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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1 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 100 mg inj IV PUSH ONCE, Clinical Instructions: for Mechanical Ventilator Intubation Radiology XR Chest *1 view AP Portable Post intubation, Stat, Pending Discharge - No, ONCE, Wet read immediately to be called to nurse Stat, 30 minutes post intubation Ventilator Initial Setup Ventilator Maintenance Phase Ventilator Weaning Assessment DAILY06 Initiate Precautions to Prevent Ventilator Associated Pneumonia Sedation Vacation: Hold all analgesics and sedations daily at 0800 until Ramsay of 2 Enteral Tube Insertion Enteral Tube Type: Orogastric, Tube Drainage Method: Low Intermittent Suction, Additional Instructions: As needed Please obtain STAT ABG draw, PRN, for oxygen saturation LESS than 92% and call results to physician Medications GEN Venous Thromboembolism Prophylaxis (VTE) (SUB)* ***Reminder: Order GEN Venous Thromboembolism Prophylaxis (VTE) (SUB) on a separate form*** Chlorhexidine 0.12% Vent Oral Care Kit 1 dose PO mouthwash BID Comments: For oral cleaning if patient is intubated. Protonix 40 mg inj IV PUSH DAILY Prevacid Solu Tab 30 mg tab soluble OG TUBE DAILY Diprivan 1000mg/100 ml premix bottle IV bottle Rate: 10 Rate: Titrate mcg/hour Comments: Start at 10 mcg/hr and titrate in increments of 10 mcg/kg every five minutes to Ramsay scale of 4 up to maximum of 80 mcg/hr (check lipids). Assess sedation level Q4H and Page 1 of 6
2 DRUG AND TREATMENT 30 minutes after each dose change Ativan 100 mg/d5w 100 ml IV drip IV bag Rate: 2 mg/hour Comments: Start at 2 mg/hr and titrate in increments of 2 mg every 10 minutes to Ramsay scale of 3 up to maximum of 8 mg/hr. Assess sedation level Q4H and 30 minutes after each dose change Fentanyl 2,500 mcg / 250 ml IV Set (IVS)* Sodium Chloride 0.9% IV bag Rate: Starting Rate 25 mcg/hour Comments: Start at 25 mcg/hr and titrate to Ramsay scale of 3 up to maximum of 100 mcg/hr. Assess sedation level Q4H and 30 minutes after each dose change fentanyl IV drip 2,500 mcg Versed 100 mg/ns 100 ml IV drip 100 ml IV bag Rate: 2 mg/hour Comments: Start at 2 mg/hr and titrate in increments of 2 mg every 10 minutes to Ramsay scale of 3 up to maximum of 8 mg/hr. Assess sedation level Q4H and 30 minutes after each dose change Precedex 200 mcg/ns 50 ml IV Set (IVS)* Sodium Chloride 0.9% IV iv Rate: 0.2 mcg/kg/hr Comments: Start at 0.2 mcg/kg/hr and titrate in increments of 0.1 mcg/kg every 15 minutes to Ramsay scale of 3 up to maximum of 0.7 mcg/kg/hr. Assess sedation level Q4H and 30 minutes after each dose change dexmedetomidine IV drip 200 mcg Precedex 200 mcg / 50 ml premix IV premix Rate: 0.2 mcg/kg/hr Comments: Start at 0.2 mcg/kg/hr and titrate in increments of 0.1 mcg/kg every 15 minutes to Ramsay scale of 3 up to maximum of 0.7 mcg/kg/hr. Assess sedation level Q4H and 30 minutes after each dose change morphine 2 mg inj IV PUSH Q2H, PRN Pain Moderate Comments: Titrate to Ramsay scale of 3. Assess sedation level Q4H and 30 minutes after each dose Ativan 1 mg inj IV PUSH Q4H, PRN Agitation Comments: Titrate to Ramsay scale of 3. Assess sedation level Q4H and 30 minutes after each dose Versed 2 mg inj IV PUSH Q2H, PRN Agitation Comments: Titrate to Ramsay scale of 3. Assess sedation level Q4H and 30 minutes after each dose NEURO Neuromuscular Blockade (SUB)* ***Reminder: Order NEURO Neuromuscular Blockade (SUB) on a separate form*** Radiology XR Chest *1 view AP Portable Page 2 of 6
3 DRUG AND TREATMENT failure, Routine, Pending Discharge - No, DAILY, Daily while intubated for respiratory failure Mode; AC, Rate; 10, Fi02; 1, PEEP; 5, Tidal Volume: 8 ml/kg of ideal body wt (DEF)* Mode; PRVC, Rate; 10, Fi02; 1, PEEP; 5, Tidal Volume: 8 ml/kg of ideal body wt Routine, Daily while intubated Consults Nutrition Consult TPN (DEF)* Tube Feeding Weaning & Extubation Phase ASDIR, Q5MINS x 4, then Q15MINS x 2, then Q30MINS x 2. See Order Comments for additional instructions Comments: During weaning process: monitor and document HR, rhythm, BP, respiratory rate, level of consciousness, tidal volume, oxygen saturation, and signs of intolerance (see Ventilator Weaning Intolerance Criteria-Reference Text order) If patient meets pre wean criteria (Wean Assessment Score greater than 17 and Ramsay score less than 4) coordinate for mechanical vent weaning with RT. Confirm cuff leak test greater than 110 ml (predeflation VTe - post-deflation VTe) prior to extubation Ventilator Weaning Intolerance Criteria-Reference Text Notify Provider Routine, Must call physician prior to ventilator extubation Hold IV sedation except Precedex (unavailable at Baptist Beaches and Baptist Nassau) (DEF)* For Baptist Beaches and Nassau, see Order Comments Comments: Reduce Propofol by 5 mcg/kg/min every 5 minutes until off. Restart Propofol if patient becomes agitated (to level necessary to sedate to Ramsey Level II). When Ramsey Level II achieved, Check NIF, and respiratory rate. Once NIF greater than 20, FVC greater than 8 ml/kg and respiratory rate less than 30, place patient on : Pressure Support 0 cm, CPAP 5 cm, and FIO2 50% for a 30 minute breathing trial Extubate Patient Extubate to venti mask at current FIO2 if patient meets pre wean criteria Extubate Patient Extubate to Bipap 12/5 setting if patient meets pre wean criteria Extubate Patient Extubate to room air if patient meets pre wean criteria Routine, May increase FiO2 to maintain O2 sat greater than 92% but not to exceed FiO2 of 50%. If ph less than 7.35 and/or PO2 less than 60, resume previous ventilator settings for next 24 hours Page 3 of 6
