Med Stroke Admission Order Set (2367) [2367] Admission

Transcription

1 Med Stroke Admission Order Set (2367) [2367] Admission Admit [4398] Admit to [NUR35N10145] Unit: Level of care: FYI, Starting today, Cardiac Monitor (Single Response) [34406] Cardiac monitor is not indicated for Chronic CHF without Acute Exacerbation, Pneumonia, Chronic Asthma, NCB/DNR/DNI without symptomatic arrhythmia, Acute Alcohol Withdrawal, GI Bleed not needing progressive or intensive care, Hyponatremia, Hydralazine push, Patients with normal pacer interrogation, Non-Cardiac Chest Pain in patients with COPD or Pneumonia. Guidelin URL es for Cardiac Monitorin g : itor_use.htm Cardiac Monitor not indicated [NUR35N10176] Patient is to be admitted to a Telemetry, Critical Care, or Progressive Care Unit. (Cardiac monitoring is a standard of care.) [NUR35N11482] Cardiac monitor [NUR35N10442],, Reason for Ordering Cardiac Monitor: FYI, Starting today For 1 Occurrences, Discontinue Cardiac Monitor [55367] Discontinue Cardiac Monitor [NUR35N11186], FYI, Starting today, Code Status (Single Response) [3635] The patient is full resuscitation unless the following is ordered. Up to the point of cardiopulmonary arrest, maximal therapeutic care will be given. Full Code. [COD22N10002] Resuscitation measures as directed (add detail): [COD22N10001] No Code Blue [COD22N10000], Resuscitation medications? (must do compressions): Countershock? Intubation for respiratory arrest?, Page 1 of 16

2 Code status unable to be addressed (patient will be full code unless changed). [COD22N10005], Notify [142925] Notify provider with any neurological changes or concerns. [NUR35N10177] Check for sliding scale insulin orders. If order not present, contact provider for blood glucose greater than 140. [NUR35N10177],, Consults [142926] Courtesy notification of patient's primary provider (Add detail) [CON30N10101] Courtesy notification (Add detail) [CON30N10101] Consult to (Add detail) [CON30N10102] Consult to (Add detail) [CON30N10102] Consult to (Add detail) [CON30N10102] Partial transfer of Care [CON30N10103] Total Transfer of Care [CON30N10100] Care Management Screening [CON30N10088], ONCE, Starting today,, Consult To (General Specialty): Reason for Consult/Notification? Already contacted? (If Yes, provider will not be renotified): ONCE, Starting today, Consult To (General Specialty): Reason for Consult/Notification? Already contacted? (If Yes, provider will not be renotified): Consult To (General Specialty): Reason for Consult/Notification? Already contacted? (If Yes, provider will not be renotified): Reason for transfer of partial care: Already contacted? (If Yes, provider will not be renotified): Urgent consultation (requires provider to provider communication), Normal Consult From: To: Reason for transfer of total care:, Page 2 of 16

3 Rehab Admission Coordinator Consult [CON30N10002] If patient is on warfarin and followed by the River Campus Anticoagulation Clinic, notify them (x52823) [NUR35N10176],, FYI, Starting today For 1 Occurrences, Laboratory [142929] Troponin now if not already done this admission. Serum pregnancy if child bearing age if not already done this admission. Troponin [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences,, No results found for: TROP Serum pregnancy test [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences,, No results found for: UPT Glucose by Glucose Meter checks QID x 4 Occurrences [LAB ] Routine, Bedside, QID AC AND HS For 4 Occurrences, Glycosolated Hemoglobin [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences,, No results found for: A1C CBC with Differential and Platelet Count [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Chem 8 [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Prothrombin Time/INR [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences,, No results found for: PT, INR Partial Thromboplastin Time [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences,, No results found for: APTT Toxicology Screen (recommended for young to middle age) [LAB ] Routine, Unit Collect, ONCE, Starting today For 1 Occurrences, Laboratory-If familial disposition for stroke or if less than 45 consider the following: [50863] Lupus Inhibitor [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Phospholipid Antibody IGG and IGM [LAB ], ONCE, Starting today For 1 Occurrences, Protein C [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Protein S [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Factor V Leiden Mutation [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Fibrinogen [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Prothrombin Mutation [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Page 3 of 16

