DRUG ALLERGIES WT: KG
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1 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 enter diagnosis on the Diagnosis Tab, Anticipated LOS: More than two midnights (Medicare) Nursing Orders Blood Glucose Monitor POC Q1H Int Monitor PvO2 every hour until consistently GREATER than 35 or venous saturation GREATER than 65%. Then monitor every 2 hours Notify Pharmacy and discontinue steroids if initial cortisol level is GREATER than 25 Cooling Blanket Cooling Therapy Duration 1 times, Cooling Therapy Mode: Blanket, Target Core Temp(DegC) 38, Turn on for patient temperature GREATER than 39.4 deg C or 103 deg F. Turn off if patient temperature LESS than 38.3 deg C or 101 deg F. Comments: Target core temperature - 38 degree C or degree F Central Venous Pressure (CVP) ASDIR, Pre and Post NS Bolus Fluid Challenge Central Venous Pressure (CVP) Q1H, Pre and Post NS Bolus Fluid Challenge Notify Provider Vital Signs/Urine Output Temperature > 101 F, HR > 120, HR < 50, SBP > 160, SBP < 90, DBP > 110, MAP < 65, RR > 24, RR < 12, SpO2 < 90 Notify Provider Call physician for PaO2 LESS than 60 mmhg; ph LESS than 7.34 Notify Change in patient status; if positive culture result Notify Provider With results of Lactic Level GREATER than 2 mmol/l GEN Nasogastric/Orogastric Tube Insertion(SUB)* ***Reminder: Order GEN Nasogastric/Orogastric Tube Insertion (SUB) on a separate form.*** Notify Provider Routine Comments: Notify provider for a rise in FiO2 or new onset of wheezing. Obtain portable chest x- ray and ABG first. Abdominal Bladder Pressure Q4H, Notify MD for Pressure > 20 mmhg Page 1 of 12
2 DRUG AND TREATMENT ***NOTE*** Select the "Transfuse Blood Previously on Hold" order below, to transfuse blood on hold Transfuse Blood Previously on Hold Medications heparin (subcutaneous) 5,000 unit inj SUBCUT Q8H enoxaparin (Lovenox) 40 mg inj SUBCUT Q24H Int Comments: Pharmacy to adjust dose based on renal function ranitidine (Zantac) 50 mg inj IV PUSH Q8H Comments: Pharmacy to adjust dose based on renal function GEN Correction Insulin (Sliding Scale)(SUB)* ***Reminder: Order GEN Correction Insulin (Sliding Scale) (SUB) on a separate form.*** hydrocortisone (Solu-Cortef) 100 mg inj IV PUSH STAT Comments: ONCE. IF COSYNTROPIN TEST IS POSITIVE ( LESS than 10 point rise from baseline or third cortisol level is LESS than 20 mg/dl). hydrocortisone (Solu-Cortef) 50 mg inj IV PUSH Q8H Comments: Start AFTER 1st dose of 100mg IVP stat order. IF COSYNTROPIN TEST IS POSITIVE (LESS than 10 point rise from baseline or third cortisol level is LESS than 20 mg/dl). Antibiotics ***NOTE*** All antibiotics should be started STAT after Blood Cultures obtained. SUB Sepsis Pneumonia Antibiotics(SUB)* ***Reminder: The above subphase is available at the end of the plan.*** SUB Sepsis Urinary Tract Infection Antibiotics(SUB)* ***Reminder: The above subphase is available at the end of the plan.*** SUB Sepsis GI/Abdominal Antibiotics(SUB)* ***Reminder: The above subphase is available at the end of the plan.*** SUB Sepsis Skin/Soft Tissue Antibiotics(SUB)* ***Reminder: The above subphase is available at the end of the plan.*** SUB Sepsis CNS/Meningitis Antibiotics(SUB)* ***Reminder: The above subphase is available at the end of the plan.*** PRN Medications acetaminophen (Tylenol) 650 mg tab PO Q4H, PRN Fever GREATER than 101 F (DEF)* 650 mg supp PR Q4H, PRN Fever GREATER than 101 F 650 mg liquid NG TUBE Q4H, PRN Fever GREATER than 101 F IV Solutions ***NOTE*** Normal Saline at 30 ml/kg is recommended for Septic Shock, Hypotension or Lactic Acid GREATER than or EQUAL to 4 mmol/l Page 2 of 12
