Wear Brace/Splint Cervical Collar, at all times, Constant Indicator Wear Brace/Splint Other Brace, Aspen QuickDraw, for comfort, PRN Order Wear

Transcription

1 Unique Plan Description: Surgery ICU General Admission Adult Plan Selection Display: Surgery ICU General Admission Adult PlanType: Medical Version: 25 Begin Effective Date: 4/29/ :49 End Effective Date: Current Available at all facilities Surgery ICU General Admission Adult Admit/Transfer/Discharge Admit Type Assign to Utilization Review assessment protocol Admit Patient Discharge Contemplated within 24 Hours Transfer Patient Condition Patient Condition Code status other than full code requires a separate physician order.(note)* Code Status Vital Signs/Monitoring Vital Signs Basic Vital Signs, Q1HR Delirium Assessment Q12HR Measurements Weight, On Admission, ONCE Daily Weight Weight, QNIGHT Notify Provider Vital Signs Notify House Officer for, SBP> 180, SBP< 90, HR> 100, HR< 60, O2 Sat< 92%, RR> 30, RR< 10, T> 38.5 Notify Provider Vital Signs For Head Trauma patients, notify House Officer for, SBP> 180, SBP< 90, HR> 130, HR< 60, MAP< 65, O2 Sat< 94%, RR> 24, RR< 8, T> 38.5, UOP> 200, UOP< 30 Notify Provider Hemodynamic Measures For Head Trauma Patients, notify House Officer for, CPP< 60 Patient Monitor Telemetry Pulse Oximetry, May be Off Monitor for N/A (DEF)* Telemetry, May be Off Monitor for N/A Pulse Oximetry, May be Off Monitor for N/A Patient Monitor Other, Specify in Special Instructions, May be Off Monitor for N/A CVP monitoring Q1HR (DEF)* Other, Specify in Special Instructions, May be Off Monitor for N/A CVP monitoring, Q1HR Comments: Transduce femoral catheter ICP Monitoring Intake and Output-Strict Q1HR (DEF)* include EVD output, Q1HR Neurological Checks Q1HR Neurovascular Checks Q1HR (DEF)* with doppler ultrasound, Q1HR Intra-Abdominal Pressure Q1HR Activity Activity Bedrest, Constant Indicator (DEF)* Bedrest with Logrolling, Constant Indicator Up with Assistance Up to Chair, TID Up with Assistance Ambulate in Hall, TID Turning Q2HR Wear Brace/Splint Thoracic Lumbar Brace, May ambulate when wearing brace, Constant Indicator

2 Wear Brace/Splint Cervical Collar, at all times, Constant Indicator Wear Brace/Splint Other Brace, Aspen QuickDraw, for comfort, PRN Order Wear Brace/Splint Other Brace, Sling (DEF)* Other Brace, Sling, for comfort, PRN Order Hygiene Activity Shower, Preoperatively (DEF)* Shower, Hibeclens Scrub and shower Shower, Every Day, Hibeclens Scrub and shower Nursing SCIP Quality Measures Fecal Management System without Medication Administration Adult/Pediatric Subphase(SUB)* Fecal Management System with Medication Administration Adult/Pediatric Subphase(SUB)* Notify Provider Isolation Precautions Standard Precautions (DEF)* Standard Precautions Contact Precautions Standard Precautions Droplet Precautions Standard Precautions Contact Precautions Droplet Precautions Standard Precautions Neutropenic Precautions Standard Precautions Airborne Precautions Safety Precautions