Physician Orders ADULT: Medical Response Team Standing Orders Protocol Plan
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- Warren Hunt
- 5 years ago
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1 Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase When to Initiate: Other-See Special Instructions, If MRT is notified per MD, Condition H or any associate, review and Initiate appropriate phase below. Signs of Resp Distress Standing Order Phase Criteria for use: Patient complains of SOB, work required to breathe increases, cyanosis, family states patient cannot breathe.(note)* Start, INT Suction Patient PRN, Suction: Oral, For airway management Suction Patient PRN, Suction: Nasal Suction: Nasotracheal, For airway management STAT, obtain qualified physician interpretation of EKG Routine, Special Instructions: Oxygen to increase O2 saturation to 92% ISTAT Blood Gases (RT Collect), Special Instructions: for agonal breathing; respiratory distress, respiratory rate greater than 22, or SPO2 less than 88%, T;N 500 ml, Injection, IV Piggyback, once, STAT, 1,000 ml/hr Comments: for SBP greater than 90mmHg or MAP less than 60mmHg may give once and call physician. +1 Hours D50W Syringe 50 ml, Injection, IV Push, once, PRN Hypoglycemia, STAT, for Accucheck less than 60mg/dL MED Medical Response Team Standing Orders Protocol Plan QM0816 PP Rev Page 1 of 5 *111*
2 Lactate Level EKG Start at: T;N, Priority:, Reason: Other, specify, Respiratory Distress, Transport: Portable T;N, Reason for Exam: Respiratory Distress,, Portable Consults/Notifications/Referrals Notify Physician-Once Notify For: Stridor Signs of Chest Pain Standing Orders Phase Criteria for use: Chest pain/discomfort, Chest: Upper abdomen, chest, upper back, throat, jaw, shoulders, upper arms, Pain: Discomfort or other abnormal sensation such as gas, indigestion, fullness, pressure, tightness, or heaviness.(note)* Start INT Oxygen Sat Monitoring NSG Oxygen Sat Monitoring NSG Routine, q15min For 4 hr, PRN STAT, obtain qualitied physician, interpretation of EKG For STEMI; contact physician immediately and implement ordered STEMI interventions per physician order STAT, if cardiologist on case; call cardiologist immediately Routine, Special Instructions: Oxygen to increase O2 saturation to 90% MED Medical Response Team Standing Orders Protocol Plan QM0816 PP Rev Page 2 of 5 *111*
3 500 ml, Injection, IV, N/A, STAT, (for 1 dose ), ( infuse over 1 hr ) Comments: For SBP less than 90mmHg or MAP less than 60mmHg may give once and call physician. +1 Hours aspirin 324 mg, Chew tab, PO, once, STAT Comments: If allergic to ASA hold and contact physician OR(NOTE)* +1 Hours aspirin 300 mg, Supp, PR, once, STAT, Give aspirin PR if unable to take PO Comments: If allergic to ASA hold and contact physician +1 Hours nitroglycerin 0.4 mg, Tab, SL, q15min, Chest Pain, STAT, (for 3 dose ) Comments: Give after EKG completed only if MAP greater than 60mm HG or SBP greater than 90mmHG. Call physician after 1st dose. Troponin-I EKG Start at: T;N, Priority:, Reason: Chest Pain/Angina/MI, send to ED for immediate interpretation T;N, Reason for Exam: Chest Pain,, Portable Signs of Mental Change Standing Order Phase Criteria for use: Acute confusion, cognitive impairment, loss of mental capacity, memory impairment, or MRT call for Suspected CVA. Comment: for signs and symptoms of suspected stroke such as Facial Droop, Arm Drift, Abnormal or loss of speech, aphasia, agraphia, acalculia, apraxia, gaze preference, visual field deficit, hemiparesis, hemisensory loss, neglect, flat affect, severe headache with no known cause, confusion, dizziness, loss of balance, or loss of sensation Or increase in NIHSS greater than 4pts((NOTE)* MED Medical Response Team Standing Orders Protocol Plan QM0816 PP Rev Page 3 of 5 *111*
4 Routine, q15min, For 4 hr, PRN Start INT STAT, obtain qualitied physician interpretation of EKG STAT, obtain qualitied physician MD to call BAT team STAT, obtain last known "well time before symptoms Routine, Special Instructions: Oxygen to increase O2 Saturation to 92% ISTAT Blood Gases (RT Collect), Special Instructions: for agonal breathing; respiratory distress, respiratory rate greater than 22, or SPO2 less than 88%, T;N 500 ml, Injection, IV, N/A, STAT, (for 1 dose ), ( infuse over 1 hr ) Comments: for SBP less than 90 or MAP less than 60mmHG may give once and call physician +1 Hours D50W Syringe 50 ml, Injection, IV Push, N/A, Other, specify in Comment, STAT, (for 1 dose ), For Accucheck less than 60mg/dL Comments: For Accucheck less than 60mg/dL. +1 Hours glucagon 1 mg, Injection, Subcutaneous, N/A, PRN, STAT, (for 1 dose ), For Accucheck less than 60mg/dL; Give if no IV access MED Medical Response Team Standing Orders Protocol Plan QM0816 PP Rev Page 4 of 5 *111*