3 DRUG AND TREATMENT Normal Saline Bolus 30 ml/kg IV bag STAT, PRN Other (see comment), Infuse Over: 60 min Comments: If SBP LESS than 90 mmhg or Lactic Acid GREATER than or EQUAL to 4 mmol/l. If patient remains hypotensive (SBP LESS than 90mmHg) after 1 hour, administer 1 L NS bolus if ordered and notify physician. DO NOT ROUND DOSE. Normal Saline Bolus 1000 ml IV bag ONCE, PRN Other (see comment), Infuse Over: 60 min Comments: For SBP LESS than 90 mmhg or MAP LESS than 65 AFTER 30 ml/kg IV. If patient remains hypotensive after 1 hour, call physician for additional fluid bolus Normal Saline 1000 IV bag 125 ml/hour Levophed 8 mg/d5w 250 ml IV Set (IVS)* Dextrose 5% in Water 250 IV bag mcg/min Comments: Begin at 4 mcg/min and titrate by 2 mcg/min every 3 minutes to achieve MAP of GREATER than or EQUAL to 65. MAXIMUM dosage of 30 mcg/min. If Levophed dose of 20 mcg/min and MAP remains LESS than 65, start Vasopressin as ordered. norepinephrine IV drip 8 mg Vasopressin (SHOCK) 20 units/ NS 50 ml IV Drip (IVS)* Sodium Chloride 0.9% 0 IV iv Infuse at 0.03 units / minute Comments: If Levophed has reached 20 mcg/min and MAP remains LESS than 65, then start Vasopressin.In 30 minutes, increase to 0.04 units/minute if MAP LESS than 65. Maximum dose of 0.04 units/min. vasopressin IV drip 20 unit Neo-Synephrine 50 mg/ns 250 ml IV Set (IVS)* Sodium Chloride 0.9% IV titrate, Clinical Instructions: Start at 100 mcg/min and titrate 20 mcg/min every 2 minutes to achieve MAP of GREATER than or EQUAL to 65. Maximum dose of 180 mcg/min. Neo-Synephrine IV drip 50 mg Laboratory ACTH Level STAT, Blood, ONCE Comments: Draw with Blood Culture, Urine Culture, Sputum Culture and Wound Culture if ordered Blood Culture Timed Study, BLOOD - PERIPHERAL, Q15MINS Int, 2 times (DEF)* Comments: Order if not drawn within the past 48 hours. At 2 different sites. Collect with ACTH, Urine Culture, Sputum Culture and Wound Culture if ordered.start antibiotic STAT after drawn. Timed Study, BLOOD - LINE, Q15MINS Int, 2 times Comments: Order if not drawn within the past 48 hours. At 2 different sites. Collect with ACTH, Urine Culture, Sputum Culture and Wound Culture if ordered.start antibiotic STAT after drawn. Page 3 of 12
4 DRUG AND TREATMENT Urine Culture STAT, URINE, CLEANCATCH, ONCE Comments: Order if not drawn within the past 48 hours. Collect with Blood Culture, ACTH, Sputum Culture and Wound Culture if ordered.may perform straight cath ONCE if unable to obtain urine. Sputum Culture/GS STAT, SPUTUM, ONCE Comments: Collect with Blood Culture, ACTH, Urine Culture and Wound Culture if ordered Wound Culture STAT, ONCE Comments: Wound culture if appropriate Stool Culture Routine, STOOL C Difficile Toxin (PCR) Routine, STOOL Cardiac Enzymes(SUB)* ***Reminder: Order Cardiac Enzymes (SUB) on a separate form.*** Lactic Acid STAT, Blood, ONCE Comments: If not drawn within the past 6 hours. +3 Hours Lactic Acid STAT, Blood Comments: Draw in 3 hours +6 Hours Lactic Acid STAT, Blood Comments: Draw in 6 hours CBC with Differential. STAT, Blood, ONCE +8 Hours CBC with Differential. Timed Study, Blood, Q8H Int, 32 hour CBC with Differential. T+2;, Early AM, Blood CHEM 7 STAT, Blood, ONCE +12 Hours Chem 12 Timed Study, Blood, Q12H Int, 36 hour Lipase Level STAT, Blood, ONCE (DEF)* Timed Study, Blood, ONCE Early AM, Blood, ONCE Liver Profile STAT, Blood, ONCE (DEF)* Timed Study, Blood, ONCE Early AM, Blood, ONCE Page 4 of 12
5 DRUG AND TREATMENT Prothrombin INR STAT, Blood, ONCE PTT STAT, Blood, ONCE BNP STAT, Blood, ONCE (DEF)* Timed Study, Blood, ONCE Early AM, Blood, ONCE Magnesium Level STAT, Blood, ONCE (DEF)* Timed Study, Blood, ONCE Early AM, Blood, ONCE ORSA by PCR STAT, NARES, ONCE (DEF)* Timed Study, NARES, ONCE Early AM, NARES, ONCE Type and Screen Routine ***NOTE*** 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.*** SUB Cosyntropin Stimulation Test(SUB)* ***Reminder: Order SUB Cosyntropin Stimulation Test (SUB) on a separate form.*** Cortisol Level STAT, Blood Comments: if LESS than 15 start Hydrocortisone 100 mg IV Q8H Radiology XP Chest Sepsis, Stat, Pending Discharge - No, ONCE XR Abd 1 view (KUB) Portable Abdominal pain, Stat, Pending Discharge - No, Emergent Venous Doppler Low Ext Bilat Swelling, Stat, Pending Discharge - No, Emergent, BMC Downtown Respiratory ABG/VBG Notification Stat, ABG ONCE ABG/VBG Notification Timed Study, ABG Q4H ABG/VBG Notification Routine, VBG ONCE. Draw from CVP if CVP rises GREATER than 5 mmhg and venous sat is GREATER than 65% and MAP is LESS than 65. PRN Order Page 5 of 12
