PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
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- Peregrine Curtis
- 6 years ago
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1 DRUG AND TREATMENT Available ONLY at: BMC-B BMC-D BMC-N BMC-S PACE Nursing Orders ***NOTE*** Select the "Transfuse Blood Previously on Hold" order below, to transfuse blood on hold. Transfuse Blood Previously on Hold Laboratory ORSA NA Amplification Pre-Op, NASAL, ONCE Complete Blood Count Urinalysis with Microscopic Pre-Op, URINE, ONCE Comments: Clean catch Comprehensive Metabolic Panel Prothrombin INR Partial Thromboplast Time Hemoglobin A1C Routine, Blood, ONCE Comments: For known diabetics ***NOTE*** For possible latex allergic patients Latex IgE Comments: For possible latex allergic patients Blood Bank ***NOTE*** If wanting to place specific blood products on Hold, select the GEN Blood Administration subphase and select your products with a Transfusion Priority of Hold GEN Blood Administration(SUB)* ***Reminder: Order GEN Blood Administration (SUB) on a separate form.*** Radiology XR Knee L 2 view XR Knee R 2 view XR Hip L 2 view w/ Pelvis XR Hip R 2 view w/ Pelvis Page 1 of 15
2 DRUG AND TREATMENT XR Hip L 1 view XR Hip R 1 view XR Femur R, AP femur to include hip & knee joint on 36 inch cassette XR Femur L, AP femur to include hip & knee joint on 36 inch cassette Pre Op Non Categorized Surgical Care Quality Measures Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Med/Surg with Telemetry (3) Vital Signs Vital Signs Q4H (DEF)* Q2H Neurovascular Check Monitoring Q4H, 24 hour (DEF)* Q2H, 24 hour +26 Hours Neurovascular Check Monitoring Q8H, If stable. If not stable, continue with Q4H Activity Activity Up Ad Lib Diet NPO NPO except for meds with sip of water Nursing Orders Consent on Chart Clip and Prep Operative site, PRE-OP, Special Instructions: Chlorhexidine Gluconate (HIBICLENS) & electric clippers to operative site (DEF)* Operative site, PRE-OP, Special Instructions: Povidone Lodine (BETADINE) surgical scrub & electric clippers to operative site Sequential Compression Device Knee high at 40 mmhg NON-operative extremity for total knee patients(def)* Knee high at 40 mmhg to bilateral legs for Total Hip Replacement patients preoperative Elastic Stockings Apply knee high elastic stocking to both legs for total hip (DEF)* Apply knee high elastic stocking to non-operative leg for total knee Page 2 of 15
3 DRUG AND TREATMENT Void on Call ***NOTE*** Select the "Transfuse Blood Previously on Hold" order below, to transfuse blood on hold Transfuse Blood Previously on Hold Medications Reason Beta Blocker Not Administered Peri-Operatively Reason: Allergy (DEF)* Reason: Bradycardia (HR less than 50 bpm) Reason: Hypotension (SBP less than 100 mmhg) Reason: Concurrent use of IV inotropic med Reason: Other reason charted (MD/APN/PA/PharmD) tranexamic acid 1 g inj IVPB PRE-OP (DEF)* Comments: GIVEN ONLY in SURGICAL HOLDING/OR Suite 2 g inj IVPB PRE-OP Comments: GIVEN ONLY in SURGICAL HOLDING/OR Suite Antibiotics ***NOTE*** For ordering weight based antibiotics: 80 kg = 176 lbs 100 kg = 221 lbs cefazolin (Ancef) 1 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is LESS than 80 kg unless allergic to Penicillin or has positive MRSA PCR (DEF)* Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 60 minutes of incision time. Infuse over 30 minutes. 2 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is between 80 kg to 120 kg unless allergic to Penicillin or has positive MRSA PRC Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 60 minutes of incision time. Infuse over 30 minutes. 3 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is GREATER than 120 kg unless allergic to Penicillin or has positive MRSA PRC Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 60 minutes of incision time. Infuse over 30 minutes. Reason for Vancomycin Use Inpt stay for 24 hrs before procedure (DEF)* Beta-lactam allergy High risk: acute inpt hospital past yr High risk: nsg home or ECF in past year Chronic wound care or dialysis Increased MRSA rate MRSA colonization or infection Patient undergoing valve surgery Transfer from inpt hosp after 3 day stay Other Reason Page 3 of 15