Fall Precautions (DEF)* Fall Precautions Aspiration Precautions, Keep HOB elevated 45 degrees Fall Precautions Latex Precautions Fall Precautions Seizure Precautions Fall Precautions Thrombocytopenic Precautions Pin Care Arterial Line Maintenance Arterial Line, Continuous measurement recorded Q1HR NG Tube Insertion Nasogastric/Orogastric Tube, Low Intermittent Suction NG Tube Maintenance Nasogastric/Orogastric Tube, Low Intermittent Suction, Constant Indicator OG Tube Insertion Nasogastric/Orogastric Tube, Low Intermittent Suction OG Tube Maintenance Nasogastric/Orogastric Tube, Low Intermittent Suction, Constant Indicator ND Tube Insertion Nasoduodenal/Oroduodenal Tube, Low Intermittent Suction ND Tube Maintenance Nasoduodenal/Oroduodenal Tube, Low Intermittent Suction, Constant Indicator Gastrostomy Tube Maintenance Gastrostomy Tube, Bedside Drain, Constant Indicator Urinary Catheter Insertion Indwelling Catheter, Bedside Drain, ONCE Reason Urinary Catheter Not Removed Urinary Catheter Maintenance Indwelling Catheter, Bedside Drain, Constant Indicator Drain/Tube Maintenance Jackson-Pratt, Bulb Drain, Constant Indicator Jackson-Pratt Strip Jackson-Pratt, Q4HR Drain/ Tube Flush Jackson-Pratt, Normal Saline, 30 ml Comments: Clamp drain 30 minutes then return to suction Drain/ Tube Flush Jackson-Pratt, 30 ml, tpa Comments: Clamp drain 30 minutes then return to suction Chest Tube/Blake Drain Maintenance Water-Seal 20 cm Suction, May put to water seal during ambulation (DEF)* Comments: May put to water seal during ambulation. Return to continuous wall suction when returned to bed

3 Diet Water-Seal Gravity Turn Cough Deep Breathe Q1HR While Awake Incentive Spirometry Q1HR While Awake Wound Care/Dressing Change Wet-to-Dry Dressing, TID Wound Care VAC Routine, Every Day, 125 mmhg continuous suction (DEF)* Routine, Every Day, 75 mmhg continuous suction Routine, Every Day, 125 mmhg intermittent suction Wound Care General Adult/Pediatric Subphase(SUB)* Venous Thromboembolism ProphylaxisComplete the order for the VTE Risk Assessment and the Compression Device and Stockings. If antithrombotic medication is required, go to the medication section for orders.(note)* Venous Thromboembolism Risk Assessment Low Risk-No Risk Factors, No VTE Prophylaxis Required (DEF)* Moderate Risk-1 Minor Risk Special Circumstances Apply Moderate Risk-1 Minor Risk, Constant Indicator Prophylactic Medication Contraindicated Moderate Risk-1 Minor Risk High Risk-A Major Risk or >1 Minor Risk Special Circumstances Apply High Risk-A Major Risk or >1 Minor Risk Prophylactic Medication Contraindicated High Risk-A Major Risk or >1 Minor Risk Compression Device/Stocking Seq Compress - Below the Knee Grad Compress Stocking - Knee High (DEF)* Grad Compress Stocking - Knee High Reason Stroke VTE Mechanical Prophylaxis Not Ordered Reason Stroke VTE Pharmacological Prophylaxis Not Ordered NPO Except Medications, Now (DEF)* Except Medications, At midnight Including Medications, Now Including Medications, At