6 DRUG AND TREATMENT Weaning Parameters Routine, DAILY Pulse Oximetry (Continuous) Special Instructions: Urgent, continuous monitoring Comments: Q8H sensor site must be inspected. IF circulatory condition or skin integrity has changed, the sensor should be applied to a different site. Cardiology Echocardiogram -Transthoracic Sepsis, Cardiologist of Attending Physician's choice to read. EKG Standard Stat, Urgent Consults Consult Physician Critical care, Sepsis Consult Physician (BMCD) Infectious Disease, Sepsis Consult Physician (BMCB) Infectious Disease, Sepsis Consult Physician (BMCS) Infectious Disease, Sepsis Consult Physician (BMCB) Pulmonary, Sepsis Consult Physician (BMCN) Pulmonary, Sepsis Consult Pharmacy Kinetics Dosing ************************************************************************************************** SUB Sepsis Pneumonia Antibiotics(SUB)* Medications ***NOTE*** Select ONE of the following MONO-therapy regimens: ***NOTE*** If ZOSYN ordered, select both ONCE and q8h orders. piperacillin-tazobactam (Zosyn) g bag IVPB ONCE, Infuse over: 30 min Comments: First order STAT. +6 Hours piperacillin-tazobactam (Zosyn) g bag IVPB Q8H, Infuse over: 4 hour cefepime 2 g IVPB Q8H (DEF)* 1 g IVPB Q12H Page 6 of 12
7 DRUG AND TREATMENT 1 g IVPB Q8H 2 g IVPB Q12H ***NOTE*** If meropenem ordered, select both ONCE and q8h orders. meropenem 500 mg IVPB ONCE, Infuse over: 30 min (DEF)* 1 g IVPB ONCE, Infuse over: 30 min +8 Hours meropenem 500 mg IVPB Q8H, Infuse over: 3 hour (DEF)* 1 g IVPB Q8H, Infuse over: 3 hour ***NOTE*** Consider adding Vancomycin if MRSA is suspected. other Comments: For patients GREATER than 75 kg Administer 1st dose Vancomycin after other Consult Pharmacy Routine, Kinetics Dosing Comments: Vancomycin dosing Consult Physician Infectious Disease, Sepsis, Routine ***NOTE*** OR Select ONE of the following DUAL-therapy regimen (check BOTH antibiotics) ***NOTE*** If allergic to quinolones or failed quinolone therapy, IDSA recommends the following DUAL therapy regimen: azithromycin 500 mg bag IVPB DAILY ceftriaxone 1 g bag IVPB DAILY ***NOTE*** OR the following DUAL therapy - check BOTH antibiotics. If levofloxacin ordered, consider drug-drug interactions, prolonged QT intervals, C-diff risk levofloxacin 750 mg premix IVPB DAILY ceftriaxone 1 g bag IVPB DAILY ***NOTE*** OR if allergic to beta-lactam, IDSA recommends the following DUAL therapy regimen. If levofloxacin ordered, consider drug-drug interactions, prolonged QT intervals, C-diff risk Page 7 of 12
8 DRUG AND TREATMENT aztreonam 2 g IVPB Q8H (DEF)* 1 g IVPB Q8H levofloxacin 750 mg premix IVPB DAILY ****************************************************************************************************************************************** SUB Sepsis Urinary Tract Infection Antibiotics(SUB)* Medications ***NOTE*** Select ONE of the following MONO-therapy regimens below ceftriaxone 1 g bag IVPB DAILY ***NOTE*** If ZOSYN ordered, select both ONCE and q8h orders. piperacillin-tazobactam (Zosyn) g bag IVPB ONCE, Infuse over: 30 min +6 Hours piperacillin-tazobactam (Zosyn) g bag IVPB Q8H, Infuse over: 4 hour ***NOTE*** If meropenem ordered, select both ONCE and q8h orders. meropenem 500 mg IVPB ONCE, Infuse over: 30 min (DEF)* 1 g IVPB ONCE, Infuse over: 30 min +8 Hours meropenem 500 mg IVPB Q8H, Infuse over: 3 hour (DEF)* 1 g IVPB Q8H, Infuse over: 3 hour ***NOTE*** For suspected Enterococcus, add Ampicillin to one of the above MONO-therapy regimens. ampicillin 2 g IVPB Q6H ***NOTE*** For Beta-lactam allergy and DUAL-therapy regimen; consider aztreonam AND. Vancomycin does not cover gram negative flora aztreonam 2 g bag IVPB Q8H (DEF)* 1 g bag IVPB Q8H other Page 8 of 12
