ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS

Size: px
Start display at page:

Download "ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS"

Transcription

1 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 hours then Up ad lib Up Ad Lib Diet NPO No exceptions Comments: Notify Provider once Bedside Swallow Screen is passed for diet orders Nursing Orders Quality Measures STK Patient Education Stroke/TIA, document education daily in I-View NIH Stroke Scale (NIHSS) On Admit and on Discharge Modified Rankin Scale On Admit and on Discharge Elevate Head of Bed 30 Degrees Flat in Bed Flat in Bed as tolerated for 24 hours, then HOB as desired. HOB degrees IF at risk for airway obstruction, aspiration or increased ICP Bedside Swallow Screen Raise HOB to 90 degrees briefly to perform bedside swallow screen. If patient fails screen, keep NPO including po medications until cleared by SLP; for alternate medication routes. Blood Glucose Monitor POC Q6H, while NPO then QID AC and HS. If patient is non-diabetic, may discontinue in 24 hours IF no insulin given Cardiac Monitor Neuro Checks Q4H (DEF)* Q2H Q1H Page 1 of 6

2 DRUG AND TREATMENT Temperature Greater Than 38 degrees C (100 F) Other (See Special Instructions) Blood Glucose LESS Than 60 mg/dl OR GREATER Than 400 mg/dl Other (See Special Instructions) Any occurrence of Atrial Fibrillation and obtain 12 lead ECG stat Other (See Special Instructions) Deterioration of neurologic status Systolic Blood Pressure Greater Than 220 mmhg (DEF)* Systolic Blood Pressure Greater Than 180 mmhg Systolic Blood Pressure Greater Than Diastolic Blood Pressure Greater Than 120 mmhg (DEF)* Diastolic Blood Pressure Greater Than 105 mmhg Diastolic Blood Pressure Greater Than SCD Medications ***(NOTE)***Order the appropriate medications OR select a reason from the dropdown box for medication not being given Reason for Oral Factor Xa Inhibitor Reason Stroke VTE Mechanical Prophylaxis Not Ordered Reason Stroke VTE Pharmacological Prophylaxis Not Ordered Reason Stroke VTE Prophylaxis Not Ordered Reason IV Thrombolytic Therapy Not Initiated aspirin 325 mg tab EC PO DAILY, Clinical Instructions: Do NOT give if intracranial hemorrhage. May give PO IF bedside swallowing screen passed (DEF)* 300 mg supp PR ONCE, Clinical Instructions: Do NOT give if intracranial hemorrhage 324 mg tab chew NG TUBE DAILY Comments: Use 4 81mg tabs. Reason Aspirin Not Given on Arrival Reason Aspirin Not Prescribed at Discharge aspirin-dipyridamole (Aggrenox) 1 cap PO cap ER BID Reason Antithrombotics Not Given by End Day 2 Reason Antithrombotic Therapy Not Prescribed Discharge acetaminophen (Tylenol) 325 mg tab PO BID Reason Statin Not Prescribed at Discharge Reason LDL-c Not Done Page 2 of 6

3 DRUG AND TREATMENT atorvastatin (Lipitor) 40 mg tab PO DAILY (DEF)* 20 mg tab PO DAILY rosuvastatin (Crestor) 20 mg tab PO BEDTIME Hold Medication Hold Next Dose Detail: Other (specify in Special Instructions), No sedatives or sleeping pills for 24 hours (DEF)* Hold Next Dose Detail: Other (specify in Special Instructions), No sedatives or sleeping pills for 48 hours acetaminophen (Tylenol) 650 mg tab PO Q6H, PRN Other (see comment) (DEF)* Comments: PRN Pain Mild or Temperature GREATER than 100 degfgive if GREATER Than 4 hours since last dose acetaminophen given. 650 mg supp PR Q6H, PRN Other (see comment) Comments: PRN Pain Mild or Temperature GREATER than 100 degfgive if GREATER Than 4 hours since last dose acetaminophen given. 650 mg tab chew NG TUBE Q6H, PRN Other (see comment) Comments: PRN Pain Mild or Temperature GREATER than 100 degfgive if GREATER Than 4 hours since last dose acetaminophen given. insulin aspart (Novolog) unit inj SUBCUT Q6H Comments: For Non- Diabetic patients: May discontinue in 24 H if no insulin given. Blood Glucose Administer : 1 unit, : 2 units, : 3 units, : 4 units, : 5 units, Blood Glucose > 430: 6 units and notify physician Reason Alcohol/Substance Abuse Medication Not Prescribed Reason Tobacco Cessation Med Not Given IV Solutions Sodium Chloride 0.9% (Normal Saline Bolus) 10 ml/kg IVPB bag ONCE, Duration: 1 dose, Rate: 250 ml/hour Comments: Administer 1 dose and discontinue. Max Dose 1000 ml. Sodium Chloride 0.9% (Normal Saline) IV bag 100 ml/hour (DEF)* IV bag 75 ml/hour IV bag 50 ml/hour Laboratory Sedimentation Rate (ESR) Homocysteine Level Page 3 of 6