4 Antithrombin III [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Homocysteine Plasma [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Methylmalonic Acid [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Imaging [6889] CT Head without IV Contrast [RAD ] Bilateral Carotid Ultrasound [RAD ] MRI Head without Contrast [RAD ] MRA Head Routine without contrast [RAD ] MR Carotids Neck with and without Contrast [RAD ] CTA Head [RAD ] CTA Neck [RAD ] CTA Head and Neck [RAD ] Routine, Radiology, Perform as Portable? No ONCE RAD, Starting today For 1 Occurrences, Does the patient have a pacemaker, implanted defibrillator, aneurysm clips or cochlear implant? IF YES, PT MAY NOT BE ABLE TO HAVE MRI. CHECK WITH MRI DEPT. Is the patient claustrophobic? What type of sedation does the patient require? ONCE RAD, Starting today For 1 Occurrences, Does the patient have a pacemaker, implanted defibrillator, aneurysm clips or cochlear implant? IF YES, PT MAY NOT BE ABLE TO HAVE MRI. CHECK WITH MRI DEPT. Is the patient claustrophobic? What type of sedation does the patient require? ONCE RAD, Starting today For 1 Occurrences, Does the patient have a pacemaker, implanted defibrillator, aneurysm clips or cochlear implant? IF YES, PT MAY NOT BE ABLE TO HAVE MRI. CHECK WITH MRI DEPT. Is the patient claustrophobic? What type of sedation does the patient require? Routine, Radiology, ONCE RAD, Starting today For 1 Occurrences, Routine, Radiology, ONCE RAD, Starting today For 1 Occurrences,, Cardiology [6890] 12 lead ECG if not completed this admission Page 4 of 16

5 ECG [CAR ] Transesophageal Echocardiogram [CAR ] Routine, Hospital Reason for ECG: Other (Specify) ONCE, Starting today For 1 Occurrences, Reason for test: CVA/TIA ONCE, Starting today For 1 Occurrences, Medications - IV Solutions [142930] IV Fluids Composer - select base and additives as needed [401402] at 100 ml/hr, IV infusion, CONTINUOUS Adult Admission Orders at 100 ml/hr Saline Lock [NUR35N10638], FYI, Starting today For 1 Occurrences, Sodium Chloride 0.9% lock flush [25456] Flush IV catheters per IV Flush/Fluid Protocol. (7814) (Nursing/Imaging to enter orders) [NUR35N11079] lidocaine (aka: XYLOCAINE) 1 % injection [66150] Dextrose containing fluids not recommended for first 48 hrs. Dextrose may be administered in maintenance solutions after 24 hrs, but should be avoided in bolus solutions (e.g. volume resuscitation fluids). [CON30N10039] Corticosteroids should be avoided if at all possible. If necessary, blood glucose should be closely monitored. [CON30N10039] Medications [142931] Renal Dosing Protocol Applies per Pharmacy. 3 ml, intravenous, Q8HR AND AS NEEDED, FYI, Starting today For 1 Occurrences, 0.25 ml, subdermal, AS DIRECTED PRN, pain control prior to IV insertion To IV insertion site prior to IV insertion for pain control. Reason for consult: Dextrose containing fluids not recommended for first 48 hrs. Dextrose may be administered in maintenance solutions after 24 hrs, but should be avoided in bolus solutions (e.g. volume resuscitation fluids). Reason for consult: Corticosteroids should be avoided if at all possible. If necessary, blood glucose should be closely monitored. acetaminophen (TYLENOL) Panel [159981] acetaminophen (aka: TYLENOL) tablet [1438] acetaminophen (aka: TYLENOL) suppository [1502] Milk of Magnesia (MOM) suspension [10441] "Or" Linked Panel 650 mg, oral, Q4H PRN, fever, mild pain Med Stroke Admission Order Set 650 mg, rectal, Q4H PRN, fever, mild pain If unable to take PO Med Stroke Admission Order Set 30 ml, oral, DAILY PRN, constipation Med Stroke Admission Order Set Avoid any renal failure/dialysis patients Page 5 of 16