9 DRUG AND TREATMENT Comments: For patients GREATER than 75 kg Administer 1st dose Vancomcin after other Consult Physician Infectious Disease, Sepsis, Routine Consult Pharmacy Routine, Kinetics Dosing Comments: Vancomycin dosing ****************************************************************************************************************************************** SUB Sepsis GI/Abdominal Antibiotics(SUB)* Medications Select MONO-therapy regimen(note)* ***NOTE** If ZOSYN ordered, select both ONCE and q8h orders. piperacillin-tazobactam g bag IVPB ONCE, Infuse over: 30 min +6 Hours piperacillin-tazobactam g bag IVPB Q8H, Infuse over: 4 hour ***NOTE*** If meropenem ordered, select both ONCE and q8h orders. meropenem 500 mg IV ONCE, Infuse over: 30 min (DEF)* 1 g IV ONCE, Infuse over: 30 min +8 Hours meropenem 500 mg IV Q8H, Infuse over: 3 hour (DEF)* 1 g IV Q8H, Infuse over: 3 hour ***NOTE*** OR Select ONE of the following DUAL-therapy regimens ceftriaxone 1 g bag IVPB DAILY metronidazole (Flagyl) 500 mg IV Q8H Comments: First dose STAT ***NOTE*** For Beta-lactam allergy, consider the following DUAL-therapy regimen - consider aztreonam AND metronidazole aztreonam 2 g bag IVPB Q8H (DEF)* 1 g bag IVPB Q8H metronidazole (Flagyl) 500 mg IV Q8H Comments: First dose STAT Page 9 of 12
10 DRUG AND TREATMENT ***NOTE*** For suspected Gram positive Streptococcus/Enterococcus, add to the above regimens other antibiotic. First dose STAT Comments: For patients GREATER than 75 kg Administer 1st dose Vancomycin after other Consult Pharmacy Routine, Kinetics Dosing Comments: Vancomycin dosing Consult Physician Infectious Disease, Sepsis, Routine ****************************************************************************************************************************************** SUB Sepsis Skin/Soft Tissue Antibiotics(SUB)* Medications ***NOTE*** For dual antibiotic therapy, consider ceftriaxone AND OR ceftriaxone. Vancomycin does not cover gram negative flora. ceftriaxone 1 g bag IVPB DAILY other Comments: For patients GREATER than 75 kg Administer 1st dose Vancomycin after other ***NOTE*** OR for dual antibiotic therapy, consider piperacillin AND. Vancomycin does not cover gram negative flora. ***NOTE*** If ZOSYN ordered, select both ONCE and q8h orders piperacillin-tazobactam (Zosyn) g bag IVPB ONCE, Infuse over: 30 min +6 Hours piperacillin-tazobactam (Zosyn) g bag IVPB Q8H, Infuse over: 4 hour other Comments: For patients GREATER than 75 kgadminister 1st dose Vancomycin after other Page 10 of 12
11 DRUG AND TREATMENT ***NOTE*** OR if Beta-Lactam Allergy, consider multi therapy, ciprofloxacin AND AND metronidazole ciprofloxacin 400 mg IVPB Q12H other Comments: For patients GREATER than 75 kg Administer 1st dose Vancomycin after other metronidazole 500 mg IVPB Q8H Consult Physician Infectious Disease, Sepsis, Routine Consult Pharmacy Routine, Kinetics Dosing Comments: Vancomycin dosing ****************************************************************************************************************************************** SUB Sepsis CNS/Meningitis Antibiotics(SUB)* Medications ***NOTE*** Consider multi-antibiotic therapy, ceftriaxone AND ampicillin AND acyclovir AND. Vancomycin does not cover gram negative flora. ceftriaxone 2 g bag IVPB Q12H Comments: Ok to administer prior to LP or CT if ordered. First dose STAT. ampicillin 2 g IVPB Q4H Comments: Ok to administer prior to LP or CT if ordered. First dose STAT. other Comments: For patients GREATER than 75 kg Administer 1st dose Vancomcin after other acyclovir 10 mg/kg IV Q8H Page 11 of 12
12 DRUG AND TREATMENT Consult Pharmacy Routine, Kinetics Dosing Comments: Vancomycin dosing Consult Physician Infectious Disease, Sepsis, STAT Page 12 of 12
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
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