5 Lactate Level Blood Culture STAT, T;N, q5min 2 occurrence, Specimen Source: Peripheral Blood Comments: For a temp less than 36 C or greater than 38 C. Electrocardiogram Start at: T;N, Priority:, Reason: Syncope, Transport: Stretcher Reason for Exam: Other, Enter in Comments,, Portable Comments: Change in level of consciousness. Place CT below if accucheck within normal limits and stroke suspected:(note)* CT Head/Brain W/O Cont T;N, Reason for Exam: Confusion,, Stretcher Comments: For signs and symptoms of suspected stroke such as Facial Droop, Arm Drift, Abnormal or loss of speech, aphasia, agraphia, acalculia, apraxia, gaze preference, visual field deficit, hemiparesis, hemi-sensory loss, neglect, flat affect, severe headache with no known cause, confusion, dizziness, loss of balance, or loss of sensation. Date Time Physician s Signature MD Number *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, see separate sheet R-Required order MED Medical Response Team Standing Orders Protocol Plan QM0816 PP Rev Page 5 of 5 *111*
Physician Orders ADULT: Acute MI/Acute Coronary Syndrome Adult Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Acute MI/Acute Coronary Syndrome Adult Phase, When to Initiate: Acute MI/Acute Coronary Syndrome Adlt Phase Non Categorized
Physician Orders ADULT: Atrial Fib/Flutter Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Atrial Fib/Flutter Phase, When to Initiate: Atrial Fib/Flutter Phase Non Categorized Problem: Atrial fibrillation Problem:
Physician Orders Pediatric: LEB ED Asthma Plan
LEB ED Triage Standing SOB/Wheeze Asthma Non Categorized Criteria: Patients greater than 2 years of age with a history of asthma or airway active disease or two or more previous illnesses treated with
Physician Orders ADULT: Asthma and Bronchitis Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Asthma and Bronchitis Phase, When to Initiate: Asthma and Bronchitis Phase Non Categorized Problem: Asthma Problem:
Physician 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
Physician Orders ADULT: Kidney-Panc/PancTransplant Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Kidney-Panc/Panc Transp Post Op Phase, When to Initiate: Kidney-Panc/Panc Transp Post Op Phase Vital Signs Vital
Physician 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,
Physician Orders PEDIATRIC: LEB Stroke Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Stroke Admit Phase. When to Initiate: LEB Stroke Admit Phase Admission/Transfer/Discharge Patient Status Initial
Physician Orders ADULT: Renal Transplant Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Renal Transplant Admit Phase, When to Initiate: Renal Transplant Admit Phase Non Categorized Initiate Powerplan Phase,
Physician Orders PEDIATRIC: LEB Oral Maxillofacial Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Oral Maxillofacial Postop Phase, When to Initiate: LEB Oral Maxillofacial Post Op Phase Admission/Transfer/Discharge
Physician Orders PEDIATRIC: LEB NEURO Epilepsy Monitoring Unit Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Neuro Epilepsy Monitoring Unit Admit Phase, When to Initiate: LEB Neuro Epilepsy Monitor Unit Admit Phase Non Categorized
Physician Orders PEDIATRIC: : LEB ED Trauma (Major) Plan
LEB ED Standing Orders Trauma (Major) Ph Non Categorized Criteria: Patients between 0-18 years of age that present with a Major Trauma that meet LeBonheur Trauma stat or Trauma Alert Guidelines.(NOTE)*
Physician Orders PEDIATRIC: LEB Critical Care Respiratory Plan
LEB Critical Care Respiratory Plan Patient Care Cardiopulmonary Monitor T;N Routine, Monitor Type: End Tidal Co2 (DEF)* T;N Routine, Monitor Type: Transcutaneous Co2 Respiratory Care Initiate Pediatric
Physician Orders PEDIATRIC: LEB Kidney Transplant Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Kidney Transplant Post Op Phase, When to Initiate: LEB Kidney Transplant Post Op Phase Admission/Transfer/Discharge
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available at ALL facilities Non Categorized SUB ED Chest Pain: STEMI Protocol(SUB)* SUB ED Chest Pain: STEMI Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as
Physician Orders ADULT: Head and Neck Postoperative Plan
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,
Physician Orders PEDIATRIC: LEB ED Hx of DKA with Hyperglycemia Plan
LEB ED Triage Hx of DKA w Hyperglycemia Non Categorized Criteria for use: Patients less than 18 years of age with known or suspected Diabetes Mellitus and blood glucose greater than 300mg/dL.(NOTE)* Vital
Physician Orders PEDIATRIC: LEB NEURO SURG Surgical Spine Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Neuro Surg Spine Postop Phase, When to Initiate: LEB Neuro Surgical Spine Post Op Phase Admission/Transfer/Discharge
Physician Orders ADULT: 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,