6 Mylanta/Maalox suspension [16790] Ondansetron (Zofran) 4 mg IV [68307] Bisacodyl (Dulcolax) 10 mg rectal suppository [11988] docusate sodium (aka: COLACE) 100 mg capsule [14825] 15 ml, oral, QID PRN, heartburn Med Stroke Admission Order Set Avoid any renal failure/dialysis patients 4 mg, intravenous, Q6H PRN, nausea, vomiting Med Stroke Admission Order Set 10 mg, rectal, DAILY PRN, to stimulate bowels Med Stroke Admission Order Set 100 mg, oral, BID PRN, to soften stools Med Stroke Admission Order Set Medications - Warfarin [142932] If physician is going to dose and follow patient on Warfarin, please check "Warfarin dosing" and check "Physician to dose warfarin". Warfarin dosing [17110] oral, ONCE1700 Starting today at 5:00 PM For 1 Doses Stroke Admission Orders Do not administer warfarin if most recent INR greater than 3.5, notify physician. CONTACT ANESTHESIOLOGIST BEFORE STARTING WARFARIN IF PATIENT CURRENTLY RECEIVING EPIDURAL. Dispose of wrapper in BLACK WASTE CONTAINER (DFI/Booklet) Subsequent dosing requires an order written each day (only "warfarin x1" orders will be accepted or "no warfarin today"). Physician to dose warfarin [450217] Pharmacy to dose warfarin - consult to pharmacy [NUR35N10898] oral, DAILY Stroke Admission Orders Do not administer warfarin if most recent INR greater than 3.5, notify physician. Who is following INR and dosing: Physician INR Goal Range: Pharmacy to dose warfarin and place warfarin check daily order on the MAR, Goal INR: Warfarin Indication (choose all that apply)? INR - Baseline [LAB ] Routine, Lab Collect, ONCE, Starting today For 1 Occurrences,, No results found for: PT, INR INR - Daily [LAB ] Diet [142933] Routine, Lab Collect, AM ROUTINE, Starting today at 6:00 AM For 100 Occurrences,, No results found for: PT, INR Page 6 of 16

7 NPO including oral medications until: [NUR35N10056] 2 gm Sodium, Low Saturated Fat, Low Caffeine [NUT13N10007] Regular Diet [NUT13N10001] Cardiac Diet [NUT13N10003] Diabetic Diet [NUT13N10012] Fluid Restriction [NUT13N10034] Dialysis Diet [NUT13N10009] Nurse screens for safe swallow before water, meds or meal started. If swallow impaired, make NPO and consult speech therapy to evaluate and treat for dysphasia. If swallow not impaired, diet as ordered.,, Routine, Diet Modifiers? LOW FAT,LOW CAFFEINE Special needs? Altered consistency? Routine, Diet Modifiers? Special needs? Altered consistency? Routine, Diet Modifiers? Special needs? Altered consistency? Routine, Diet Calorie or CHO level? Modifiers? Special needs? Altered consistency? Routine, Supplement How many ml? FYI, Starting today, Routine, Diet Modifiers? Special needs? Altered consistency? Patient Care [142913] O2 to maintain oxygen sats greater than 94% [NUR35N10271] Daily Weight [NUR35N10320] Intake and Output [NUR35N10105] Discontinue cardiac monitoring after 24 hours [NUR35N10176] HOB 30 degrees [NUR35N10001] Out of bed with assistance [NUR35N10340], FYI, Starting today For 1 Occurrences,, WEIGH DAILY, Starting today,,, FYI, Starting today For 1 Occurrences, Activity: FYI, Starting today For 1 Occurrences,, Page 7 of 16

