethoprim (Bactrim suspension (pediatric)) 5 mg/kg liquid PO BID sulfamethoxazole-trimethoprim (Bactrim SS tablet (pediatric)) 1 tab PO tab BID, Clinical Instructions: Trimethoprim component (Single Strength) sulfamethoxazole-trimethoprim (Bactrim DS Tablet (pediatric)) 1 tab PO tab DS BID, Clinical Instructions: Trimethoprim component (Double Strength) sulfamethoxazole-trimethoprim (Bactrim IV (pediatric)) 5 mg/kg ped_abx IVPB BID, Clinical Instructions: Trimethoprim component azithromycin (Zithromax (pediatric)) 250 mg tab PO MWF (DEF)* 500 mg tab PO MWF cetirizine (Zyrtec (pediatric)) 5 mg tab PO DAILY, Clinical Instructions: 2-5 years (DEF)* 10 mg tab PO DAILY, Clinical Instructions: Greater than 5 years 5 mg syrup PO DAILY, Clinical Instructions: 2-5 years cyproheptadine (periactin (pediatric)) 2 mg tab PO QID (DEF)* 4 mg tab PO QID lansoprazole (Prevacid (pediatric)) 15 mg tab soluble PO DAILY, Clinical Instructions: 10 to 30 kg (DEF)* 15 mg tab soluble PO BID, Clinical Instructions: 10 to 30 kg 30 mg tab soluble PO DAILY, Clinical Instructions: Greater than 30 kg 30 mg tab soluble PO BID, Clinical Instructions: Greater than 30 kg insulin glargine (Lantus (pediatric)) unit inj SUBCUT BEDTIME insulin aspart (NovoLog (pediatric)) unit inj SUBCUT Page 3 of 7
4 DRUG AND TREATMENT ***(NOTE)*** Respiratory albuterol (Proventil Neb 0.083% (pediatric)) 2.5 mg neb inh NEB QID RT, Clinical Instructions: Prior to CPT (DEF)* 2.5 mg neb inh NEB TID, Clinical Instructions: Prior to CPT 2.5 mg neb inh NEB Q4H RT albuterol Proventil 90 mcg/inh metered dose inhaler (pediatric) 2 puff INHALE aerosol QID RT (DEF)* Comments: Prior to CPT 2 puff INHALE aerosol TID RT Comments: Prior to CPT 2 puff INHALE aerosol Q4H RT, PRN Wheezing fluticasone (Flovent 44 mcg/inh (HFA) metered dose inhaler (pediatric)) fluticasone (Flovent 110 mcg/inh (HFA) metered dose inhaler (pediatric)) fluticasone (Flovent 220 mcg/inh (HFA) metered dose inhaler (pediatric)) fluticasone-salmeterol (Advair HFA 45 mcg-21 mcg/inh inhalation aerosol) Comments: May use home medication fluticasone-salmeterol (Advair HFA 115 mcg-21 mcg/inh inhalation aerosol) Comments: May use home medication fluticasone-salmeterol (Advair HFA 230 mcg-21 mcg/inh inhalation aerosol) Comments: May use home medication dornase alfa (Pulmozyme neb (pediatric)) 2.5 mg soln NEB DAILY sodium chloride (Hypertonic Saline 6.5% Neb (pediatric)) 4 ml INHALE soln BID RT Comments: For Nebulization only. Mix 2 ml of 3% solution and 2 ml of 10% solution to make a total of 4 ml 6.5% final concentration sodium chloride. budesonide-formoterol (Symbicort 80 mcg/4.5 mcg metered dose inhaler (pediatric)) budesonide-formoterol (Symbicort 160 mcg/4.5 mcg metered dose inhaler (pediatric)) tobramycin (tobramycin neb (pediatric)) 300 mg soln INHALE Q12H RT ursodiol (ursodiol (pediatric)) 10 mg/kg soln PO TID (DEF)* 10 mg/kg soln PO BID Page 4 of 7
5 DRUG AND TREATMENT pancrelipase (Zenpep 5,000 unit (pediatric)) 5,000 unit cap PO MEALS, Clinical Instructions: Meals (DEF)* 5,000 unit cap PO, Clinical Instructions: With snacks 5,000 unit cap PO, Clinical Instructions: Meals and with snacks pancrelipase (Zenpep 10,000 unit (pediatric)) 10,000 unit cap PO MEALS, Clinical Instructions: Meals (DEF)* 10,000 unit cap PO, Clinical Instructions: With snacks 10,000 unit cap PO, Clinical Instructions: Meals and with snacks pancrelipase (Zenpep 15,000 unit (pediatric)) 15,000 unit