4 DRUG AND TREATMENT Routine, Obtain ABG 30 minutes post mechanical ventilator wean or sooner if patient exhibits signs of intolerance. Call results to physician (DEF)* Results of ABG study obtained post mechanical ventilator wean or sooner if patient exhibits intolerance Trache Weaning Phase ASDIR, Q5MINS x 4, then Q15MINS x 2, then Q30MINS x 2. See Order Comments for additional instructions Comments: During weaning process: monitor and document HR, rhythm, BP, respiratory rate, level of consciousness, tidal volume, oxygen saturation, and signs of intolerance (see Ventilator Weaning Intolerance Criteria-Reference Text order) Hold IV sedation except Precedex during ventilator weaning (unavailable at Baptist Beaches and Baptist Nassau) (DEF)* For Baptist Beaches and Nassau, see Order Comments. Comments: Reduce Propofol by 5 mcg/kg/min every 5 minutes until off. Restart Propofol if patient becomes agitated (to whatever level necessary to sedate to Ramsey Level II). When Ramsey Level II achieved, Check NIF, and respiratory rate. Once NIF greater than 20, FVC greater than 8 ml/kg and respiratory rate less than 30, place patient on : Pressure Support 0 cm, CPAP 5 cm, and FIO2 50% for a 30 minute breathing trial Ventilator Weaning Intolerance Criteria-Reference Text Notify Physician If weaning intolerance and patient placed back on ventilator at PRE Weaning settings Notify Physician If weaning intolerance and patient placed back on ventilator at PRE Weaning settings or if ph is LESS than 7.34 or PaO2 of LESS than 60mmHg. Radiology XR Chest *1 view AP Portable Early AM, Pending Discharge - No, STAT in AM for post discontinuation of mechanical ventilator see order comment Comments: Therapy to conduct T-piece trial at current Fi02. If tolerated, ABG in 30mins and call results to physician. For any respiratory signs of weaning intolerance (see criteria) place patient back on ventilator at PRE WEANING settings and call physician. see order comment Comments: Therapy to place patient on VOLUME TARGETED Pressure Support with target goal of 240 ml Vte. Call physician if Vte is LESS than 280ml. Place back on PRE WEANING ventilator settings for signs of ventilator weaning intolerance (see criteria). ABG after 30mins of volume targeted pressure support and call physician with results if ph is LESS than 7.34 or PaO2 of LESS than 60mmHg Page 4 of 6
5 DRUG AND TREATMENT Once patient meets extubation criteria and physician approval obtained, discontinue Mechanical Ventilator and place on trach collar to equal O2 used during Mechanical Ventilator use. No neck rotation or movement x 4 hours O2 Therapy. 92, Titrate to O2 sat of 92% with heated humidification (post mechanical ventilator extubation) (DEF)* 92, Titrate to O2 sat of 92% with cooled humidification (post mechanical ventilator extubation) Routine, Obtain ABG 30 minutes post discontinuation of mechanical ventilator or sooner if patient exhibits signs of intolerance. Call results to physician +120 Hours Remove sutures 5 days post tracheostomy Post-Extubation Phase ASDIR, Q5MINS x 4, then Q15MINS x 2, then Q30MINS x 2, then Q1H. See Order Comments for additional instructions Comments: Post Extubation: monitor and document HR, rhythm, BP, respiratory rate, level of consciousness, tidal volume, oxygen saturation, and signs of intolerance (see Ventilator Weaning Intolerance Criteria-Reference Text order), and stridor. Diet NPO NPO times 4 hours then clear liquids and advance as tolerated post mechanical ventilator extubation Diet Order. NPO, For 4 hours then clear liquids and advance as tolerated post mechanical ventilator extubation Notify Physician If patient exhibits signs/symptoms of aspiration while eating/drinking, make NPO and notify physician Notify Provider ABG Results Special Instructions: Call physician for PaO2 LESS than 60 mmhg; ph LESS than 7.34 Medications Proventil Neb 0.083% 2.5 mg neb inh NEB Q4H RT, Duration: 72 hour DuoNeb 3 ml NEB neb inh Q4H RT, Duration: 72 hour (DEF)* 3 ml INHALE neb inh Q4H RT, Duration: 72 hour Incentive Spirometry Routine, Q1H while awake. Therapy to initiate and perform patient education first Routine, 30 minutes post mechanical ventilator extubation or sooner if stridor or patient exhibits signs of intolerance. Call physician for PaO2 LESS than 60 mmhg; ph LESS than 7.34 Page 5 of 6
6 DRUG AND TREATMENT O2 Therapy. Venti Mask, Equal to current FiO2 (DEF)* Nasal Cannula, Titrate FiO2 to maintain oxygen saturation greater than or equal to 92% Oxygen Mask, Titrate FiO2 to maintain oxygen saturation greater than or equal to 92% BIPAP Consults Consult Speech Therapy for post mechanical ventilator extubation swallow evaluation Page 6 of 6
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