8 Bedrest [NUR35N10008] Fever greater than 99 degrees should be treated with antipyretics [NUR35N11124] Bladder scan q 4-6 hours prn. Straight cath prn bladder scan volumes greater than 500 ml or residual void volumes greater than 200mL. [NUR35N10291] Urinary Catheter Protocol Panel [55729] Indwelling Urinary catheter [NUR35N10047] lidocaine 2% (aka: UROJET) mm jelp [84187] Urinary Catheter Protocol [NUR35N11490] Initiate Q-Stroke Teaching Record [NUR35N11479] Nurse to complete STOP-BANG screen [NUR35N10176] Nurse to complete PHQ-2 [NUR35N11532] Place Nicotine Dependence consult if patient agrees to see counselor. [NUR35N10176], Routine, Hospital, FYI, Starting today For 1 Occurrences,, FYI, Starting today For 1 Occurrences, Catheter indication: FYI, Starting today For 1 Occurrences, 3-10 ml, urethral, ONCE PRN For 1 Doses, discomfort with catheter insertion 3-5 ml for female patient or 10 ml for male patient,,, FYI, Starting today For 1 Occurrences,,, Protocols to Consider: [142934] see Insulin Order Set, Epic 371 Med Alcohol Withdrawal Observation [NUR35N11475] Med Alcohol Withdrawal Protocol (189) [NUR35N10305] Med Heparin Weight Based Protocol for Neurovascular and Cardiac Disease (203) [NUR35N10309] Med Heparin Weight Based Protocol for DVT/PE Peripheral Vascular Disease (327) [NUR35N10308] Med Adult Electrolyte Replacement Protocol (318) [NUR35N10307] Oncology Symptom Management and Comfort Protocol (212) [NUR35N10311] St. Cloud Hospital Over the Counter Comfort Medication Protocols for Adults (Epic 1638) [NUR35N11139],, If PTT greater than or equal to 71 hold infusion for 2 hours AND: If PTT greater than or equal to 96 hold heparin infusion for 2 hours AND:,,, Page 8 of 16

9 Initiate Nicotine Dependence Protocol (Epic 173) [NUR35N10927], Medications - Antithrombotics (Single Response) [152064] Ischemic Stroke / TIA - aspirin 325 mg PO or 300 mg PR [44204] aspirin (aka: BAYER) tablet [3161] aspirin suppository [853] Ischemic Stroke / TIA - clopidogrel (aka: PLAVIX) 75mg tablet [6987] Ischemic Stroke / TIA - clopidogrel (aka: PLAVIX) 300 mg followed by 75 mg panel [158110] clopidogrel (aka: PLAVIX) [80785] clopidogrel (aka: PLAVIX) tablet [6987] Ischemic Stroke / TIA - clopidogrel (aka: PLAVIX) 600 mg followed by 75 mg panel [158110] clopidogrel (aka: PLAVIX) [80785] clopidogrel (aka: PLAVIX) tablet [6987] Ischemic Stroke / TIA - other Antithrombotic ordered [CON30N10039] No Antithrombotics needed. [CON30N10039] "Or" Linked Panel 325 mg, oral, DAILY Do not give for 24 hours post IV tpa 300 mg, rectal, DAILY If unable to take PO Do not give for 24 hours post IV tpa 75 mg, oral, DAILY "Followed by" Linked Panel 300 mg, oral, ONCE For 1 Doses 75 mg, oral, DAILY Starting tomorrow "Followed by" Linked Panel 600 mg, oral, ONCE For 1 Doses 75 mg, oral, DAILY Starting tomorrow Reason for consult: Reason for consult: Stroke orders (Single Response) [142907] Ischemic Stroke without TPA [165257] Transthoracic Echocardiogram [CAR ] simvastatin (aka: ZOCOR) 20 mg tablet [12097] Lipid Profile [LAB ] IV Heparin is not recommended for patients with confirmed Acute Ischemic Stroke. [CON30N10039] Reason for exam: CVA ONCE, Starting today For 1 Occurrences, 20 mg, oral, NIGHTLY Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Reason for consult: Page 9 of 16