4 DRUG AND TREATMENT vancomycin 1 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is LESS THAN 100 kg if allergic to Penicillin or has positive MRSA PCR (DEF)* Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 120 minutes of incision time 1.5 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is GREATER than or EQUAL to 100 kg if allergic to Penicillin or has positive MRSA Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 120 minutes of incision time clindamycin Cleocin 600 mg bag IVPB PRE-OP Comments: To be given in surgical holding - if allergic to Penicillin or Vancomycin. Begin within 60 minutes of incision time Laboratory Complete Blood Count Urinalysis with Microscopic Pre-Op, URINE, ONCE Comments: Clean catch Urine Culture Pre-Op, URINE, CLEANCATCH, ONCE (DEF)* Pre-Op, URINE, CATHETER, ONCE Comprehensive Metabolic Panel Prothrombin INR Partial Thromboplast Time ORSA NA Amplification Pre-Op, NASAL, ONCE Hemoglobin A1C Routine, Blood, ONCE Comments: For known diabetics ***NOTE*** For possible latex allergic patients Latex IgE Comments: For possible latex allergic patients Blood Bank ***NOTE*** If wanting to place specific blood products on Hold, select the GEN Blood Administration subphase and select your products with a Transfusion Priority of Hold GEN Blood Administration(SUB)* ***Reminder: Order GEN Blood Administration (SUB) on a separate form*** Radiology XR Knee L 2 view Page 4 of 15
5 DRUG AND TREATMENT XR Knee R 2 view XR Hip L 2 view w/ Pelvis Pre op ortho procedure, Pre-op, Pending Discharge - No XR Hip R 2 view w/ Pelvis Pre op ortho procedure, Pre-op, Pending Discharge - No XR Hip L 1 view Pre op ortho procedure, Pre-op, Pending Discharge - No XR Hip R 1 view Pre op ortho procedure, Pre-op, Pending Discharge - No XR Femur L, AP femur to include hip & knee joint on 36 inch cassette XR Femur R, AP femur to include hip & knee joint on 36 inch cassette Intra Op Nursing Orders Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley) (SUB) on a separate form.*** Sequential Compression Device Knee high at 40 mmhg to bilateral leg intraoperative (DEF)* Thigh high at 40 mmhg to bilateral leg intraoperative Knee high at 40 mmhg on non operative leg intraoperative Cryotherapy Special Instructions: To Operative Area Medications Intra-Op Medication (Strength Medication) Kenalog 40 mg PERIOP_ONCE Comments: 40 mg (2 ml) Local Anesthetic Agents Marcaine 0.25% PF inj soln 1 dose INFILTRATE PERIOP_ONCE Comments: For intraoperative local injection Marcaine 0.5% PF inj soln 1 dose INFILTRATE PERIOP_ONCE Marcaine 0.25%-Epinephrine 1:200,000 MDV inj 1 dose INFILTRATE PERIOP_ONCE Marcaine 0.5%-Epinephrine 1:200,000 MDV inj 1 dose INFILTRATE PERIOP_ONCE Xylocaine 1% MDV inj soln 1 dose INFILTRATE PERIOP_ONCE Xylocaine-MPF 2% injectable solution 1 dose INFILTRATE PERIOP_ONCE Comments: For intraoperative local injection Page 5 of 15
6 DRUG AND TREATMENT Xylocaine 1%-epinephrine 1:100,000 MDV inj 1 dose INFILTRATE PERIOP_ONCE Comments: For intraoperative local injection Xylocaine 1%-epinephrine 1:200,000 MPF inj 1 dose INFILTRATE PERIOP_ONCE Naropin (5mg/mL) 1 dose INFILTRATE PERIOP_ONCE Lidocaine 0.5% PF 1 dose INFILTRATE PERIOP_ONCE Comments: For intraoperative local injection Irrigants Ancef 1g/500 ml NS 500 ml IRRIGATE PERIOP_ONCE Ancef 2g/3000 ml NS 3000 ml IRRIGATE PERIOP_ONCE Comments: 3L NS for intraoperative pulse lavage Vancomycin 1 g/500 ml NS 500 ml IRRIGATE PERIOP_ONCE Vancomycin 2 g/3000 ml NS 3000 ml IRRIGATE PERIOP_ONCE polymyxin B unit/bacitracin unit NS 500 ml IRRIGATE PERIOP_ONCE epinephrine 1:1000 topical solution 1 vial IRRIGATE PERIOP_ONCE (DEF)* Comments: Add to 0.9% Normal Saline 5,000 ml for Intra-Op Irrigation epinephrine 1:1000 topical solution 2 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 5,000 ml for Intra-Op Irrigation epinephrine 1:1000 topical solution 3 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 5,000 ml for Intra-Op Irrigation epinephrine 1:1000 topical solution 4 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 5,000 ml for Intra-Op Irrigation epinephrine 1:1000 topical solution 1 vial IRRIGATE PERIOP_ONCE (DEF)* Comments: Add to 0.9% Normal Saline 3000 ml for Intra-Op Irrigation (BCMB) epinephrine 1:1000 topical solution 2 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 3000 ml for Intra-Op Irrigation (BCMB) epinephrine 1:1000 topical solution 3 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 3000 ml for Intra-Op Irrigation (BCMB) epinephrine 1:1000 topical solution 4 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 3000 ml for Intra-Op Irrigation (BCMB) Hemostatic Agents Topical Hemostatic Agents Dressing Type: Floseal (DEF)* Dressing Type: Surgiflo Page 6 of 15
7 DRUG AND TREATMENT Surgicel 1 unit TOPICAL PERIOP_ONCE Intra-Op Medication (IV Infusion) Tranexamic Acid 1 g / Normal Saline 100 ml 1 g IV PERIOP_ONCE (DEF)* Comments: GIVEN ONLY in SURGICAL HOLDING/OR Suite. Not available at Baptist Nassau Tranexamic Acid 2 g / Normal Saline 100 ml 2 g IV PERIOP_ONCE Comments: GIVEN ONLY in SURGICAL HOLDING/OR Suite. Not available at Baptist Nassau ***NOTE*** Order Thrombin if needed for Hemostatic Agent thrombin topical 5000 units powder 1 dose TOPICAL PERIOP_ONCE Comments: Mix with Hemostatic Agent to surgical field for hemostasis thrombin topical units powder 1 dose TOPICAL PERIOP_ONCE Comments: Mix with Hemostatic Agent to surgical field for hemostasis. Not available at Baptist Nassau thrombin topical units powder 1 dose TOPICAL PERIOP_ONCE Comments: Mix with Hemostatic Agent to surgical field