cap PO MEALS, Clinical Instructions: Meals (DEF)* 15,000 unit cap PO, Clinical Instructions: With snacks 15,000 unit cap PO, Clinical Instructions: Meals and with snacks pancrelipase (Zenpep 20,000 unit (pediatric)) 20,000 unit cap PO MEALS, Clinical Instructions: Meals (DEF)* 20,000 unit cap PO, Clinical Instructions: With snacks 20,000 unit cap PO, Clinical Instructions: Meals and with snacks pancrelipase (Creon 6 (pediatric)) cap PO cap MEALS, Clinical Instructions: Meals (DEF)* cap PO cap, Clinical Instructions: with snacks cap PO cap, Clinical Instructions: Meals and with snacks ***(NOTE)*** Vitamins multivitamin with minerals (AquADek oral tablet (pediatric)) 1 tab PO tab DAILY multivitamin with minerals (AquADEKs Pediatric) 1 ml PO drops DAILY ***(NOTE)***PRN*** acetaminophen (acetaminophen (pediatric)) 10 mg/kg susp PO Q4H, PRN Other (see comment) (DEF)* Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. Give if GREATER than 4 hours since last dose acetaminophen given. If ineffective use ibuprofen. Do NOT administer over a total 3g/day acetaminophen. 325 mg tab PO Q4H, PRN Other (see comment) Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. Give if GREATER than 4 hours since last dose acetaminophen given. If ineffective use ibuprofen. Do NOT administer over a total 3g/day acetaminophen. 500 mg tab PO Q4H, PRN Other (see comment) Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. Give if GREATER than 4 hours since last dose acetaminophen given. If ineffective use ibuprofen. Do NOT administer over a total 3g/day acetaminophen. Page 5 of 7
6 DRUG AND TREATMENT ibuprofen (ibuprofen (pediatric)) 10 mg/kg susp PO Q6H, PRN Other (see comment) (DEF)* Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen. If acetaminophen not given or ineffective. 200 mg tab PO Q6H, PRN Other (see comment) Comments: PRN pain mild OR fever GREATER than 38.3 degrees Celsius. If last dose of acetaminophen given GREATER than 1 hour or LESS than 4 hours, may give ibuprofen. If acetaminophen not given or ineffective. Laboratory CBC with Differential. CRP CHEM 12 ESR GGT Hemoglobin A1C Vitamin A Level Vitamin E Tocopherol CF Sputum Culture Expedite/ASAP, SPUTUM, ONCE (DEF)* Expedite/ASAP, THROAT, ONCE PT INR Vitamin D IgE Sputum for AFB Expedite/ASAP, SPUTUM, ONCE HCG Screen Urine Expedite/ASAP, URINE, ONCE CBC with Differential. Timed Study, BLOOD, QWEEK Int BUN Timed Study, BLOOD, QWEEK Int Page 6 of 7
7 DRUG AND TREATMENT Creatinine Serum Timed Study, BLOOD, QWEEK Int Radiology XR Chest *2 view PA and LAT CF Exacerbation, Pending Discharge - No Respiratory Chest Physiotherapy Routine, TID, May substitute vest, for 2 treatments a day (DEF)* Routine, QID RT, May substitute vest, for 2 treatments a day Oxygen Therapy (WCH) Maintain O2 Saturation >: 92% Consults Nutrition Consult Nutrition Assessment, for intake evaluation Social Work Consult Routine, Emotional/Spiritual Support, Physician (DEF)* Routine, Other - See Special Instructions, Physician, Chronic Disease Assessment and Support Routine, Discharge Planning, Physician Routine, Other - See Special Instructions, Physician, Financial Assistance Support Physical Therapy Consult (Peds) No exercise PICC Consult-Ped Routine, PICC Line Insertion Pediatric Sedation Service Consult Routine, PICC Line Placement Consult Pharmacy Kinetics Dosing Child Life Consult-Ped Routine, Distraction Page 7 of 7
PEDIATRIC CYSTIC FIBROSIS PLAN - Phase:.
PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Per Unit Standards, with Sleeping SpO2 nightly until sat greater than 92% Daily Weight Every AM In AM on Monday, Wednesday,
Physician Orders ADULT: LEB Asthma Admit Plan. Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N Attending Physician:
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: LEB Asthma Admit Phase, When to Initiate: LEB Asthma Admit Phase Non Categorized Add To Problem List Problem: Asthma
Physician Orders PEDIATRIC: LEB Critical Care Respiratory Plan
LEB Critical Care Respiratory Plan Patient Care Cardiopulmonary Monitor T;N Routine, Monitor Type: End Tidal Co2 (DEF)* T;N Routine, Monitor Type: Transcutaneous Co2 Respiratory Care Initiate Pediatric
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available at: BMC-B BMC-D BMC-N BMC-S Activity Activity Bedrest with BRP, with assistance at nurse's discretion (DEF)* Ambulate with Assistance Diet Communication Order Patient to remain NPO while in PACU
Cystic Fibrosis: Pulmonary Exacerbations Management Guidelines
Cystic Fibrosis: Pulmonary Exacerbations Management Guidelines Inclusion Criteria: Age 1 year with cystic fibrosis admitted for a pulmonary exacerbation. Exclusion Criteria: ICU Admission Newborn with
Physician Orders PEDIATRIC: LEB Kidney Transplant Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Kidney Transplant Post Op Phase, When to Initiate: LEB Kidney Transplant Post Op Phase Admission/Transfer/Discharge
Sample. Affix patient label within this box.
Instructions for completing orders Complete pages 1-3 for General Inpatient Orders. All pathway compatible orders (indicated by ) within the General Inpatient Orders will be followed automatically. Optional
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Med/Surg without Telemetry (1) (DEF)* Patient Status: Inpatient,
PICU ADMIT DKA PLAN - Phase: Begin Immediately
- Phase: Begin Immediately Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: PICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: PICU, Pt Status: Observation
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: ALL Adult Facilities Non Categorized SUB Protocol(SUB)* SUB Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form***
Physician Orders PEDIATRIC: LEB Oral Maxillofacial Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Oral Maxillofacial Postop Phase, When to Initiate: LEB Oral Maxillofacial Post Op Phase Admission/Transfer/Discharge
PHYSICIAN ORDERS Diagnosis
PICU PROCEDURE PLAN PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Patient Care
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available ONLY at: BMC-B BMC-D BMC-N BMC-S Nursing Orders Communication Order If CVP unavailable, administer fluid boluses every 30 minutes except monitor O2 requirements Comments: Every
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available at ALL facilities Non Categorized SUB ED Chest Pain: STEMI Protocol(SUB)* SUB ED Chest Pain: STEMI Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
Available at: ALL Adult Facilities Non Categorized SUB Protocol(SUB)* SUB Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form*** Nursing Orders
Physician Orders ADULT: Asthma and Bronchitis Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Asthma and Bronchitis Phase, When to Initiate: Asthma and Bronchitis Phase Non Categorized Problem: Asthma Problem:
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: ALL Adult Facilities Non Categorized SUB ED Abdominal Pain Protocol(SUB)* ***The above subphase is available at the end of the plan*** SUB ED Abdominal Pain Protocol Lab
IDPH ESF-8 Plan: Pediatric and Neonatal Surge Annex Sample Pediatric Admission Orders 2015
Purpose: To provide guidance to practitioners caring for pediatric patients who need inpatient hospital care during a disaster. Disclaimer: This guideline is not meant to be all inclusive, replace an existing
PEDIATRIC LIFEGIFT BRAIN DEATH PLAN
PHYSICIAN S Diagnosis Weight Allergies Admit/Discharge/Transfer THIS PLAN IS TO BE ED ONLY ON THE LIFEGIFT ENCOUNTER, WITH DR LIFEGIFT AS THE ATTENDING. Patient Status Pt Status: Inpatient (Inpatient only
LIFEGIFT BRAIN DEATH PLAN
Diagnosis Weight Allergies Admit/Discharge/Transfer ***THIS PLAN IS TO BE ED ONLY ON THE LIFEGIFT ENCOUNTER, WITH DR LIFEGIFT AS THE ATTENDING*** Patient Status Pt Status: Inpatient (Inpatient only procedure)