10 If an Acute Ischemic Stroke patient needs to be started on oral anticoagulation, it is recommended to start on hospital day 2 [CON30N10039] Vitals Signs and Neuro Assessment q 2 hrs x 8, then q 4 hrs [NUR35N10107] Notify Provider for SBP greater than, SBP less than 90, DBP greater than, Pulse greater than, Temperature greater than. (Add detail) (Acceptable BP 220/120) [NUR35N10177] Physical Therapy evaluation and treat for any functional deficit [PT ] Occupational Therapy evaluation and treat for any functional deficit [OT ] Speech Therapy evaluation and treat [ST ] Ischemic Stroke with TPA [142914] Transthoracic Echocardiogram [CAR ] simvastatin (aka: ZOCOR) 20 mg tablet [12097] Lipid Profile [LAB ] IV Heparin is not recommended for patients with confirmed Acute Ischemic Stroke. [CON30N10039] Reason for consult: If an Acute Ischemic Stroke patient needs to be started on oral anticoagulation, it is recommended to start on hospital day 2, Systolic BP greater than: Diastolic BP greater than: HR greater than: Temp greater than: Physical Therapy evaluation and treat for any functional deficit What, if any, range of motion restrictions does the patient have? Occupational Therapy evaluation and treat for any functional deficit What, if any, range of motion restrictions does the patient have? Reason for exam: CVA ONCE, Starting today For 1 Occurrences, 20 mg, oral, NIGHTLY Routine, Lab Collect, ONCE, Starting today For 1 Occurrences, Reason for consult: Page 10 of 16

11 If an Acute Ischemic Stroke patient needs to be started on oral anticoagulation, it is recommended to start on hospital day 2 [CON30N10039] Physical Therapy evaluation and treat for any functional deficit [PT ] Occupational Therapy evaluation and treat for any functional deficit [OT ] Speech Therapy evaluate and treat [ST ] Hemorrhagic Stroke [165258] labetalol (aka: NORMODYNE, TRANDATE) mg IV [18211] labetalol (aka:normodyne) infusion [405458] nicardipine (aka: CARDENE) 50 mg in sodium chloride 0.9% 250 ml infusion [405428] Reason for consult: If an Acute Ischemic Stroke patient needs to be started on oral anticoagulation, it is recommended to start on hospital day 2 Physical therapy evaluation and treat for amy functional deficit. What, if any, range of motion restrictions does the patient have? Occupational therapy evaluation and treat and functional deficit What, if any, range of motion restrictions does the patient have? mg, intravenous, Q15MIN PRN, hypertension Start with 10 mg, if not effective double dose up to 40 mg (max 300 mg per day) (For ETC, ICU or PCU only) Stroke Admission Orders Target blood pressure: 160/90 2 mg/min, IV infusion, TITRATE Start at 2 mg/min, then increase 1 mg/min q 10 mins prn to maintain BP within target (max 300 mg/day) (ICU only). Stroke admission Orders Target blood pressure: 160/ mg/hr, IV infusion, TITRATE Continuous infusion start at 5 mg per hr, titrate up to 15 mg per hour to maintain BP within target (ICU only) Hemorrhagic Stroke Orders Target blood pressure: 160/90 Page 11 of 16