midnight Clear Liquid Diet Full Liquid Diet Regular Diet Dietary Supplements Adult Diabetic Diet, 1800 kcal (DEF)*, 2000 kcal, 2200 kcal Low Sodium Diet Low Fat/Low Cholesterol Diet Cardiac Diet (Low Fat/Cholesterol/Na) Low Residue Diet Renal Diet Post Gastrectomy Diet Dysphagia Puree (Level 1) Dysphagia Mechanically Altered (Level 2) Dysphagia Advanced (Level 3) Advance Diet as Tolerated Advance To Regular Diet, As Tolerated, per Guidelines (DEF)*

4 Advance To Clear Liquid Diet, As Tolerated, per Guidelines Advance To Full Liquid Diet, As Tolerated, per Guidelines Advance To Adult Diabetic Diet, 1800 kcal, As Tolerated, per Guidelines Advance To Adult Diabetic Diet, 2000 kcal, As Tolerated, per Guidelines Advance To Adult Diabetic Diet, 2200 kcal, As Tolerated, per Guidelines Advance To Low Sodium Diet, As Tolerated, per Guidelines Advance To Low Fat/Low Cholesterol Diet, As Tolerated, per Guidelines Advance To Dysphagia Mechanically Altered (Level 2), As Tolerated, Per Guidelines Advance To Renal Diet, As Tolerated, per Guidelines If selecting Tube Feeding order, please complete either the Enteral Nutrition Initiation Adult Subphase or the Parenteral Nutrition Initiation Adult Subphase to order the specific feeding details.(note)* Bolus ADULT Tube Feeding Continuous ADULT Tube Feeding Enteral Nutrition Initiation Adult Subphase(SUB)* Parenteral Nutrition Initiation Adult Subphase(SUB)* Continuous Infusions NS IVF NS-KCl 20mEq/L 1000mL IVF LR IVF LR-KCl 20mEq/L 1000mL IVF (IVS)* LR IVF KCl ADDITIVE 20 meq D5-1/2NS-KCl 20mEq/L 1000mL IVF D5-NS IVF D5LR IVF bicarb in sterile water reserved for TBI patients(note)* sodium bicarbonate 150mEq/L in sterile water 1000mL IVF (IVS)* sterile water IVF Comments: Total Volume = 1000mL; Sodium Bicarb 150mEq/L sodium bicarbonate ADDITIVE 150 meq sodium bicarbonate 150mEq/L in dextrose 5% 1000mL IVF (IVS)* D5W IVF Comments: Total Volume = 1000mL; Sodium Bicarb 150mEq/L sodium bicarbonate ADDITIVE 150 meq Replacement fluids for NGT output(note)* LR IVF 1,000 ml, replace NGT output with 0.5mL LR : 1mL output, IV, Injection Replacement fluids for ileoscopy output(note)* LR IVF 1,000 ml, replace ileostomy output with 0.5mL LR: 1mL output, IV, Injection Replacement fluids for fistula output(note)* LR IVF 1,000 ml, replace fistula output with 0.5mL LR : 1mL output, IV, Injection Replacement fluids for urine output(note)* 1/4NS 1000mL IVF 1,000 ml, replace urine output with 0.5mL 1/4NS : 1mL output, IV, Injection IV drips(note)* amiodarone 1.8 mg/ml in D5W 250 ml IV Drip (mg/min) (IVS)* D5W IV Drip - INET IV Comments: Infuse at 1 mg/min x 6 hours then change rate to 0.5 mg/min x 18 hours;conc: 1.8 mg/ml; Total Volume = 250 ml amiodarone ADDITIVE - INET