for hemostasis. Not available at Baptist Nassau Analgesics Intra-Op Medication (Strength Medication) fentanyl 25 mcg ITHECAL PERIOP_ONCE Comments: For intraoperative injection Intra-Op Medication (Strength Medication) Duramorph PF 5 mg IARTICULR PERIOP_ONCE Intra-Op Medication (Strength Medication) Toradol 15 mg IARTICULR PERIOP_ONCE (DEF)* Comments: For intraoperative local injection Toradol 30 mg IARTICULR PERIOP_ONCE Comments: For intraoperative local injection Corticosteroids Strength Medication Depo-Medrol 40 mg IARTICULR PERIOP_ONCE Comments: 40mg/1mL TOPICAL intraoperatively Strength Medication Celestone Soluspan 6 mg IARTICULR PERIOP_ONCE Post Op Vital Signs Vital Signs ASDIR, Q4H Neurovascular Check Monitoring Q2H Int, 24 hour, Capillary filling and sensation on affected extremity +26 Hours Neurovascular Check Monitoring Q4H, Capillary filling and sensation on affected extremity Activity Weight Bearing Page 7 of 15
8 DRUG AND TREATMENT None Activity Bedrest with BRP, Increase per Joint Center Regimen. Baptist Jacksonville ONLY (DEF)* Bedrest with BRP, Recommended for Baptist Beaches, Baptist Nassau, and Baptist South OR Baptist Jacksonville patients not in Joint Center Regimen Comments: Keep Knee immobilizer ON to ambulate ONLY. Begin exercises on arrival to floor. Diet Diet Order Clear Liquid, Advance as Tolerated to Full Liquid (DEF)* Comments: Then advance to regular when bowel sounds are present Regular--adult menu Nursing Orders Elevate Operative Extremity, Begin in PACU Cryotherapy To operative site, Q1H, Special Instructions: Begin in PACU. Apply for 20 minutes every hour Reference Text - Anterior Hip Precautions Reference Text - Posterior Hip Precautions Sequential Compression Device Knee high at 40 mmhg to bilateral legs for both Total Hip and Total Knee Replacement patients postoperative Elastic Stockings Knee high on non-operative leg for Knee Arthroplasty; apply thigh high to operative leg when ace wrap removed (DEF)* Knee high to bilateral leg for total hip Blood Glucose Monitor POC In PACU Drain Care Type of Drain: Hemovac, Begin in PACU. Record Output Q8H Discontinue when drainage is LESS than 30 ml/8 hours (DEF)* Type of Drain: Hemovac, Begin in PACU. Record Output Q8H Leave in until physician specifies Type of Drain: Hemovac, Begin in PACU. Record Output Q8H Discontinue In AM Type of Drain: Jackson-Pratt, Pulled by RN or MD on day 3 Straight Catheterization PRN, 24 hour, PRN Order, For symptoms of urgency and inability to void after 6 hours. May repeat X 2. If 700 ml residual volume, leave catheter in. Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley) (SUB) on a separate form.*** +20 Hours Discontinue Indwelling Urinary Catheter Discontinue Criteria: POD #2 or when patient is able to sit at bedside or on commode (DEF)* Special Instructions: Do bladder scan if patient unable to void within 6 hours of removal of urinary catheter UNLESS other instructions are specified. If residual is GREATER than than 300 ml, contact physician for further orders. AVOID urinary catheter reinsertion if possible. Comments: An indwelling urinary catheter placed during/for surgery should be removed on POD# 1 or by the end of POD#2. If an indwelling urinary catheter should be Page 8 of 15
9 DRUG AND TREATMENT continued, MD needs to document rationale for continuing urinary catheter Discontinue Criteria: POD #1 or when patient is able to sit at bedside or on commode Special Instructions: Do bladder scan if patient unable to void within 6 hours of removal of urinary catheter UNLESS other instructions are specified. If residual is GREATER than than 300 ml, contact physician for further orders. AVOID urinary catheter reinsertion if possible. Comments: An indwelling urinary catheter placed during/for surgery should be removed on POD# 1 or by the end of POD#2. If an indwelling urinary catheter should be continued, MD needs to document rationale for continuing urinary catheter Orthopedic Device Immobilizer, Knee CPM Monitoring 0 degrees extension to 50 degrees flexion. Start POD #0; advance 15 degrees /day Dressing Change ABD Pad, POD #3, ABD Dressing and 4 x 4 gauze with Aquacel Medications ferrous sulfate 325 mg tab PO MEALS Antibiotics Reason for Extending PostOp Antibiotics Past 24 Hours Current bone tumor/operative extremity (DEF)* Demeclocycline administered postop Documentation of postop infection Erythromycin to improve gastric motility Pneumocystis PN prophylaxis with AIDS Dx Treatment of hepatic encephalopathy ***NOTE*** For ordering weight based antibiotics: 80 kg = 176 lbs 100 kg = 221 lbs +8 Hours cefazolin (Ancef) 1 g bag IVPB Q8H Int, Duration: 2 dose, Clinical Instructions: For weight LESS than 80 kg unless allergic to Penicillin (DEF)* Comments: first dose 8 hours after pre-op dose 2 g bag IVPB Q8H Int, Duration: 2 dose, Clinical Instructions: FOR weight GREATER than or equal to 80 kg unless allergic to Penicillin Comments: Give first dose 8 hours after pre-op dose Reason for Vancomycin Use Inpt stay for 24 hrs before procedure (DEF)* Beta-lactam allergy High risk: acute inpt hospital past yr High risk: nsg home or ECF in past year Chronic wound care or dialysis Increased MRSA rate MRSA colonization or infection Patient undergoing valve surgery Page 9 of 15