12 Transthoracic Echocardiogram [CAR ] EEG [NEU ] Continuous EEG [NEU ] Vital Signs and Neuro Assessment q 1 hour x 8, and then q 2 hours x 4, and then q 4 hours [NUR35N10107] Notify Provider for SBP greater than or SBP less than 90. (Add detail) (Acceptable BP 160/90) [NUR35N10177] Assess/Monitor patient for signs/symptoms of increased intracranial pressure (ICP) [NUR35N10122] Physical Therapy evaluation and treat for any functional deficit. [PT ] Occupational Therapy evaluation and treat for any functional deficit. [OT ] Speech Therapy evaluation and treat. [ST ] TIA Panel [165254] Transthoracic Echocardiogram [CAR ] Lipid Profile [LAB ] Vital Signs and Neuro Assessment every 2 hours x 8 then every 4 hours [NUR35N10107] Reason for exam: Sleep Deprived EEG? Continuous EEG, Video Needed?, ASA Guidelines recommend target BP 160/90., Systolic BP greater than: Signs/symptoms include: Nausea, vomiting, reduced level of consciousness, loss of cranial nerve function, disconjugate gaze or posturing. If signs/symptoms of increased ICP, contact managing physician.,, What, if any, range of motion restrictions does the patient have? What, if any, range of motion restrictions does the patient have? Reason for exam: Routine, Lab Collect, ONCE, Starting today For 1 Occurrences,, Page 12 of 16

13 Notify Provider for SBP greater than, DBP greater than, Pulse greater than, Temperature greater than. (Add detail) (Acceptable BP 220/120) [NUR35N10177] simvastatin (aka: ZOCOR) tablet [11699] Physical Therapy evaluation and treat for any functional deficit [PT ] Occupational Therapy evaluation and treat for any functional deficit [OT ] Speech Therapy evaluate and treat [ST ] Systolic BP greater than: Diastolic BP greater than: HR greater than: Temp greater than: 20 mg, oral, NIGHTLY Physical Therapy evaluation and treat for any functional deficit What, if any, range of motion restrictions does the patient have? Occupational therapy evaluation and treat for any functional deficit What, if any, range of motion restrictions does the patient have? VTE Prophylaxis (Single Response) [7361] Page 13 of 16

14 Low Risk: Less than 5% of inpatients are low risk Observation patients or minor surgery (less than 30 minutes) with zero risk factors. Expected length of stay less than 48 hours Already on therapeutic anticoagulation Moderate Risk: Prior VTE/PE Most general, thoracic, open gynecological or urological surgery patients Medical patients with decrease in usual ambulation AND VTE risk factors (MI, Stroke, CHF, active inflammation/infection, age greater than 60) Active Cancer Known thrombophilia Major surgery within 7 prior days High Risk: Major lower extremity or pelvic orthopedic surgery Multiple major trauma without active signs of bleeding Spinal cord injury or major neurosurgery Abdominal or pelvic surgery for cancer Acute stroke with hemiparesis No (added) VTE prophylaxis required - Observation patient or patient with an expected length of stay of less than 48 hours. [NUR35N11126] No (added) VTE prophylaxis required - Outpatient procedure or minor surgery (less than 30 minutes) with zero risk factors. [NUR35N11126] No (added) VTE prophylaxis required - Already on therapeutic anticoagulation [NUR35N11126] Moderate risk patient and no exclusion criteria for ENOXAPRARIN administration (preferred if clinically appropriate) [162059] VTE Risk Assessment: Low risk patient or currently anticoagulated, Routine, Hospital Low risk for VTE: Observation patient or patient with an expected length of stay of less than 48 hours. FYI, Starting today, VTE Risk Assessment: Low risk patient or currently anticoagulated, Routine, Hospital Low risk for VTE: Outpatient procedure or minor surgery (less than 30 minutes) with zero risk factors. FYI, Starting today, VTE Risk Assessment: Low risk patient or currently anticoagulated, Routine, Hospital Low risk for VTE: Already on therapeutic anticoagulation FYI, Starting today, "And" Linked Panel Page 14 of 16