4 DRUG AND TREATMENT ANA Screen Serum B12 level Vitamin D Hemoglobin A1C TSH Serum CRP Lipid Profile Early AM, ONCE Comments: Patient needs to be fasting Liver Profile Comments: If not already done CBC. Early AM, DAILY BMP Early AM, DAILY Urinalysis Routine, ONCE Urine Culture Routine, ONCE Toxicology Screen 12 - Urine Routine, ONCE Troponin Platelet Function Assay Expedite/ASAP, Blood, ONCE Platelet P2Y12 Monitoring Expedite/ASAP, Blood, ONCE Radiology ***(NOTE)***IF Kidney function is within normal limits, no contrast allergy and able to have MRI CT Angio Head/Neck w/wo Contrast MR Brain w/o Contrast ***(NOTE)***If kidney function within normal limits, CONTRAST ALLERGY PRESENT and able to have MRI: MR Brain w/o Contrast Page 4 of 6

5 DRUG AND TREATMENT MR Angio Head w/o Contrast MR Angio Neck w/ Contrast ***(NOTE)***If kidney function within normal limits, no contrast allergy and UNABLE to have MRI: CT Angio Head/Neck w/wo Contrast +24 Hours CT Head w/o Contrast ***(NOTE)***If ABNORMAL kidney function and able to have MRI: MR Brain w/o Contrast MR Angio Head w/o Contrast US Carotid Doppler Scan ***(NOTE)***If ABNORMAL kidney function and UNABLE to have MRI: US Carotid Doppler Scan US Transcranial Doppler Scan Stroke, Pending Discharge - No, ONCE +24 Hours CT Head w/o Contrast Respiratory Oxygen Therapy. Nasal Cannula, 2, if O2 Sat Less than 94% Pulse Oximetry (Continuous) Special Instructions: Reposition pulse oximetry probe Q8H and assess skin that has been in contact with probe Cardiology ECG Standard Routine, If not done in ED. ECG Standard Stat, 12 Lead ECG for any occurrence of atrial fibrillation Echo 2-D and M-Mode with Bubble Study Consults Neurology, Stroke Patient Neuropsychology, Stroke, Contact Dr. Rossilli ( ) Comments: Consult should not delay discharge Rehab Medicine, Stroke, Contact Adria Johnson ( ) Endovascular Neurosurgery, Stroke Page 5 of 6

6 DRUG AND TREATMENT Cardiology, Stroke Social Work Consult Consult Physical Therapy Stroke Patient Consult Occupational Therapy Stroke Patient Consult Speech Therapy Stroke Patient Dietitian Consult Consult Diabetes-Adult Consult Palliative Care, Adult Consult Hospice Consult Wound Care Consult Pharmacy Page 6 of 6

DRUG ALLERGIES WT: KG

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

More information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

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

More information

ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS

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

More information

Diagnosis: Allergies with reaction type:

Diagnosis: Allergies with reaction type: Patient Name: Diagnosis: Allergies with reaction type: ICU Stroke-Ischemic S/P tpa Version 2 5/29/14 This order set is designed to be used with an admission set or for a patient already admitted Nursing