5 450 mg, 1, mg/min diltiazem 1 mg/ml in NS 125 ml IV Drip (mg/hr) (IVS)* NS IV Drip - INET parameters IV, 5 mg/hr = Titration Increment, 15 min = Titration Interval Comments: Titrate to maintain sinus rhythm.hold for HR below.hold for SBP below.*conc: 1 mg/ml* diltiazem ADDITIVE - INET 125 mg, 5, mg/hr DOPamine 1600 mcg/ml in D5W 250mL PREMIX IV Drip(mcg/kg/min) (IVS)* premix product INET parameters IV, 2 mcg/kg/min = Titration Increment, 2 min = Titration Interval Comments: Titrate to goal MAP above.*conc: 1600 mcg/ml* DOPamine INET premix 400 mg/250 ml 400 mg, 2, mcg/kg/min epinephrine 20 mcg/ml in NS 250 ml IV Drip (mcg/kg/min) (IVS)* NS IV Drip - INET parameters IV, 0.02 mcg/kg/min = Titration Increment, 2 min = Titration Interval Comments: Titrate to goal MAP above.*conc: 20 mcg/ml* epinephrine ADDITIVE (concentration=1mg/ml) - INET 5 mg, 0.01, mcg/kg/min insulin regular 1 unit/ml in NS 100 ml IV Drip (unit/kg/hr) (IVS)* NS IV Drip - INET IV Comments: Start at 0.1 unit/kg/hr; Titrate per ICU insulin infusion protocol; Conc: 1 unit/ ml; Total Volume = 100 ml insulin regular IV ADDITIVE - INET 100 unit, 0.1, unit/kg/hr nitroprusside 200 mcg/ml in NS 250 ml IV Drip (mcg/kg/min) (IVS)* NS IV Drip - INET parameters IV, 0.5 mcg/kg/min = Titration Increment, 2 min = Titration Interval Comments: Titrate to goal MAP below.hold for SBP less than.*conc: 200 mcg/ml* nitroprusside ADDITIVE - INET 50 mg, 0.3, mcg/kg/min vasopressin 1 unit/ml in NS 100 ml IV Drip (unit/hr) (IVS)* NS IV Drip - INET IV Comments: For non-sepsis indications and organ donation: Starting dose of 1 unit/hr - titrated to a MAP goal of For sepsis: Dose of unit/hr - fixed dose, do NOT titrateconc: 1 unit/ml; Total Volume = 100 ml vasopressin ADDITIVE - INET 100 unit, unit/hr propofol 10 mg/ml in 100mL PREMIX IV Drip (mcg/kg/min) (IVS)* premix product INET parameters IV Emulsion, 5 mcg/kg/min = Titration Increment, 5 min = Titration Interval Comments: Titrate to goal RASS of.*conc: 10 mg/ml* propofol INET premix 1,000 mg/100 ml 1,000 mg, 5, mcg/kg/min midazolam 1 mg/ml in NS 100 ml PREMIX IV Drip (mg/hr) (IVS)* premix product INET parameters IV, 1 mg/hr = Titration Increment, 30 min = Titration Interval Comments: Titrate to goal RASS of.contact physician if adequate sedation not reached at 10 mg/hr.*conc: 1 mg/ml* midazolam INET premix 100 mg/100 ml 100 mg, 2, mg/hr lorazepam 1 mg/ml in D5W 100 ml IV Drip (mg/hr) (IVS)* D5W IV Drip - INET parameters IV, 1 mg/hr = Titration Increment, 30 min = Titration Interval Comments: Titrate to goal RASS of.contact physician if adequate sedation not reached at 10 mg/hr.*conc: 1 mg/ml* lorazepam ADDITIVE - INET 100 mg, 2, mg/hr fentanyl 20 mcg/ml in NS 250 ml PREMIX IV Drip (mcg/kg/hr) (IVS)* premix product INET parameters IV, 0.25 mcg/kg/hr = Titration Increment, 30 min = Titration Interval