15 enoxaparin (aka:lovenox) syringe [900002] Platelet count [LAB ] Moderate Risk Patient and No Exclusion Criteria For HEPARIN Administration [162060] Heparin Injection [900004] Platelet Count [LAB ] High Risk Patient and No exclusion criteria for ENOXAPARIN administration: ENOXAPARIN and compression devices (preferred if clinically appropriate) [49090] enoxaparin (aka:lovenox) syringe [900002] 40 mg, subcutaneous, DAILY Enoxaparin 40 mg subcut every 24 hours (30 mg subcut every 24 hours if CrCL is less than 30mL/min) Low molecular weight heparin. Check with anesthesia prior to administration of enoxaparin within 24 hours of any neuraxial (Epidural, Intrathecal, Lumbar Puncture, or any other spinal anesthesia) procedure, catheter manipulation, or if epidural catheter is in place CONTACT ANESTHESIA BEFORE STARTING IF ON EPIDURAL. Note on Pre-Surgical Evaluation Enoxaparin 40 mg subcut every 24 hours (30 mg subcut every 24 hours if CrCL is less than 30mL/min) Routine, Lab Collect, Q72H, Starting 7/18/16 at 6:00 AM For 4 Occurrences,, No results found for: PLT "And" Linked Panel 5,000 Units, subcutaneous, Q8HR Check with anesthesia prior to administration of heparin within 24 hours of any neuraxial (Epidural, Intrathecal, Lumbar Puncture, or any other spinal anesthesia) procedure, catheter manipulation, or if epidural catheter is in place Routine, Lab Collect, EVERY OTHER DAY, Starting tomorrow at 6:00 AM For 14 Days,, No results found for: PLT "And" Linked Panel 40 mg, subcutaneous, DAILY Enoxaparin 40 mg subcut every 24 hours (30 mg subcut every 24 hours if CrCL is less than 30mL/min) Low molecular weight heparin. Check with anesthesia prior to administration of enoxaparin within 24 hours of any neuraxial (Epidural, Intrathecal, Lumbar Puncture, or any other spinal anesthesia) procedure, catheter manipulation, or if epidural catheter is in place CONTACT ANESTHESIA BEFORE STARTING IF ON EPIDURAL. Note on Pre-Surgical Evaluation Enoxaparin 40 mg subcut every 24 hours (30 mg subcut every 24 hours if CrCL is less than 30mL/min) Page 15 of 16

16 Platelet count [LAB ] Intermittent pneumatic compression devices [NUR35N10204] High Risk Patient and No exclusion criteria for Heparin administration: heparin and compression devices [49012] Heparin Injection [900004] Platelet count [LAB ] Intermittent pneumatic compression device [NUR35N10204] Meet Exclusion Criteria for Heparin/Enoxaparin Administration - compression devices [49111] Contraindication to Pharmacologic VTE Prophylaxis [NUR35N11281] Intermittent pneumatic compression devices [NUR35N10204] Routine, Lab Collect, Q72H, Starting 7/18/16 at 6:00 AM For 4 Occurrences,, No results found for: PLT Type: Knee FYI, Starting today For 1 Occurrences, "And" Linked Panel 5,000 Units, subcutaneous, Q8HR Check with anesthesia prior to administration of enoxaparin within 24 hours of any neuraxial (Epidural, Intrathecal, Lumbar Puncture, or any other spinal anesthesia) procedure, catheter manipulation, or if epidural catheter is in place Routine, Lab Collect, EVERY OTHER DAY, Starting tomorrow at 6:00 AM For 14 Days,, No results found for: PLT Type: Knee FYI, Starting today For 1 Occurrences, "And" Linked Panel Pharmacologic VTE prophylaxis contraindicated: Type: Knee FYI, Starting today For 1 Occurrences, Page 16 of 16