More information

DRUG ALLERGIES WT: KG

DRUG 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 information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

PHYSICIAN 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 information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

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

More information

Acute Stroke with Alteplase Administration Order Set

Acute Stroke with Alteplase Administration Order Set Review Due Date: 2017 October PATIENT CARE DERS Weight: Adverse Reactions or Intolerances Drug No Yes (list) Food No Yes (list) _ Latex No Yes Admission Admit to Neurology service: Dr. Critical Care Diagnosis:

More information

Standard Precautions Droplet Precautions Standard Precautions Contact Precautions Droplet Precautions Standard Precautions Neutropenic Precautions

Standard 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 information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

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

More information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

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***

More information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

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

More information

PICU ADMIT DKA PLAN - Phase: Begin Immediately

PICU 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 information

Physician Orders PEDIATRIC: LEB Stroke Admit Plan

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

More information

Neurosurgery 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. 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 information

Physician Orders ADULT: PCI Post Procedure Plan

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,

More information

Physician Orders ADULT: Acute MI/Acute Coronary Syndrome Adult Plan

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

More information

Physician Orders PEDIATRIC: LEB NEURO Epilepsy Monitoring Unit Admit Plan

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

More information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

PHYSICIAN 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 information

DRUG ALLERGIES WT: KG

DRUG ALLERGIES WT: KG DRUG AND TREATMENT Available ONLY at: BMC-B BMC-D BMC-N BMC-S Pre-Op Nursing Orders Communication Order Confirm patient has brought corresponding films for surgery (e.g. back films for back surgery, brain

More information

Physician Orders PEDIATRIC: LEB Oral Maxillofacial Post Op Plan

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

More information

Physician Orders ADULT: Kidney-Panc/PancTransplant Post Op Plan

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

More information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG 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 information

ADMIT DIABETIC KETOACIDOSIS (DKA) PLAN - Phase: Begin Immediately/Emergency Center

ADMIT 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 information

Physician Orders ADULT: Renal Transplant Admit Plan

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,

More information

Physician Orders PEDIATRIC: LEB Kidney Transplant Post Op Plan

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

More information

PHYSICIAN SIGNATURE DATE TIME

PHYSICIAN SIGNATURE DATE TIME DRUG AND TREATMENT Condition/Status Patient Status (WCH) Patient Status: Inpatient Update Resident Team C (DEF)* A B X Vital Signs Vital Signs Q4H, Do not wake for vitals 2300-0700 (DEF)* DAILY Q4H Blood

More information

Admit date (YYYY/MM/DD): Cardiologist On-Call: Diagnosis: Lab Tests. CBC, Electrolytes, Urea, Creatinine, Glucose, INR, PTT, Urinalysis

Admit 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 information

PEDIATRIC SPINE SURGERY POST-OP PLAN - Phase:.

PEDIATRIC SPINE SURGERY POST-OP PLAN - Phase:. - Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Patient Activity Bedrest Maintain Surgical Drain Maintain JP Drain, Measure Output q12h, and PRN Convert IV to INT when tolerating

More information

PEDIATRIC SPINE SURGERY POST-OP PLAN - Phase: Pediatric Spine Surgery General Orders

PEDIATRIC 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 information

Canadian Stroke Best Practices Initial ED Evaluation of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 1)

Canadian Stroke Best Practices Initial ED Evaluation of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 1) Canadian Best Practice Recommendations for Stroke Care: All patients presenting to an emergency department with suspected stroke or transient ischemic attack must have an immediate clinical evaluation

More information

Physician Orders PEDIATRIC: LEB NEURO SURG Surgical Spine Post Op Plan

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

More information

Physician s Order Form. Physician s Order Form. Telemetry/Progressive Care Orders. Continued on next page. >>>>>>> Continued on next page.