Physician Orders ADULT: LEB Asthma Admit Plan. Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N Attending Physician:
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: LEB Asthma Admit Phase, When to Initiate: LEB Asthma Admit Phase Non Categorized Add To Problem List Problem: Asthma
Physician Orders PEDIATRIC: LEB DKA Diabetes Mellitus Admit Plan
Initiate Orders Phase Non Categorized R Powerplan Open Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Admit DKA Two-Bag Calculations Phase, When to Initiate: Initiate Powerplan Phase Phase:
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Non Categorized SUB Sub Phase (SUB)* Non Categorized Quality Measures STK Diet ED NPO Until Bedside Swallow Screen passed Nursing Orders Activate Code Stroke Vital Signs Q15MINS Int
Physician Orders ADULT: Vascular Surgery AAA Endovascular Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: AAA Endovascular PACU Phase, When to Initiate: Initiate Powerplan Phase Phase: Mechanically Ventilated Patients Phase,
UMC Health System Patient Label Here PHYSICIAN ORDERS
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Physician Orders ADULT Order Set: Respiratory Failure Orders
[R] = will be ordered Height: cm Weight: kg Allergies: [ ] No known allergies [ ]Medication allergy(s): [ ] Latex allergy [ ]Other: Admission/Transfer/Discharge [ ] Patient Status Initial Inpatient Attending
Physician Orders ADULT: Vascular Surgery AAA Repair Open Post Op Plan
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,
Attach patient label here. Physician Orders ADULT: Palliative Care Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Palliative Care Phase, When to Initiate: Palliative Care Phase Admission/Transfer/Discharge Patient Status Initial
Physician Orders PEDIATRIC: LEB Eating Disorder Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Eating Disorder Admit Phase, When to Initiate: When patient arrives to unit LEB Eating Disorder Admit Phase Admission/Transfer/Discharge
Physician 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
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
Available at: ALL Adult Facilities Non Categorized SUB Protocol(SUB)* SUB Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form*** Nursing Orders
Physician s Order Form. Physician s Order Form. Telemetry/Progressive Care Orders. Continued on next page. >>>>>>> Continued on next page.
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
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Vital Signs Vital Signs Q4H (DEF)* Q2H Q1H Vital Signs Orthostatic Activity Activity Bedrest, for 12 hours then Up ad lib (DEF)* Bedrest, for 24
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
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
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Physician Orders ADULT
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PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: ALL Adult Facilities Non Categorized SUB ED Abdominal Pain Protocol(SUB)* ***The above subphase is available at the end of the plan*** SUB ED Abdominal Pain Protocol Lab
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PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: ALL Adult Facilities Non Categorized SUB Protocol(SUB)* SUB Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form***
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Height: cm Weight: kg Allergies: [ ] No known allergies [ ] Initiate Powerplan Phase T;N, Phase: LEB PICU Admit Phase Admission/Transfer/Discharge [ ] Admit Patient to Dr. [ ] Admit Status: [ ] Inpatient
Physician Orders. PED Endocrine General Admit Plan [X or R] = will be ordered unless marked out. [ ] No known allergies
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Physician Orders ADULT: Cardiac Surgery Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Cardiac Surgery Post Op Phase, When to Initiate: Initiate Powerplan Phase Phase: Mechanically Ventilated Patients (Vent
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
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PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available ONLY at: BMC-B BMC-D BMC-N BMC-S Intubation Phase Notify Therapy for STAT intubation SUB Rapid Sequence Induction(SUB)* ***The above subphase is available at the end of the powerplan under the
*111* attach patient label here
Physician Orders ADULT [R] = will be ordered Height: cm Weight: kg Allergies: No known allergies Medication allergy(s): Latex allergy Other: Admission/Transfer/Discharge Patient Status Initial Inpatient
Physician Orders PEDIATRIC: LEB Ortho Accelerated Posterior Spinal Fusion Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Ortho Accelerated PSF Post Op Initial Phase, When to Initiate: Initiate Powerplan Phase Phase: LEB Ortho Accelerated
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