6 Comments: Titrate to maintain pain score less than.*conc: 20 mcg/ml* fentanyl INET 5,000 mcg/250 ml 5,000 mcg, 0.5, mcg/kg/hr pantoprazole 0.8 mg/ml in NS 100mL IV Drip (mg/hr) (IVS)* NS IV Drip - INET IV Comments: Conc: 0.8 mg/ml; Total Volume = 100mL pantoprazole ADDITIVE - INET 80 mg, 8, mg/hr dexmedetomidine 4 mcg/ml in NS 50 ml IV Drip (mcg/kg/hr) (IVS)* NS IV Drip - INET parameters IV, 0.1 mcg/kg/hr = Titration Increment, 10 min = Titration Interval Comments: Titrate to goal RASS of.*conc: 4 mcg/ml* dexmedetomidine ADDITVE - INET 200 mcg, 0.2, mcg/kg/hr Medications Alcohol Withdrawal (LOW Dose) Prophylaxis Adult Subphase(SUB)* Alcohol Withdrawal (HIGH Dose) Prophylaxis Adult Subphase(SUB)* Sedation / Paralysis(NOTE)* Critical Care IV Sedation Orders Adult Subphase(SUB)* Critical Care IV Paralysis Adult Subphase(SUB)* GI Prophylaxis(NOTE)* Stress Ulcer Prophylaxis Adult Subphase(SUB)* pantoprazole IV 40 mg, IVPB, Injection Powder, Q24HR DVT Prophylaxis(NOTE)* Venous Thromboembolism Prophylaxis Adult Subphase(SUB)* enoxaparin SQ (mg/kg) 1.5 mg/kg, SQ, Injection, Q24HR Dextran 40 in 0.9% Sodium Chloride IV 500 ml, 15 ml/hr, IV, Injection, x 1 dose(s) (DEF)* 500 ml, 15 ml/hr, IV, Injection 500 ml, 30 ml/hr, IV, Injection, x 1 dose(s) 500 ml, 30 ml/hr, IV, Injection Therapeutic Anticoagulation(NOTE)* enoxaparin SQ (mg/kg) 1 mg/kg, SQ, Injection, Q12HR Heparin IV Drip Weight Based (Surgery) Adult Protocol Subphase(SUB)* PRN Medications - Pain Management(NOTE)* Common PRN and Routine Medications Adult Subphase(SUB)* hydrocodone-acetaminophen 5-325mg oral solid-lortab 1 tab, PO, Q4HR, PRN, x 10 day(s), Hard Stop (DEF)* 2 tab, PO, Q6HR, PRN, x 10 day(s), Hard Stop acetaminophen IV for patients without TBI(NOTE)* acetaminophen IV for >,= 50kg 1,000 mg, IV, Injection, Q6HR, PRN Other (see comment), x 24 hour(s) Comments: prn pain or fever > 40. Max acetaminophen dose is 4 grams per 24 hours acetaminophen IV for patients with TBI(NOTE)* acetaminophen IV for >,= 50kg 1,000 mg, IV, Injection, Q6HR, PRN Other (see comment), x 24 hour(s) Comments: prn temp > Max acetaminophen dose is 4 grams per 24 hours ketorolac IV 30 mg, IV, Injection, Q8HR, x 5 day(s), Hard Stop fentanyl IV 50 mcg, IV, Injection, Q30MIN, PRN, x 10 day(s), Hard Stop fentanyl transdermal patch 25 mcg, transdermal, Patch, Q72HR, x 10 day(s), Hard Stop (DEF)* 50 mcg, transdermal, Patch, Q72HR, x 10 day(s), Hard Stop 75 mcg, transdermal, Patch, Q72HR, x 10 day(s), Hard Stop Use the Epidural Adult or the Patient Controlled Analgesia PCA Adult/Pediatric PowerPlan if these analgesia types are in use or need to be ordered.(note)* Nausea Management(NOTE)* ondansetron IV 4 mg, IV, Injection, Q8HR, PRN Nausea If promethazine also ordered, ondansetron should be first option.(note)*

7 promethazine should be used if nausea does not improve with ondansetron(note)* promethazine IV 12.5 mg, IV, Injection, Q4HR, PRN Nausea Comments: use promethazine if nausea does not improve with ondansetron Fever Management(NOTE)* acetaminophen oral solid 975 mg, PO, Tab, Q6HR, PRN Temperature Comments: Max acetaminophen dose is 4 grams per 24 hours acetaminophen PR / IV for patients without TBI(NOTE)* acetaminophen rectal suppository 650 mg, PR, Supp, Q6HR, PRN Other (see comment) Comments: prn temp > 40. Max acetaminophen dose is 4 grams per 24 hours acetaminophen IV for >,= 50kg 1,000 mg, IV, Injection, Q6HR, PRN Other (see comment), x 24 hour(s) Comments: prn temp > 40. Max acetaminophen dose is 4 grams per 24 hours acetaminophen PR / IV for patients with TBI(NOTE)* acetaminophen rectal suppository 650 mg, PR, Supp, Q6HR, PRN Other (see comment) Comments: prn temp > Max acetaminophen dose is 4 grams per 24 hours acetaminophen IV for >,= 50kg 1,000 mg, IV, Injection, Q6HR, PRN Other (see comment), x 24 hour(s) Comments: prn temp > Max acetaminophen dose is 4 grams per 24 hours Allergy / Itching Management(NOTE)* diphenhydramine oral solid 25 mg, PO, Tab, Q8HR, PRN Itch diphenhydramine IV 12.5 mg, IV, Injection, Q8HR, PRN Itch Miscellaneous PRN Medications(NOTE)* Artificial Tears ophthalmic solution 2 drop, both eyes, Soln, BID Artificial Tears ophthalmic solution 2 drop, both eyes, Soln, Q4HR, PRN Dry Eyes simethicone oral solid 80 mg, PO, Chew tab, Q8HR, PRN Gas benzocaine-menthol 6 mg-10 mg mucous membrane lozenge (Cepacol) 1 lozenge, PO, Q8HR, PRN Sore Throat lacrilube ophthalmic ointment 1 app, both eyes, Ointment, Q4HR, PRN Dry Eyes Bowel Regimen(NOTE)* docusate oral solid 100 mg, PO, Cap, BID senna oral solid 187 mg, PO, Tab, BID Comments: 187mg standardized senna concentrate = 8.6mg sennosides bisacodyl rectal suppository 10 mg, PR, Supp, ONCE polyethylene glycol oral powder-miralax 17 gm, PO, Granules, Every Day Comments: 1 tablespoon=17 grams mineral oil light oral liquid 15 ml, PO, ONCE, PRN (DEF)* 30 ml, PO, ONCE, PRN For persistent constipation, may order bowel regimen combination of: bisacodyl PO or PR + mineral oil + prune juice(note)* bisacodyl oral solid 10 mg, PO, EC Tablet, ONCE Comments: give with 4 oz prune juice bisacodyl rectal suppository 10 mg, PR, Supp, ONCE Comments: give with 4 oz prune juice mineral oil light oral liquid 40 ml, PO, ONCE Comments: give with 4 oz prune juice Bowel Prep(NOTE)* magnesium citrate oral liquid

8 300 ml, PO, Liquid, Q24HR, x 2 dose(s) Golytely oral solution 4,000 ml, PO, Soln, ONCE Comments: per Standard Prep Protocol Enema Administration Fleets, PRN Order IV Antibiotics - ***For TREATMENT Use Only - Not for Surgical Prophylaxis"(NOTE)* For Post-Op Surgical Prophylaxis Antibiotics use "Post-Op Surgical Prophylaxis Antibiotic Adult" Powerplan(NOTE)* levofloxacin IV 750 mg, IVPB, IV minibag, Q24HR, x 10 day(s), Hard Stop (DEF)* 500 mg, IVPB, IV minibag, Q24HR, x 10 day(s), Hard Stop 250 mg, IVPB, IV minibag, Q24HR, x 10 day(s), Hard Stop metronidazole IV 500 mg, IV, IV minibag, Q8HR, x 10 day(s), Hard Stop piperacillin-tazobactam IV-Zosyn gm, IVPB, Injection Powder, Q8HR, Over 4 hour(s), x 10 day(s), Hard Stop Comments: (Give first dose over 30 minutes)crcl >= 20 ml/min, continuous renal replacement therapy -> gm IV Q8HR (4-HR infusion)crcl < 20 ml/min, hemodialysis, peritoneal dialysis -> gm IV Q12HR (4-HR infusion) ampicillin/sulbactam IV 1.5 gm, IVPB, Injection Powder, Q6HR, x 10 day(s), Hard Stop vancomycin IV (mg/kg) ADULT (per pharmacy protocol) 15 mg/kg, IV, Injection Powder, Q12HR, x 10 day(s), Hard Stop (DEF)* Comments: pharmacy to adjust per