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

More information

ADULT POST NEUROLOGIC INTERVENTION ORDERS 2 of 4

ADULT POST NEUROLOGIC INTERVENTION ORDERS 2 of 4 9 Actual 9 Estimated DOWNTIME INTERVENTION 1 of 4 Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Admit to Dr.: Bed Type: Dx: ( ) Check, circle and/or fill in all

More information

Physician Orders LEB PICU Status Epilepticus Plan. [ ] No known allergies

Physician Orders LEB PICU Status Epilepticus Plan. [ ] No known allergies 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

More information

Canadian Stroke Best Practices Prevention of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 4)

Canadian Stroke Best Practices Prevention of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 4) Canadian Best Practice Recommendations for Stroke Care: All patients presenting to an emergency department or outpatient setting (family physician s office, ambulatory clinic, out-patient setting etc.)

More information

*111* attach patient label here

*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

More information

Physician Orders ADULT: Head and Neck Postoperative Plan

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,

More information

***SPECIAL CONSIDERATION:

***SPECIAL CONSIDERATION: ADULT ANESTHESIA POST-OP OUTPATIENT SURGERY PLAN Dx PHYSICIAN S Weight Allergies DETAILS Admit/Discharge/Transfer Return Patient to PACU Patient Care ***Patients who are at high risk for obstructive sleep

More information

CBC with Differential. PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

CBC 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 information

UMC Health System Patient Label Here PHYSICIAN ORDERS

UMC Health System Patient Label Here PHYSICIAN ORDERS Weight Allergies Patient Care Vital Signs Per Unit Standards, Q5 min during critical event. Insert Peripheral Line Use 20 gauge or larger. Notify Nurse (DO NOT USE FOR MEDS) Place crash cart with cardiac

More information

Physician Orders ADULT: Asthma and Bronchitis Plan

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:

More information

Physician Orders ADULT

Physician 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

More information

ORTHO TOTAL KNEE REPLACEMENT POST-OP PLAN - Phase: PACU Ortho Phase

ORTHO TOTAL KNEE REPLACEMENT POST-OP PLAN - Phase: PACU Ortho Phase - Phase: PACU Ortho Phase PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Patient Condition Acuity Level Floor Status Acuity Level Critical Acuity Level Intermediate

More information

Bariatric Surgery Post Op Plan PACU Phase

Bariatric 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 information

ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS

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 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 information

Protocol for IV rtpa Treatment of Acute Ischemic Stroke

Protocol for IV rtpa Treatment of Acute Ischemic Stroke Protocol for IV rtpa Treatment of Acute Ischemic Stroke Acute stroke management is progressing very rapidly. Our team offers several options for acute stroke therapy, including endovascular therapy and

More information

Gabapentin Research Pain Study for Ortho Total Knee Replacement Post-Op Plan - PACU Ortho Phase

Gabapentin Research Pain Study for Ortho Total Knee Replacement Post-Op Plan - PACU Ortho Phase Total Knee Replacement Post-Op Plan - PACU Ortho Phase Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: 3W, Pt Status: Inpatient (LOS > 2 midnights) Patient Condition

More information

IV Acetaminophen Pain Study for Neurosurgery Post Op Non ICU Admit Plan Begin Immediately/PACU

IV 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 information

ED Stroke Panel Page 1 of 2

ED Stroke Panel Page 1 of 2 ED Stroke Panel Page 1 of 2 Reference EMMC *************************Usec: Call Operator to page a Stroke Alert ********************** Laboratory Bedside Glucose Monitoring ONCE Notify provider if glucose

More information

Atrial Fibrillation Version 2 11/4/15 This order set must be used with an admission order set if patient not already admitted.

Atrial Fibrillation Version 2 11/4/15 This order set must be used with an admission order set if patient not already admitted. Patient Name: Diagnosis: Allergies with reaction type: Atrial Fibrillation Version 2 11/4/15 This order set must be used with an admission order set if patient not already admitted. Telemetry Medical Telemetry:

More information

DRUG ALLERGIES WT: KG

DRUG 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 information

ISCHEMIC STROKE/TIA PLAN

ISCHEMIC STROKE/TIA PLAN ISCHEMIC STROKE/TIA PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards, Every 15 min x 2 hrs; then every 30 min x 6 hrs; then every 1 hr x 16 hrs Perform Neurological