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available ONLY at: BMC-B BMC-D BMC-N BMC-S Non Categorized Quality Measure Sepsis Bundle Admit to Inpatient Patient Status: Inpatient, Level of Care: Intensive Care (8), Diagnosis: Please
PEDIATRIC SPINE SURGERY POST-OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert IV to INT when tolerating
Physician Orders ADULT Order Set: Respiratory Failure Orders
[R] = will be ordered Height: cm Weight: kg Allergies: [ ] No known allergies [ ]Medication allergy(s): [ ] Latex allergy [ ]Other: Admission/Transfer/Discharge [ ] Patient Status Initial Inpatient Attending
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available ONLY at: BMC-B BMC-D BMC-N BMC-S Pre-Op Nursing Orders Communication Order Confirm patient has brought corresponding films for surgery (e.g. back films for back surgery, brain
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Intensive Care (8) Place in Observation Patient Status: Outpatient- Refer for Observation Status,
PEDIATRIC SPINE SURGERY POST-OP PLAN - Phase: Pediatric Spine Surgery General Orders
- Phase: Pediatric Spine Surgery General Orders PHYSICIAN S Diagnosis Weight Allergies Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert
Physician Orders PEDIATRIC: LEB NEURO SURG Surgical Spine Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Neuro Surg Spine Postop Phase, When to Initiate: LEB Neuro Surgical Spine Post Op Phase Admission/Transfer/Discharge
Physician Orders ADULT: Kidney-Panc/PancTransplant Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Kidney-Panc/Panc Transp Post Op Phase, When to Initiate: Kidney-Panc/Panc Transp Post Op Phase Vital Signs Vital
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Acute Diabetic Ketoacidosis Condition/Status ***(NOTE)*** For purpose of this DKA Regimen, DKA is considered clear only when the CO2 is GREATER than 18 meq/l and the anion gap is LESS
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available ONLY at: BMC-B BMC-D BMC-N BMC-S NEURO Intracranial Hemorrhage (Factor VII) Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Intensive Care
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available ONLY at: BMC-B BMC-D BMC-N BMC-S Intubation Phase Notify Therapy for STAT intubation SUB Rapid Sequence Induction(SUB)* ***The above subphase is available at the end of the powerplan under the
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
DRUG AND TREATMENT Intubation Phase Notify Therapy for STAT intubation Medications SUB Rapid Sequence Induction (SUB)* ***Reminder: Order SUB Rapid Sequence Induction (SUB) on a separate form*** lidocaine
ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP ADMIT PLAN - Phase: Begin Immediately/PACU
- Phase: Begin Immediately/PACU Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Pt Status:
Diagnosis: Allergies:
Patient Name: Diagnosis: Allergies: ICU Sepsis Version 5 1/11/17 This order set must be used with an admission order set if patient not already admitted. Nursing Orders Verify that cultures have been obtained
Physician Orders PEDIATRIC: LEB Eating Disorder Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Eating Disorder Admit Phase, When to Initiate: When patient arrives to unit LEB Eating Disorder Admit Phase Admission/Transfer/Discharge
PICU BRONCHIOLITIS PLAN
PICU BRONCHIOLITIS PLAN Diagnosis Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Patient Care Code
Physician Orders PEDIATRIC: LEB Stroke Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Stroke Admit Phase. When to Initiate: LEB Stroke Admit Phase Admission/Transfer/Discharge Patient Status Initial
LRI Children s Hospital
Title: Prescribing in Cystic Fibrosis Page 1 of 10 LRI Children s Hospital Prescribing in Cystic Fibrosis Staff relevant to: Clinical staff working within the UHL Children s Hospital. Team & AWP approval
Acute Stroke with Alteplase Administration Order Set
Review Due Date: 2017 October PATIENT CARE DERS Weight: Adverse Reactions or Intolerances Drug No Yes (list) Food No Yes (list) _ Latex No Yes Admission Admit to Neurology service: Dr. Critical Care Diagnosis:
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Non Categorized SUB Sub Phase (SUB)* Non Categorized Quality Measures STK Diet ED NPO Until Bedside Swallow Screen passed Nursing Orders Activate Code Stroke Vital Signs Q15MINS Int
ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP PLAN - Phase: Begin Immediately/PACU
- Phase: Begin Immediately/PACU PHYSICIAN S Diagnosis Weight Allergies Laboratory Calcium Level STAT Outpatient/PACU, T;N PTH Intact STAT Outpatient/PACU, T;N 1 of 7 - Phase: When Patient Arrives to Room
DONATION AFTER CARDIAC DEATH PLAN
DONATION AFTER CARDIAC DEATH PLAN Diagnosis Weight Allergies Patient Care Core Body Temperature Monitoring Maintain body temp 96-99 degrees Farenheit. Utilize Hyper/Hypothermia blanket prn Insert Gastric
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available ONLY at: BMC-A BMC-B BMC-C BMC-D BMC-N BMC-S BMC-T Non Categorized SUB (SUB)* SUB Alert Protocol(SUB)* SUB Alert Protocol Lab Tests(SUB)* Quality Measure Sepsis Bundle Nursing
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Bedrest STRICT Bedrest Up to
ADMIT DIABETIC KETOACIDOSIS (DKA) PLAN - Phase: Begin Immediately/Emergency Center
- Phase: Begin Immediately/Emergency Center Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Requested Location: MICU, Pt Status: Inpatient (LOS > 2 midnights) Requested Location: 5E
Pediatric Outpatient Surgery Plan - Diagnostic/Pre-Op Orders
Pediatric Outpatient Surgery Plan - Diagnostic/Pre-Op Orders Diagnosis Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Request for Outpatient Services Location: Outpatient Surgery Communication Misc
***SPECIAL CONSIDERATION:
ADULT ANESTHESIA POST-OP OUTPATIENT SURGERY PLAN Dx PHYSICIAN S Weight Allergies DETAILS Admit/Discharge/Transfer Return Patient to PACU Patient Care ***Patients who are at high risk for obstructive sleep
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT *****ALSO ORDER SUB ACUTE DKA IV FLUIDS REGIMEN & SUB ACUTE ELECTROLYTE REPLACEMENT on separate forms ***** Condition/Status For purpose of this DKA Regimen, DKA is considered clear
IR Central Venous Access [ ] Pre Procedure
![IR Central Venous Access [ ] Pre Procedure](/thumbs/90/104119758.jpg "IR Central Venous Access [ ] Pre Procedure")
IR Central Venous Access [1050200001] Pre Procedure Case Request/Scheduling Procedure Enter IR Case Request if not already completed (All hospitals except Grant Medical Center) [ ] Case Request IR Lab
INPATIENT INTERVENTIONAL RADIOLOGY PLAN - Phase: Pre-Procedure Orders
- Phase: Pre-Procedure Orders DETAILS Patient Care Obtain Consent If one is not present on chart today. Vital Signs Per Policy Insert Peripheral Line T;N, Start IV on right side If left radial access is
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Discharge Anticipated in 24 Hour (Patient Discharge Anticipated in 24 Hours) Patient
UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
COPD PLAN UMC Health System PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest
Physician Orders Pediatric: LEB ED Asthma Plan
LEB ED Triage Standing SOB/Wheeze Asthma Non Categorized Criteria: Patients greater than 2 years of age with a history of asthma or airway active disease or two or more previous illnesses treated with
THROMBOLYTIC THERAPY FOR PERIPHERAL OCCLUSION
THROMBOLYTIC THERAPY FOR PERIPHERAL OCCLUSION PHYSICIAN S Diagnosis Weight Allergies Admit/Discharge/Transfer ***PROVIDER MUST CHECK MEDICATION LIST PRIOR TO PLACING THESE S*** Patient Care Vital Signs
UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
PHYSICIAN S Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: NICU, Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Pt Status: Inpatient
Physician Orders ADULT: Sickle Cell Inpatient Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Sickle Cell Inpatient Phase, When to Initiate: When patient arrives to unit Sickle Cell Inpatient Phase Admission/Transfer/Discharge
Bariatric Surgery Post Op Plan PACU Phase
Bariatric Surgery Post Op Plan PACU Phase PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Code Status
CBC with Differential. PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Non Categorized SUB ED Snakebite Protocol (SUB)* Non Categorized ***(NOTE)*** This plan is designed to be used as part of a larger plan, not independently. Please do NOT order individually.