protocolreserve for known or presumed MRSA, round dose to nearest 250 mg; Draw trough serum concentration prior to fourth dose. 15 mg/kg, IV, Injection Powder, Q24HR, x 10 day(s), Hard Stop Comments: pharmacy to adjust per protocolreserve for known or presumed MRSA, round dose to nearest 250 mg; Draw trough serum concentration prior to fourth dose. 15 mg/kg, IV, Injection Powder, Q48HR, x 10 day(s), Hard Stop Comments: pharmacy to adjust per protocolreserve for known or presumed MRSA, round dose to nearest 250 mg; Draw trough serum concentration prior to fourth dose. if fluconazole is appropriate antibiotic choice, select BOTH order sentences for fluconazole(note)* fluconazole IV +24 Hours fluconazole IV 200 mg, IV, Injection, Q24HR, x 10 day(s) clindamycin IV 900 mg, IVPB, Injection, Q8HR, x 10 day(s) daptomycin IV (mg/kg) 4 mg/kg, IV, Injection Powder, Every Day, x 10 day(s) (DEF)* Comments: REQUIRES ID CONSULT/APPROVAL 6 mg/kg, IV, Injection Powder, Every Day, x 10 day(s) Comments: REQUIRES ID CONSULT/APPROVAL linezolid IV 600 mg, IVPB, Injection, Q12HR, x 10 day(s) Comments: REQUIRES ID CONSULT/APPROVAL meropenem IV 1 gm, IVPB, Injection Powder, Q8HR, x 10 day(s) voriconazole IV (mg/kg) 4 mg/kg, IV, Injection Powder, Q12HR, x 10 day(s) Comments: Maintenance Dose. Max Maintenance Dose = 200 mg. caspofungin IV 50 mg, IVPB, Injection Powder, Q24HR, x 10 day(s) (DEF)* Comments: REQUIRES ID CONSULT/APPROVAL 70 mg, IVPB, Injection Powder, Q24HR, x 10 day(s) Comments: REQUIRES ID CONSULT/APPROVAL micafungin IV 50 mg, IV, Injection Powder, Q24HR, x 10 day(s), Hard Stop (DEF)* Comments: protect from light; flush line with NS prior to administration 100 mg, IV, Injection Powder, Q24HR, x 10 day(s), Hard Stop Comments: protect from light; flush line with NS prior to administration 150 mg, IV, Injection Powder, Q24HR, x 10 day(s), Hard Stop Comments: protect from light; flush line with NS prior to administration Other Medication(NOTE)* mannitol IV

9 50 gm, IV, Injection, ONCE acetazolamide IV 500 mg, IV, Injection Powder, Every Day, x 3 day(s), Hard Stop furosemide IV 20 mg, IV, Injection, ONCE Reason Beta-Blocker Not Prescribed at Discharge Respiratory Medications(NOTE)* Mucomyst 20% jet neb RT treatment 2 ml, INH, Soln, ONCE normal saline 0.9% jet neb RT treatment 5 ml, jet neb, Soln, QID Comments: with EzPAP sodium bicarbonate for RT LAVAGE 2.5 meq, endotracheal, Soln, ONCALL, x 1 dose(s) Comments: 2.5mEq/5mL of 4% soln DuoNeb jet neb RT treatment 3 ml, jet neb, Soln, QID Laboratory Point of Care(NOTE)* Capillary Blood Glucose Q8HR On Admission(NOTE)* ABG w/meas Sat Amylase Basic Metabolic Panel Calcium Ionized, Serum CBC with Diff CK Total Blood, Urgent collect, Q6HR INTERVAL 3 time(s) Comprehensive Metabolic Panel Lactic Acid Lipase Level Magnesium Level Phosphorus Inorganic Prothrombin Time Comments: Includes INR APTT Troponin I Quant Blood, Urgent collect, Q6HR INTERVAL 3 time(s) Urinalysis Urine, Urgent collect, ONCE Urine Pregnancy Qualitative Urine, Urgent collect, ONCE MRSA PCR Nasal, Urgent collect, ONCE Blood Culture Site 1 Blood from Intravascular Line, Urgent collect, ONCE (DEF)* Blood Venipuncture, Routine collect, ONCE Culture Respiratory + Gram Sputum, Routine collect, ONCE Culture Urine Urine Clean Catch Midstream, Routine collect, ONCE (DEF)* Urine Catheterized, Routine collect, ONCE