More information

Physician Orders. PED Endocrine General Admit Plan [X or R] = will be ordered unless marked out. [ ] No known allergies

Physician Orders. PED Endocrine General Admit Plan [X or R] = will be ordered unless marked out. [ ] No known allergies Height: cm Weight: kg Allergies: [ ] No known allergies [ ] Initiate Powerplan Phase T;N, Phase:PED Endo General Admit Phase Admission/Transfer/Discharge [ ] Admit Patient to Dr. Admit Status: [ ] Inpatient

More information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

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

More information

Operation Stroke. How to Reduce the Risk of Stroke Complications

Operation Stroke. How to Reduce the Risk of Stroke Complications Operation Stroke How to Reduce the Risk of Stroke Complications Objectives Focus on Acute Stroke as an active disease Discuss the most common stroke complications Describe how first 72 hours sets the stage

More information

Physician Orders ADULT: Sickle Cell Inpatient Plan

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

More information

Physician Orders ADULT: Atrial Fib/Flutter Plan

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:

More information

DRUG ALLERGIES WT: KG

DRUG ALLERGIES WT: KG DRUG AND TREATMENT Acute Diabetic Ketoacidosis Condition/Status ***(NOTE)*** For purpose of this DKA Regimen, DKA is considered clear only when the CO2 is GREATER than 18 meq/l and the anion gap is LESS

More information

Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017

Bariatric 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 information

BARIATRIC SURGERY POST-OP PLAN - Phase: PACU Phase

BARIATRIC 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 information

PEDIATRIC CYSTIC FIBROSIS PLAN - Phase:.

PEDIATRIC CYSTIC FIBROSIS PLAN - Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Per Unit Standards, with Sleeping SpO2 nightly until sat greater than 92% Daily Weight Every AM In AM on Monday, Wednesday,

More information

Emergency Department Chest Pain, Suspected Cardiac Adult Order Set

Emergency Department Chest Pain, Suspected Cardiac Adult Order Set Form Title Form Number Chest Pain, Suspected Cardiac Adult Order Set 20746 2018, Alberta Health Services, CKCM This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0

More information

DRUG ALLERGIES WT: KG

DRUG ALLERGIES WT: KG DRUG AND TREATMENT Available ONLY at: BMC-A BMC-B BMC-C BMC-D BMC-N BMC-S BMC-T Non Categorized SUB (SUB)* SUB Alert Protocol(SUB)* SUB Alert Protocol Lab Tests(SUB)* Quality Measure Sepsis Bundle Nursing

More information

NEUROSURGERY ICU PLAN

NEUROSURGERY ICU PLAN NEUROSURGERY ICU PLAN PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards Per Unit Standards, including cerebral perfusion pressure (CPP) and end tidal CO2. Perform

More information

IR Central Venous Access [ ] Pre Procedure

IR 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

More information

Physician Orders PEDIATRIC: LEB Eating Disorder Admit Plan

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

More information

IDPH ESF-8 Plan: Pediatric and Neonatal Surge Annex Sample Pediatric Admission Orders 2015

IDPH ESF-8 Plan: Pediatric and Neonatal Surge Annex Sample Pediatric Admission Orders 2015 Purpose: To provide guidance to practitioners caring for pediatric patients who need inpatient hospital care during a disaster. Disclaimer: This guideline is not meant to be all inclusive, replace an existing

More information

Physician Orders PEDIATRIC: LEB DKA Diabetes Mellitus Admit Plan

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:

More information

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG DRUG AND TREATMENT *****ALSO ORDER SUB ACUTE DKA IV FLUIDS REGIMEN & SUB ACUTE ELECTROLYTE REPLACEMENT on separate forms ***** Condition/Status For purpose of this DKA Regimen, DKA is considered clear

More information

CARD OPEN HEART PRE-OP PLAN

CARD 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 information

Physician Orders ADULT Order Set: Respiratory Failure Orders

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

More information

THROMBOLYTIC THERAPY FOR PERIPHERAL OCCLUSION

THROMBOLYTIC 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 information

DRUG ALLERGIES WT: KG

DRUG 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 information

WAIS AFZAL, MD. PGY-1 Department of Internal Medicine Jamaica Hospital Medical Center