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 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
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PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
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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
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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
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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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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
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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
KICU Spontaneous Awakening Trial (SAT) Questionnaire
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WHS POSTOPERATIVE POWERPLAN CHANGES
Medications simplified and standardized to improve safety and effectiveness in the management of pain, itching, nausea/vomiting. Management: o The Anesthesiologist will continue to manage pain in the PACU.
Indirect Calorimetry and the GE Engstrom Carestation. Jorge E. Rodriguez BSRC, RRT
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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
Organ Donor Management Recommended Guidelines ADULT CARDIAC DEATH (DCD)
Date: Time: = Always applicable = Check if applicable ADMISSION INSTRUCTIONS Move to Comfort Care Note in chart. Contact initiated with BC Transplant Consent for Organ Donation obtained Code Status: Full
Organ Donor Management Recommended Guidelines ADULT Brain Death (NDD)
Date: Time: = Always applicable = Check if applicable ADMISSION INSTRUCTIONS Neurological Determination of Death (NDD) has been performed by at least 2 licensed physicians Contact initiated with BC Transplant
Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor
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Sample Case Study. The patient was a 77-year-old female who arrived to the emergency room on
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Chris Cameron Clinical pharmacologist & General Physician CCDHB. Oxygen- A prescribing Blindspot?
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OPEN AAA/MAJOR ABDOMINAL POST-OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Maintain Gastric Tube Maintain Nasogastric - NG, Low Intermittent Suction Maintain Nasogastric - NG, Low Constant
APRV Ventilation Mode
APRV Ventilation Mode Airway Pressure Release Ventilation A Type of CPAP Continuous Positive Airway Pressure (CPAP) with an intermittent release phase. Patient cycles between two levels of CPAP higher
Printed copies of this document may not be up to date, obtain the most recent version from
Children s Acute Transport Service Clinical Guidelines Acute Severe Asthma Document Control Information Author E Randle Author Position CATS Consultant Document Owner E Polke Document Owner Position Co-ordinator
Initials * Page 1 of 6. (place patient label here) Patient Name: Diagnosis: Allergies with reaction type:
Patient Name: Diagnosis: Allergies with reaction type: Orthopedic Upper Ext Post Op Version 3 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro General Medical
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv
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UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA
ENT ADMISSION ORDERS TO TOWER 7 MSICU Attending: Fellow: Resident: Diagnosis: Surgery: Isolation: Allergies: (Food & Med.) Respiratory Settings: FiO2 SIMV TV PS PEEP. O2 Therapy L, %, NP Mask Cupula Heated
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
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
UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
PHYSICIAN S Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: NICU, Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Pt Status: Inpatient
***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
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
MAKING RSI SAFER. Nick Taylor ETU THK 2015
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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,
PICU TRAUMA PLAN - Phase:.
- Phase:. UMC Health System PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care CR Monitoring Vital Signs Per Unit Standards Daily Weight Perform Neurological Checks q15min q30min q1h Special Instructions,
Caring Practice: Evidence-based Terminal Ventilator Withdrawal
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PEEP recruitment maneuver
Robert M. Rodriguez, MD FAAEM Clinical Professor of Medicine and Emergency Medicine, UCSF Case 1: 40 yo Male restrained driver high speed MVA P 140, RR 40 labored, BP 100/70, O 2 sat 70 Chest wheeze, crackles
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
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,
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:
Sample. Affix patient label within this box.
Instructions for completing orders Complete pages 1-3 for General Inpatient Orders. All pathway compatible orders (indicated by ) within the General Inpatient Orders will be followed automatically. Optional