10 Daily Labs(NOTE)* ABG w/meas Sat Amylase Basic Metabolic Panel Calcium Ionized, Serum CBC with Diff CK Total Blood, Timed Study collect, Q8HR INTERVAL 3 time(s) Comprehensive Metabolic Panel Blood, Routine collect, AM LAB 1 time(s) Lactic Acid Lipase Level Magnesium Level Phosphorus Inorganic Osmolality Blood, Timed Study collect, Q6HR INTERVAL 4 time(s) Prealbumin Blood, Routine collect, MTH LAB 2 time(s) Prothrombin Time Comments: Includes INR APTT Troponin I Quant Blood, Timed Study collect, Q6HR INTERVAL 3 time(s) Clostridium Difficile PCR Stool, Routine collect, ONCE Fecal Occult Blood Stool, Routine collect, ONCE Occult Blood Gastric Gastric Fluid, Routine collect, ONCE Blood Bank Type (ABO/Rh) Blood Comments: Fenwall Label Sample Required Antibody Screen Red Blood Cell Order Fresh Frozen Plasma Order Platelet Pheresis Order Transfuse Blood Products Respiratory Oxygen Therapy Nasal Cannula, Keep SPO2 greater/equal 92%, Improve Oxygenation (DEF)* Nasal Cannula, 2 L/min, Keep SPO2 greater/equal 90%, Improve Oxygenation Nasal Cannula, 4 L/min, Keep SPO2 greater/equal 90%, Improve Oxygenation Nasal Cannula, Keep SPO2 greater/equal 90%, Improve Oxygenation Chest Physiotherapy QID, Improve/Prevent Atelectasis EzPAP ONCE, Per Hyperinflation Protocol Ventilator Settings General/Surgical Ventilator Protocol Rehab PT/OT/ST/AUD PT Adult Eval and Treat OT Adult Eval and Treat Speech Therapy Adult Eval And Treat

11 Radiology/Imaging XR Chest 1 View Frontal XR Chest 2 Views XR Abdomen AP XR Abdomen Series w/ Chest 1 View XR Abdomen Complete w/ Decub/Erect CT Head or Brain w/o Contrast CT Soft Tissue Neck w/o Contrast CT Soft Tissue Neck w/ + w/o Contrast CT Thorax w/ + w/o Contrast CT Abdomen/Pelvis w/ + w/o Contrast CT Angiography Chest w/ + w/o Contrast CT Angiography Pelvis w/ + w/o Contrast CT Angiography Lower Extremity Left CT Angiography Lower Extremity Right CT Angiography Abdomen US LE Venous Duplex Bilateral Diagnostic Tests All diagnostic tests must be ordered on paper diagnostic order forms.(note)* Order for EKG must be placed on paper order form and Ordercommed to be scheduled.(note)* Consults/Ancillary Services All medical service consults remain on paper consult form.(note)* Consult to Food and Nutrition Consult Respiratory Therapy Consult to Case Management Other Patient Education *Report Legend: DEF - This order sentence is the default for the selected order GOAL - This component is a goal IND - This component is an indicator INT - This component is an intervention IVS - This component is an IV Set NOTE - This component is a note Rx - This component is a prescription SUB - This component is a sub phase