10 DRUG AND TREATMENT Transfer from inpt hosp after 3 day stay Other Reason +8 Hours vancomycin 1 g bag IVPB ONCE, Duration: 1 dose, Clinical Instructions: For weight LESS than 100 kg (DEF)* Comments: Give 12 hours after pre-op dose 1.5 g bag IVPB ONCE, Duration: 1 dose, Clinical Instructions: For weight GREATER than or EQUAL to 100 kg Comments: Give 12 hours after pre-op dose +8 Hours clindamycin (Cleocin) 600 mg bag IVPB Q8H Int, Duration: 2 dose Comments: Give first dose 8 hours after pre-op dose Analgesics ***NOTE*** Scheduled Pain Management +5 Hours oxycodone (OxyContin) 10 mg tab CR PO BEDTIME (DEF)* Comments: Begin POD #0 at bedtime when patient able to swallow and bowel sounds present. 20 mg tab CR PO BEDTIME Comments: Begin POD #0 at bedtime when patient able to swallow and bowel sounds present. +18 Hours oxycodone (OxyContin) 10 mg tab CR PO Q12H, Clinical Instructions: Begin POD #1 (DEF)* 20 mg tab CR PO Q12H, Clinical Instructions: Begin POD #1 celecoxib (Celebrex) 200 mg cap PO BEDTIME Comments: Begin POD #0 at bedtime when patient able to swallow and bowel sounds present. Do NOT give if sulfa allergic or serum creatinine GREATER than or EQUAL to 1.2. Begin AFTER intraspinal analgesic discontinued/completed ***NOTE*** ANES Patient Controlled Analgesia (PCA): Consider No Basal Rate, especially for patients with diagnosed or suspected OSA ANES Patient Controlled Analgesia (PCA)(SUB)* ***NOTE*** Moderate to Severe Parenteral Pain Medications Please choose only ONE parenteral: hydromorphone (Dilaudid) 0.5 mg inj IV PUSH Q2H Int, PRN Pain Moderate/Severe (DEF)* Comments: If pain control ineffective in 15 minutes, may give an additional 0.5 mg IV. If a second dose is required in 15 minutes, may begin next scheduled dose at 1 mg. NOT to exceed 1 mg in two hour period. Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. 1 mg inj IV PUSH Q2H Int, PRN Pain Moderate/Severe Comments: If pain control ineffective in 15 minutes, may give an additional 0.5 mg IV. If a second dose is required in 15 minutes, may begin next scheduled dose at 1.5 mg. NOT to exceed 1.5 mg in two hour period.use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. 1.5 mg inj IV PUSH Q2H Int, PRN Pain Moderate/Severe Comments: Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. morphine 2 mg inj IV PUSH Q3H, PRN Pain Moderate/Severe Page 10 of 15
11 DRUG AND TREATMENT Comments: If pain control ineffective in 15 minutes, may give an additional 2 mg IV. If second dose is required in 15 minutes, may begin next dose at 4 mg. NOT to exceed 4 mg in two hour period.use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. ***NOTE*** Moderate to Severe PO Pain Medications Please choose only ONE PO: oxycodone 5 mg tab PO Q3H, PRN Pain Moderate Comments: When able to take PO, If pain control ineffective in 30 minutes, may give an additional tablet (5 mg). If second dose is required in 30 minutes, may begin next dose at 2 tablets (10 mg). acetaminophen-hydrocodone (Norco 325 mg-5 mg oral tablet) 1 tab PO tab Q4H Int, PRN Pain Moderate/Severe Comments: When able to take PO. If pain control ineffective in 30 minutes, may give an additional tablet. If second dose is required in 30 minutes, may begin next dose at 2 tablets. acetaminophen-hydrocodone (Norco 325 mg-7.5 mg oral tablet) 1 tab PO tab Q4H Int, PRN Pain Moderate/Severe Comments: When able to take PO. If pain control ineffective in 30 minutes, may give an additional tablet. If second dose is required in 30 minutes, may begin next dose at 2 tablets. acetaminophen-hydrocodone (Norco 325 mg-10 mg oral tablet) 1 tab PO tab Q4H Int, PRN Pain Moderate/Severe Comments: When able to take PO. hydromorphone (Dilaudid) 2 mg tab PO Q3H, PRN Pain Moderate/Severe Comments: When able to take PO. If pain control ineffective, may give additional tablet (2 mg). If second dose is required in 30 minutes, may begin next dose at 2 tablets (4 mg) ***NOTE*** Mild Pain or Fever Medications acetaminophen (Tylenol) 650 mg tab PO Q4H, PRN Other (see comment) Comments: PRN mild pain OR for fever GREATER than 101 degrees Fahrenheit. If patient received IV Tylenol, wait 6 hours to give PO Tylenol. Anticoagulants ***NOTE*** VTE Prophylaxis Reason Surgical Care VTE Mechanical Prophylaxis Not Ordered Bilateral amputations lower extremities (DEF)* Bilateral lower extremity trauma IV heparin 24 hrs before/after surgery Patient refusal Other Reason Reason Surgical Care VTE Pharmacological Prophylaxis Not Ordered Active bleeding (DEF)* Bleeding risk GI bleed Hemorrhage IV heparin 24 hrs before/after surgery Patient refusal Page 11 of 15