RITUXIMAB RHEUMATOLOGY VASCULITIS
. PHYSICIAN (Patient Sticker) ORDER SET : CDH 208-237 Approved - Page 1 of 5 Patient: DOB: Gender: Patient Phone #: Height: Weight: Diagnosis: ICD-10 Code: Treatment Start Date: Provider Facility Name:
Physician Orders PEDIATRIC: LEB NEURO Epilepsy Monitoring Unit Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Neuro Epilepsy Monitoring Unit Admit Phase, When to Initiate: LEB Neuro Epilepsy Monitor Unit Admit Phase Non Categorized
OB/GYN ANTEPARTUM PLAN
OB/GYN ANTEPARTUM PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Bedrest STRICT Bedrest Up to Bedside Commode Only
Cumulative Math Practice Worksheet
Name: Date: Use the following to answer questions 1-3: Fill in the blank for each pair of ratios to form a proportion: 1. How many capsules are needed to fill a prescription for three days for mefenamic
Children s Hospital, LHSC Cystic Fibrosis: Paediatric Clinic
Children s Hospital, LHSC Cystic Fibrosis: Paediatric Clinic Patient Report and Review NAME: DATE OF VISIT: Please complete the following information about details of your CF Health care since your last
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked
Available at: BMC-B BMC-D BMC-N BMC-S Condition/Status ***(NOTE)***For purpose of this DKA Regimen, DKA is considered clear only when the CO2 is GREATER than 18 meq/l and the anion gap is LESS than 12
Card Open Heart POD1 POD3 Plan Post Op Day 1
Day 1 PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Transfer Patient Transfer to: Floor, Pt Status: Inpatient (LOS > 2 midnights) Vital Signs q2h, POD 1 Vital Signs q2h for 24 hours then per unit
Study Orders Center for Clinical Investigation
Please indicate if this visit is an INPATIENT admission or an OUTPATIENT visit Subject Legal Name: D.O.B.: Age: Medical Record #: Gender: Ethnicity: Race: Admitting Information INPATIENT or OUTPATIENT
IV Acetaminophen Pain Study for Neurosurgery Post Op Non ICU Admit Plan Begin Immediately/PACU
Post Op Non ICU Admit Plan Begin Immediately/PACU PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Request Patient Bed Requested Location: 3W, Pt Status: Inpatient (LOS > 2 midnights) Patient Condition
LYSIS OF ADHESIONS POST-OP PLAN - Phase: PACU Phase
- Phase: PACU Phase PHYSICIAN S Diagnosis Weight Allergies Communication Place Device at Bedside Confirm there are 3 x Aliquots of 0.2% Ropivacaine. 2 x Medfusion Infusion pumps. Confirm 3 x PF Aliquots
Emergency Department Protocol Initiative
Emergency Department Protocol Initiative ACUTE ASTHMA MANAGEMENT TOOLKIT March 2006 Provincial Emergency Services Project PHYSICIAN ORDER TEMPLATE FOR CTAS LEVEL 1 ASTHMA ADULT PEDIATRIC Date: Site: Arrival
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT PACE Vital Signs Vital Signs PRE-OP, On arrival Nursing Orders Initiate ANES Anesthesia PACE PowerPlan Weigh Patient PRE-OP Pre op. Provide patient with incentive spirometry teaching
Physician Orders ADULT: Acute MI/Acute Coronary Syndrome Adult Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Acute MI/Acute Coronary Syndrome Adult Phase, When to Initiate: Acute MI/Acute Coronary Syndrome Adlt Phase Non Categorized
EPIDURAL / INTRATHECAL POST-OP PLAN
EPIDURAL / INTRATHECAL POST-OP PLAN Diagnosis Weight PHYSICIAN S Allergies Patient Care Vital Signs Per Unit Standards, PLUS check and record RR q1h x 12, then q2h x 6, until 24h following narcotic administration.