WAIS AFZAL, MD. PGY-1 Department of Internal Medicine Jamaica Hospital Medical Center WAIS AFZAL, MD PGY-1 Department of Internal Medicine Jamaica Hospital Medical Center CHIEF COMPLAINT My Head Is Blowing HPI 47 y.o. female, presented to ER with intermittent headaches, and intermittent

More information

Secondary Prevention of Stroke Order and Documentation Template

Secondary Prevention of Stroke Order and Documentation Template The following actions are based on the 2014 Update of for (www.strokebestpractices.ca). This document is intended to be used as a template to ensure alignment of organization specific care with the Stroke

More information

DONATION AFTER CARDIAC DEATH PLAN

DONATION AFTER CARDIAC DEATH PLAN DONATION AFTER CARDIAC DEATH PLAN Diagnosis Weight Allergies Patient Care Core Body Temperature Monitoring Maintain body temp 96-99 degrees Farenheit. Utilize Hyper/Hypothermia blanket prn Insert Gastric

More information

GENERAL MEDICINE PLAN

GENERAL 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 information

Physician Orders ADULT: Medical Response Team Standing Orders Protocol Plan

Physician Orders ADULT: Medical Response Team Standing Orders Protocol Plan 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

More information

CARD POST CARDIAC CATHETERIZATION PLAN

CARD POST CARDIAC CATHETERIZATION PLAN CARD POST CARDIAC CATHETERIZATION PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Intermittent Telemetry Continuous Telemetry (Intermediate Care) Vital Signs Per Unit Standards POC ACT If arterial

More information

ADMIT GENERAL MEDICINE PLAN - Phase: Begin Immediately

ADMIT 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 information

PHYSICIAN S ORDERS Page 1 of 5 PNEUMONIA. Resuscitation (Code)Status: Admit to: Diagnosis: Pneumonia Other: Consult:

PHYSICIAN S ORDERS Page 1 of 5 PNEUMONIA. Resuscitation (Code)Status: Admit to: Diagnosis: Pneumonia Other: Consult: Inpatient Observation Bed Type: Med/Surg PHYSICIAN S ORDERS Page 1 of 5 Satellite Telemetry Telemetry ICU Resuscitation (Code)Status: Admit to: Diagnosis: Pneumonia Other: Consult: Condition: Stable Guarded

More information

Diagnosis: Allergies:

Diagnosis: Allergies: Patient Name: Diagnosis: Allergies: ICU Sepsis Version 5 1/11/17 This order set must be used with an admission order set if patient not already admitted. Nursing Orders Verify that cultures have been obtained

More information

DOWNTIME Physician Order CARD CHF Heart Failure

DOWNTIME Physician Order CARD CHF Heart Failure DOWNTIME Physician Clinical Category ADT/Comm unication Patient Status ASC Extended Recovery Observation Services Inpatient Admission CCU Admit as Inpatient History and Physical by House Physician Vital

More information

ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked

ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked Available at: BMC-B BMC-D BMC-N BMC-S Condition/Status ***(NOTE)***For purpose of this DKA Regimen, DKA is considered clear only when the CO2 is GREATER than 18 meq/l and the anion gap is LESS than 12

More information

Card Open Heart POD1 POD3 Plan Post Op Day 1

Card Open Heart POD1 POD3 Plan Post Op Day 1 Day 1 PHYSICIAN S Weight Allergies Admit/Discharge/Transfer Transfer Patient Transfer to: Floor, Pt Status: Inpatient (LOS > 2 midnights) Vital Signs q2h, POD 1 Vital Signs q2h for 24 hours then per unit

More information

LIFEGIFT BRAIN DEATH PLAN

LIFEGIFT BRAIN DEATH PLAN Diagnosis Weight Allergies Admit/Discharge/Transfer ***THIS PLAN IS TO BE ED ONLY ON THE LIFEGIFT ENCOUNTER, WITH DR LIFEGIFT AS THE ATTENDING*** Patient Status Pt Status: Inpatient (Inpatient only procedure)