12 DRUG AND TREATMENT Thrombocytopenia Other Reason +16 Hours enoxaparin (Lovenox) 30 mg inj SUBCUT Q12H (DEF)* Comments: first dose 22 hours post anesthesia end time unless contraindicated on intraspinal anesthesia orders. Renal dose adjust per pharmacy recommendations 40 mg inj SUBCUT DAILY Comments: first dose 22 hours post anesthesia end time unless contraindicated on intraspinal anesthesia orders. Renal dose adjust per pharmacy recommendations ***NOTE*** Arixtra: consider only if calculated creatinine clearance is GREATER than 30 ml/min and patient weight is GREATER than 50 kg. NOT available at Baptist Nassau. +16 Hours fondaparinux (Arixtra) 2.5 mg inj SUBCUT DAILY Comments: if calculated creatinine clearance is GREATER than 30 ml/min and patient weight is GREATER than 50 kg. First dose 22 hours post anesthesia end time unless contraindicated on intraspinal anesthesia orders. +16 Hours rivaroxaban (Xarelto) 10 mg tab PO DAILY Comments: If calculated creatinine clearance is GREATER than 30 ml/min and patient weight is GREATER than 50 kg. First dose 22 hours post anesthesia end time. Do NOT give within 23 hours of any other anticoagulant. GEN Warfarin Initiation(SUB)* ***Reminder: Order GEN Warfarin Initiation (SUB) on a separate form.*** aspirin 325 mg tab EC PO BID Muscle Spasms/Relaxation methocarbamol (Robaxin) 750 mg tab PO Q6H Int, PRN Muscle Spasms Comments: Hold for systolic blood pressure LESS than 100 mmhg diazepam (Valium) 5 mg tab PO Q4H Int, PRN Muscle Spasms (DEF)* Comments: or PRN Sleep 5 mg inj IV PUSH Q4H Int, PRN Muscle Spasms Comments: or PRN Sleep Antiemetics ondansetron (Zofran) 4 mg inj IV PUSH Q6H, PRN Nausea/Vomiting Comments: May give PO if patient able to take PO. If Zofran ineffective in 30 minutes, may give Phenergan if ordered. ondansetron (Zofran ODT) 4 mg tab soluble PO Q6H, PRN Nausea/Vomiting promethazine (Phenergan) 6.25 mg inj IV PUSH Q4H Int, PRN Nausea/Vomiting (DEF)* Comments: FOR patients 65 years and older: If ineffective in 15 minutes, may repeat ONCE. If second dose is required in 15 minutes, may begin next dose at 12 mg. If patient has IV running, dilute promethazine dose in 10 ml of normal saline and administer slowly over 3 to 5 minutes at Page 12 of 15
13 DRUG AND TREATMENT the port furthest from the IV insertion site. If the patient does not have an IV running, dilute the promethazine in 50 ml normal saline and administer over 15 minutes mg inj IV PUSH Q4H Int, PRN Nausea/Vomiting Comments: FOR patients LESS than 65 years. If patient has IV running, dilute promethazine dose in 10 ml of normal saline and administer slowly over 3 to 5 minutes at the port furthest from the IV insertion site. If the patient does not have an IV running, dilute the promethazine in 50 ml normal saline and administer over 15 minutes. Antihistamines cetirizine (Zyrtec) 10 mg tab PO DAILY, PRN Itching Comments: May increase to BID if needed. diphenhydramine (Benadryl) 12.5 mg cap PO DAILY, PRN Itching Comments: If unable to tolerate Zyrtec. If patient LESS than 65 years of age and itching control ineffective, may repeat 12.5 mg PO once in 1 hour then increase next dose to 25 mg Sleep Aids temazepam (Restoril) 15 mg cap PO BEDTIME, PRN Sleep/Insomnia Comments: If patient is LESS than 65 years of age, may repeat once in one hour if needed. Gastrointestinal Agents docusate-senna (Peri-Colace) 2 tab PO tab BID Comments: Start day of surgery (POD 0) at bedtime when tolerating PO. If no BM by POD 1 at bedtime, increase to 4 tabs PO BID. Hold for loose stools polyethylene glycol 3350 (MiraLax) 17 g packet PO BID Comments: Start day of surgery (POD 0) when tolerating PO. Hold for loose stools bisacodyl (Dulcolax) 10 mg tab EC PO ASDIR, PRN Constipation, Duration: 1 dose Comments: On day of discharge if no bowel movement. May give PR if unable to take PO. Hold for loose stools bisacodyl (Dulcolax) 10 mg supp PR ASDIR, PRN Constipation, Duration: 1 dose Comments: On day of discharge if no bowel movement, if unable to take PO. Hold for loose stools +8 Hours pantoprazole (Protonix) 40 mg tab EC PO ACBRKF Comments: Start POD# 1 Reason Beta Blocker Not Administered Peri-Operatively Reason: Allergy (DEF)* Reason: Bradycardia (HR less than 50 bpm) Reason: Hypotension (SBP less than 100 mmhg) Reason: Concurrent use of IV inotropic med Reason: Other reason charted (MD/APN/PA/PharmD) Reason Alcohol/Substance Abuse Medication Not Prescribed Reason: Patient Refused (DEF)* Page 13 of 15