DOWNTIME Physician Order CARD CHF Heart Failure
DOWNTIME Physician Clinical Category ADT/Comm unication Patient Status ASC Extended Recovery Observation Services Inpatient Admission CCU Admit as Inpatient History and Physical by House Physician Vital
Calculation of Medications for Special Populations Based on Body Weight and Patient Age
West Los Angeles College Worksheet #10 Calculation of Medications for Special Populations Based on Body Weight and Patient Age Calculate the following doses. Use the labels provided as appropriate. 1.
PHYSICIAN S ORDERS Page 1 of 5 PNEUMONIA. Resuscitation (Code)Status: Admit to: Diagnosis: Pneumonia Other: Consult:
Inpatient Observation Bed Type: Med/Surg PHYSICIAN S ORDERS Page 1 of 5 Satellite Telemetry Telemetry ICU Resuscitation (Code)Status: Admit to: Diagnosis: Pneumonia Other: Consult: Condition: Stable Guarded
Neurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other
![Neurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other](/thumbs/96/128298591.jpg "Neurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other")
Neurosurgery Pre-Op [1710] Patient Name MRN General Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT Inpatient Only Procedure (Single Response) ( ) Admit to Inpatient Diagnosis:
1. Attending Physician: Dr Syn Pager: Cell: Co-Morbidities:
BARIATRIC SURGERY IMMEDIATE POST-OP PLAN (Includes Post Op Day 1) Denotes order requirement Antibiotic administered in the OR at: 1. Attending Physician: Dr Syn Pager: 740-6545 Cell: 438-9415 2. To remain
PEDIATRIC ACUTE ASTHMA SCORE (P.A.A.S.) GUIDELINES. >97% 94% to 96% 91%-93% <90% Moderate to severe expiratory wheeze
Inclusion: Children experiencing acute asthma exacerbation 24 months to 18 years of age with a diagnosis of asthma Patients with a previous history of asthma (Consider differential diagnosis for infants
Physician Orders PEDIATRIC: : LEB ED Trauma (Major) Plan
LEB ED Standing Orders Trauma (Major) Ph Non Categorized Criteria: Patients between 0-18 years of age that present with a Major Trauma that meet LeBonheur Trauma stat or Trauma Alert Guidelines.(NOTE)*
EFFECTIVE DATE: 01/2007 REVISED: 07/2008, 6/11, 3/12, 8/12, 1/15. Purpose:
1 TITLE/DESCRIPTION: DEPARTMENT: PERSONNEL: Rapid Response Team (RRT) Patient Care Services RN s and RT s EFFECTIVE DATE: 01/2007 REVISED: 07/2008, 6/11, 3/12, 8/12, 1/15 Purpose: A group of select health
Gabapentin Research Pain Study for Ortho Total Knee Replacement Post-Op Plan - PACU Ortho Phase
Total Knee Replacement Post-Op Plan - PACU Ortho Phase Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: 3W, Pt Status: Inpatient (LOS > 2 midnights) Patient Condition
OB/GYN CESAREAN SECTION POST-OP PLAN - Phase: General Orders
- Phase: General Orders DETAILS Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom Privileges Bedrest Up to Bedside Commode
BARIATRIC SURGERY POST-OP PLAN - Phase: PACU Phase
- Phase: PACU Phase Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Pt Status: Inpatient (Inpatient
Sample. Affix patient label within this box.