More information

CARD POST CARDIAC CATHETERIZATION PLAN

CARD POST CARDIAC CATHETERIZATION PLAN CARD POST CARDIAC CATHETERIZATION PLAN Diagnosis Weight PHYSICIAN S Allergies DETAILS Patient Care Intermittent Telemetry Continuous Telemetry (Intermediate Care) Vital Signs Per Unit Standards POC ACT

More information

Thrombolysis Delivery, Care, and Monitoring. 5 Acute Trusts - 6 Primary Care Trusts Ambulance Trust 4 Local Authorities

Thrombolysis Delivery, Care, and Monitoring. 5 Acute Trusts - 6 Primary Care Trusts Ambulance Trust 4 Local Authorities Thrombolysis Delivery, Care, and Monitoring Documentation & Pathways Need to follow locally agreed policies and procedures Follow thrombolysis pathway? Need to complete Sits database Weight Dose matters!

More information

2016 Stroke Statistics

2016 Stroke Statistics 2016 Stroke Statistics Carotid Artery Procedure Mortality Rate *The Joint Commission Requirement < 6 % LUMC 3.0% *The Joint Commission Requirement < 3 % LUMC 0.0% Rate of stroke or death within 30 days

More information

POST-OP CARDIAC SURGERY PHYSICIAN S ORDER SHEET USE BALLPOINT PEN ONLY. CARDIAC INTENSIVE CARE UNIT

POST-OP CARDIAC SURGERY PHYSICIAN S ORDER SHEET USE BALLPOINT PEN ONLY. CARDIAC INTENSIVE CARE UNIT 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

More information

Patient: Becky Smith DOB: 01/26/XXXX Age: 5 y/o Attending: Dr. D. Miles Allergies: NKA MR#: 203. Patient Chart #203 Becky Smith

Patient: Becky Smith DOB: 01/26/XXXX Age: 5 y/o Attending: Dr. D. Miles Allergies: NKA MR#: 203. Patient Chart #203 Becky Smith Patient Chart #203 Becky Smith 1 Property of CSCLV CSCLV Rev: 06/04/2018 Chief Complaint: Abdominal pain. Informant: Parents. HISTORY & PHYSICAL HPI: Ill looking patient, healthy until 2 days ago when

More information

Pediatric Outpatient Surgery Plan - Diagnostic/Pre-Op Orders

Pediatric 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 information

Physician Orders ADULT: LEB Asthma Admit Plan. Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N Attending Physician:

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

More information

OB Well Baby Nursery Admission (Term) [ ] For specialty focused order sets for your patient, refer to: General

OB Well Baby Nursery Admission (Term) [ ] For specialty focused order sets for your patient, refer to: General OB Well Baby Nursery Admission (Term) [3040000234] For specialty focused order sets for your patient, refer to: 3040000424 Neonatal Circumcision Order Set 3040000522 Neonatal Herpes Viral Order Set 3040000524

More information

Physician Orders PEDIATRIC: : LEB ED Trauma (Major) Plan

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)*

More information

Primary Stroke Center Quality & Performance Measures

Primary Stroke Center Quality & Performance Measures Primary Stroke Center Quality & Performance Measures This section of the manual contains information related to the quality performance of Primary Stroke Centers. Brain Attack Coalition Definitions Recognition

More information

2017 Stroke Statistics

2017 Stroke Statistics 2017 Stroke Statistics 2017 LUMC Stroke Volumes by Type of Stroke Ischemic Stroke Treatment by Type 2017 17% 8% 75% Ischemic Intracerebral Hemorrhage Aneurysmal Subarachnoid Hemorrhage 31 42 25 r-tpa Administered

More information

Primary Stroke Center Acute Stroke Transfer Guidelines When to Consider a Transfer:

Primary Stroke Center Acute Stroke Transfer Guidelines When to Consider a Transfer: When to Consider a Transfer: Hemorrhagic Stroke Large volume intracerebral hematoma greater than 5cm on CT Concern for expanding hematoma Rapidly declining mental status, especially requiring intubation

More information