14 DRUG AND TREATMENT Reason: Allergy to FDA Approved Medication Reason: Drug Interaction to All FDA Approved Med Reason: Cognitive Impairment Reason: Left Against Medical Advice Reason: Does Not Meet Criteria ETOH Use Disorder Reason: Patient Expired Reason: Hospice Patient Reason: Not a Resident of United States Reason Tobacco Cessation Med Not Given Allergy to ALL tobacco cessation meds (DEF)* Drug interaction for ALL approved meds Other Reason IV Solutions Lactated Ringers Injection IV 75 ml/hour Comments: Discontinue POD#2 NS IV 75 ml/hour Comments: Discontinue POD#2 Laboratory Hemoglobin STAT, Blood Comments: In PACU Hemoglobin and Hematocrit Early AM, Blood, DAILY, 2 times CHEM 7 Blood Radiology XR Knee L 2 view Portable Post-Op, Pending Discharge - No, Patient in PACU XR Knee R 2 view Portable Post-Op, Pending Discharge - No, Patient in PACU XR Hip L 1 view Portable Post-Op, Pending Discharge - No, Patient in PACU XR Hip R 1 view Portable Post-Op, Pending Discharge - No, Patient in PACU XR Hip L 2 view w/pelvis Portable Post-Op, Pending Discharge - No, Patient in PACU XR Hip R 2 view w/pelvis Portable Post-Op, Pending Discharge - No, Patient in PACU Respiratory O2 Therapy. Nasal Cannula, 3, Liters overnight. May discontinue in AM POD #1 if O2 sats are greater than 92% on room air Page 14 of 15
15 DRUG AND TREATMENT Incentive Spirometry Routine, Q2H while awake Consults Consult Physician (BMCD) Baptist Primary Care Hospitalist, For post-op medical management (DEF)* Baptist Primary Care Hospitalist, STAT, Patient in PACU Hospitalist on call Hospitalist on call, STAT, Patient in PACU Consult Physician (BMCB) For post-op medical management Consult Physician (BMCN) For post-op medical management Consult Physician (BMCS) For post-op medical management Consult Physician Infectious Disease, STAT, patient in PACU Comments: Infectious Disease unavailable at Baptist Nassau Physical Therapy Consult Non weight bearing (DEF)* Partial weight bearing Toe touch weight bearing Weight bearing as tolerated Partial 30 pounds Occupational Therapy Consult Social Work Consult Discharge Planning, Physician, Discharge Pending (DEF)* Arrange home health care versus extended care facility as indicated Home Care Physical Therapy Eval and Treatment, Total joint replacement post op care, Physical Therapy daily for 2-4 days, starting day after discharge, then progress to 3x/week for 1-2 weeks as long as patient progressing with the therapy protocols. PT to eval (DEF)* Physical Therapy Eval and Treatment, THA post op care, As indicated for appropriate THA precautions., If PT assessment identifies need for specific OT followup or for more frequent home visits, contact surgeon for specific orders. Assist with transition Durable Medical Equipment (Home DME) Walker - Rolling, 99 mos, 2-wheel, 3:1 to be used at bedside Consult Cast Tech Page 15 of 15
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Available at: BMC-A BMC-B BMC-C BMC-D BMC-N BMC-S BMC-T BMC-W PACE Nursing Orders Patient Education Instruct patient to bring corresponding films to surgery (e.g. back films for back surgery, brain films
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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
More informationPEDIATRIC 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
More informationPHYSICIAN 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***
More informationPHYSICIAN 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
More informationPHYSICIAN 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
More informationOrthopedic Admission Hip Fracture Version 2 1/25/2017
Patient Name: Initial each page and Sign/Date/Time last page Diagnosis: Allergies with reaction type: Orthopedic Admission Hip Fracture Version 2 1/25/2017 Patient Placement Patient Status If the physician
More informationPediatric 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
More informationGENERAL SURGERY PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom Privileges
More informationBariatric Surgery Post Op Day Version 2 Approved 11/13/2017
Patient Name: Diagnosis: Allergies with reaction type: Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017 Diagnosis Preferred Location/Unit Surgical ICU Code Status: Full Code Activity Ambulate
More informationWHS 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.
More informationSample. 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
More informationPhysician 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
More informationr*po1004*r PHYSICIAN S ORDERS Page 1 of 7 HOUR THORACOTOMY POSTOPERATIVE ORDERS General x Admit to Inpatient Status x Admitting Physician: Admit to:
PHYSICIAN S ORDERS Page 1 of 7 General x Admit to Inpatient Status x Admitting Physician: Admit to: SICU Telemetry Med/Surg room x Resuscitation status: see Resuscitation Status Order Activity x Bed rest
More information1. 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
More informationIV 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
More informationPHYSICIAN 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
More informationA UMC Health System Performance Improvement Initiative for use in all units where cardiac/surgical patients are admitted.