Instructions for completing orders: Determine PRAM Clinical Score as per the Alberta Acute Childhood Asthma Pathway for Emergent/Urgent Care and select orders based on PRAM Score. Custom orders can be
Medications for Managing COPD in Hospice Patients. Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources
Medications for Managing COPD in Hospice Patients Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources Goal of medications in COPD Decrease symptoms and/or complications Reduce frequency
UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
PICU GENERAL PLAN UMC Health System PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Bedrest Up Ad Lib/Activity as Tolerated Strict Intake
Blue Team Survival Guide (Revised 2/27/2012, JL Goralski MD and JE Pittman MD)
Blue Team Survival Guide (Revised 2/27/2012, JL Goralski MD and JE Pittman MD) Rounds: - Meet either at desk at 5 Children s (weekdays at 8:30AM) or in 5 Children s Conference Room in CICC (weekends at
Sample. Fractured Hip Post-Operative Orders. Legend < Mandatory fields o Optional fields. Height Allergies: List or o Up to date in electronic system
Legend Mandatory fields o Optional fields Height Allergies: List or o Up to date in electronic system cm Weight Diagnosis kg Date (yyyy-mon-dd) Time (hh:mm) Anticipated Date Of Discharge (ADOD) o Greater
PEDIATRIC ARGININE CLONIDINE STIMULATION TEST PLAN
Diagnosis Weight Allergies Patient Care Arginine Clonidine Stimulation Test Guid (Arginine Clonidine Stimulation Test Guidelines) See Reference Guidelines. Vital Signs Routine, q1h, With BP, During the
PHYSICIAN ORDER SET : Patient: DOB: Gender: Patient Phone #: Height: Weight:
. (Patient Sticker) CDH 208-203 Approved 2/18 - Page 1 of 5 Patient: DOB: Gender: Patient Phone #: Height: Weight: Diagnosis: ICD-10 Code: Treatment Start Date: Provider Facility Name: Ordering Provider:
WHS POSTOPERATIVE POWERPLAN CHANGES
Medications simplified and standardized to improve safety and effectiveness in the management of pain, itching, nausea/vomiting. Management: o The Anesthesiologist will continue to manage pain in the PACU.
SCVMC RESPIRATORY CARE PROCEDURE
Page 1 of 8 Rev. - 11/99, 11/05, 4/11 R-NC - 08/99,08/00, 04/03,10/08,04/09, 07/11, 6/12 B7180-43 OBJECTIVE Continuous Nebulization allows for continuous, controlled drug delivery to the lung, avoiding
Physician Orders PEDIATRIC: LEB Ortho Accelerated Posterior Spinal Fusion Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Ortho Accelerated PSF Post Op Initial Phase, When to Initiate: Initiate Powerplan Phase Phase: LEB Ortho Accelerated
Attach patient label here. Physician Orders ADULT: Palliative Care Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Palliative Care Phase, When to Initiate: Palliative Care Phase Admission/Transfer/Discharge Patient Status Initial
Physician Orders LEB PICU Status Epilepticus Plan. [ ] No known allergies
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Height: cm Weight: kg Allergies: [ ] No known allergies [ ] Initiate Powerplan Phase T;N, Phase: LEB PICU Admit Phase Admission/Transfer/Discharge [ ] Admit Patient to Dr. [ ] Admit Status: [ ] Inpatient
Disclosure. Case. Objectives. Case Continued. Inhalers. Asthma: A GINA Update to the NAEPP 2007 Guidelines 1/20/2015
Disclosure Asthma: A GINA Update to the NAEPP 2007 Guidelines Robert (RC) Hellinga, Pharm.D. PGY 1 Pharmacy Resident Wolfson Children s Hospital/Baptist Health I do not have a vested interest in or affiliation