A UMC Health System Performance Improvement Initiative for use in all units where cardiac/surgical patients are admitted Denotes guideline requirement Attending Physician: Resident/Fellow: Allergies_ Diagnosis:
More informationDRUG 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
More informationGeneral. Code Status (Single Response) ( ) Full Code Details ( ) Full code - unverified Details ( ) DNRCC Allow additional therapies?
Post Operative Above and Below Knee Amputation Admission [3041300028] Consider adding Insulin Adult -- Subcutaneous Insulin and Hypoglycemia Management [3041300000] General Admission (Single Response)
More informationADMIT 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
More informationPhysician Orders ADULT: Ortho Total Joint Plan
Initiate Orders Phase Non Categorized R Powerplan Open Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Ortho Total Joint Preop Phase, When to Initiate: Other-See Special Instructions, initiate
More informationALL 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
More informationGENERAL SURGERY POST-OP PLAN
GENERAL SURGERY POST-OP PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom
More informationPHYSICIAN 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,
More informationBariatric 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
More informationPICU 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
More informationGENERAL MEDICINE PLAN
GENERAL MEDICINE PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom
More informationA UMC Health System Performance Improvement Initiative for use in all units where patients with are admitted for Surgical Care Improvement Project.
ENDOLUMINAL AAA POST-OP PLAN A UMC Health System Performance Improvement Initiative for use in all units where patients with are admitted for Surgical Care Improvement Project. *Denotes guideline requirement
More informationADMIT GENERAL MEDICINE PLAN - Phase: Begin Immediately
- Phase: Begin Immediately Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Patient Condition Acuity Level Floor Status Acuity Level Critical Acuity Level Intermediate Continuous Telemetry
More informationCARD THORACOTOMY PRE-OP PLAN
CARD THORACOTOMY PRE-OP PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Perform Oral Care Perform night before surgery. Brush teeth with toothpaste, then swish and spit 15 ml chlorhexidine mouth
More informationGabapentin Research Pain Study for Ortho Total Knee Replacement Post Op Plan PACU Ortho Phase
Total Knee Replacement Post Op Plan PACU Ortho Phase PHYSICIAN S Weight Allergies DETAILS Admit/Discharge/Transfer Request Patient Bed Requested Location: 3W, Pt Status: Inpatient (LOS > 2 midnights),
More informationPHYSICIAN 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,
More informationALL 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
More informationBARIATRIC 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
More informationDRUG 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
More informationLYSIS 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
More informationDRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at ALL facilities Condition/Status Place in Outpatient to a Bed Status Requested Location: PCU H3S (DEF)* Requested Location: CCU - Heart Hospital Requested Location: Heart
More informationCARD OPEN HEART PRE-OP PLAN
PHYSICIAN S Diagnosis Weight Allergies Patient Care Perform Oral Care Per Unit Standards, Perform night before surgery. Brush teeth with toothpaste. Peridex mouth wash (15 ml swish and spit). chlorhexidine
More informationLONG TERM CARE FACILITY ADMIT ORDERS
Page 1 of 7 LONG TERM CARE FACILITY ADMIT ORDERS ADMISSION: Admit patient to Skilled Nursing Facility: Admit patient to Acute Rehabilitation Facility: Admit patient to Subacute Rehabilitation Facility:
More informationPatient Label Here. ORTHOPEDIC POST-OPERATIVE ADMIT PLAN (Includes Post Op Days 1-2) Antibiotic administered in the OR at:
ORTHOPEDIC POST-OPERATIVE ADMIT PLAN (Includes Post Op Days 1-2) A UMC Health System Performance Improvement Initiative for use in all units where surgical patients receive care in support of Surgical
More informationIR 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
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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
More informationUMC 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
More information1. Attending Physician: Resident/Fellow: 2. Consult
COLON POST OP PLAN A UMC Health System Performance Improvement Initiative for use in all units where surgical patients receive care in support of Surgical Care Improvement Program (SCIP). * Denotes guideline
More informationCBC 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.
More information1 of 5. Integrated Order Set Inpatient, Adult. Gynecological Surgery Enhanced Recovery Orders apply to patients 18 years and older.
Orders apply to patients 18 years and older. All preprinted doses are based on normal renal and hepatic function and must be assessed for adjustment against the individual patient s renal and hepatic function
More informationmorphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice
PATIENT CONTROLLED ANALGESIA (PCA) PLAN Allergies: Medication Selection: morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice HYDROmorphone (Dilaudid ) 6 mg/ 30 ml (0.2 mg/ml) fentanyl 300 mcg/ 30 ml (10 mcg/ml)
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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
More informationDRUG 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
More informationENT 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:
More informationOB/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
More informationAdmit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests. CBC, Electrolytes, Urea, Creatinine, Glucose, INR, PTT, Urinalysis
of nurse 1. Admit under ward Attending Physician: Dr. Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests 2. On admission (if not already performed in Emergency Department or in Coronary
More informationProcedure: Laser Transurethral Resection of Prostate or Transurethral Resection of Prostate
Laser Transurethral Resection Of Prostate Or Transurethral Resection Of Prostate Post-Operative Plan Patient Label Here A UMC Health System Performance Improvement Initiative for use in all units where
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GENERAL UROLOGY PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Strict Intake and Output Per Unit Standards q4h q12h Patient Activity Assist as Needed Up in Chair,
More information1. Attending Physician: Resident/Fellow: 2. Admit: MEDICAL/SURGICAL ICU Other: Designation: In Patient Out Patient. 5.
UROLOGY POST OPERATIVE PLAN Patient Label Here A UMC Health System Performance Improvement Initiative for use in all units where surgical patients receive care in support of Surgical Care Improvement Program
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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
More informationOB/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
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Diagnosis Allergies Nursing Assess and Document PCA: 1. Assess and document pain rating, sedation level and respiratory rate every 2 hours; assess and document pain rating, sedation level and respiratory
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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.
More informationPhysician Orders ADULT
Admission Height (Actual) : cm Admission Weight (Actual): kg Allergies: No known allergies Medication allergy(s): Latex allergy Other: Non-Categorized ATTENTION SURGEON: Please discontinue Open Heart Post
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- 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
More informationUMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
GI BLEED PLAN UMC Health System Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Notify Provider of VS Parameters Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist
More informationAssessment. Consults & Referrals
University of Virginia Health System Clinical Pathway: Whipple Enhanced Recovery After () LOS: 4-5 days Date of Origin/Revision: June 29, 2016/September 6, 2017/January 31, 2018 : SAS : : : D1 D2 D 3/
More informationOB/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
More informationPhysician Orders ADULT: ANES Enhanced Recovery After Surgery (ERAS) Plan
Initiate Orders Phase Non Categorized R Powerplan Open Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Anes (ERAS) Pre-insertion Phase, When to Initiate: Other-See Special Instructions,
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Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Head and Neck Postoperative Phase, When to Initiate: Head and Neck Post Operative Phase, Monitor and Record T,P,R,BP,
More informationPhysician Orders ADULT: PCI Post Procedure Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: PCI Post Procedure Phase, When to Initiate: Initiate Powerplan Phase Phase: Post Cath/PCI Hydration Protocol Phase,
More informationOB/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
More informationTRANSCATHETER AORTIC VALVE REPLACEMENT POST- OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards, q15min x 4, q30min x 2, then q1h x 4 until sheath discontinued. Per Unit Standards Perform Neurovascular
More informationPhysician 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
More informationNeurosurgery 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:
More informationStandard Precautions Droplet Precautions Standard Precautions Contact Precautions Droplet Precautions Standard Precautions Neutropenic Precautions
Unique Plan Description: Neurosurgery Subarachnoid Hemorrhage Admission Adult Plan Selection Display: Neurosurgery Subarachnoid Hemorrhage Admission Adult PlanType: Medical Version: 10 Begin Effective
More informationTRANSCATHETER AORTIC VALVE REPLACEMENT POST- OP ADMIT PLAN - Phase: Begin Immediately/PACU Phase
- Phase: Begin Immediately/PACU Phase PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Requested Location: CICU Patient Condition Acuity Level Critical Acuity Level
More informationAdmit Heart Failure Plan - Begin Immediately
Admit Heart Failure Plan - Begin Immediately Diagnosis Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Requested Location: CICU, Pt Status: Observation (LOS < 2 midnights) Requested
More informationTHROMBOLYTIC 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
More informationALL 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
More informationPHYSICIAN 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
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PHYSICIAN S SHEET Automatically Activate, if not in agreement, cross out and initial Activated by Checking Box ALLERGIES: None known YES Patient s Height: Patient s Weight: ALL MEDICATION and INTRAVENOUS
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Quality Improvement Updates Foley Discontinuation Protocol Surgical Care Improvement Project Barbara J Martin, RN, MBA Quality Consultant, Center for Clinical Improvement Indwelling Urinary Catheters Insertion,
More informationBaptist Health Lexington. ERAS Protocols
Baptist Health Lexington ERAS Protocols Enhanced Recovery After Surgery BHLex Colorectal ERAS Protocol Preoperative Patient/Family Education: PAT and office, ERAS brochure & educational flyer/checklist
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Clinical der Set Page of 7 Admit to thopaedics MRP is Code Status: Full Code No-CPR see further written orders regarding CPR/DNR MRP to determine Consults Hospitalist Geriatric medicine Other Inpatient
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DATE: TIME: DATE TIME INTRAVENOS FLID and MEDICATION Status: Admit to Telemetry Admit to Progressive Care nit Transfer to Progressive Care nit Note: Discontinue Previous Orders Transfer to Telemetry nit
More informationPHYSICIAN 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
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Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: AAA Repair Open Postop Phase, When to Initiate: Initiate Powerplan Phase Phase: Mechanically Ventilated Patients Phase,
More informationPatient Label Here CAROTID POST OP PLAN. Antibiotic administered in the OR at: Physician Signature Date/Time
CAROTID POST OP PLAN A UMC Health System Performance Improvement Initiative for use in all units where patients with carotid surgery are admitted in support of the Surgical Care Improvement Program (SCIP).
More informationGENERAL SURGERY POST OP ORDERS. Admit to floor to Dr. l Inpatient l Observation l Telemetry
Check appropriate boxes: ** Admit to floor to Dr. l Inpatient l Observation l Telemetry Diagnosis: Consult Dr. Reason: l I have called Dr., add to his/her list. Diet: l NPO l Regular NURSING ERS: Activity:
More informationAttach 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
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