Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017
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- Samuel Hancock
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1 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 Additional instructions: In halls every shift starting day of surgery Out of bed to chair daily Nursing Orders Vital signs per unit standard Leg exercises at time of Vital Signs, dorsiflexion and plantar flex both feet x10 Point of Care Capillary Blood Glucose 4 times a day, before meals and at bedtime Medical Telemetry: Patient may be off telemetry for showering or transport for diagnostic tests [ ] Yes [ ] No Intake and output per unit standard Intake and output STRICT Daily Weight Additional Instruction: Standing Initiate MRSA Testing and Treatment Protocol Notify Physician: Temperature >101.3 F (38.5 C); Pulse <50 or >120; SBP <90 or >180; DBP <60 or > 100; RR >26 or <10; Urine Output <30ml/hr Incentive Spirometer every 1 hour x10 Maintain JP Drain Empty and Record Output: when full and at least once per shift Discontinue: Dressings Change Begin: When JP is discontinued Type: [ x ] Place gauze with tegaderm. Leave in place for 2 days, after which it can be removed and either redressed or left open Frequency: [ ] Daily [x ] PRN Additional Instructions: Other: * Page 1 of 5
2 Respiratory Pulse oximetry continuous Oxygen administration Nasal Cannula RN/RT to determine flow and titrate to maintain Oxygen saturation greater than 90% Additional Instructions: via Nasal Cannula Other: at Lpm Continuous positive airway pressure (CPAP), patient may use own- as per home settings Other: Diet (pick only one) NPO Clear Liquid Diet with Bariatric Modifiers Full Liquid Diet with Bariatric Modifiers Optisource/protein supplement (with Full Liquid Diet) 4 ounces every 2 hours, 6 times per day Additional Instructions: No red dye, no straws, no caffeine, no carbonated beverage, no juices. Artificial sweeteners ONLY. Required intake: 6 ounces fluid per hour. IV/ Line Insert and/or Maintain Maintain Peripheral IV Sodium Chloride 0.9% IV (Normal Saline Flush) 10 milliliter intravenously 2 times a day IV Fluids - Maintenance Specific Fluid Lactated Ringers 1,000mL with Thiamine 100mg, Folic Acid 1 mg, Magnesium Sulfate 1gm and MVI 10ml 125 milliliter/hour continuous intravenous infusion x1 bag Then, Lactated Ringers IV 150 milliliter/hour continuous intravenous infusion IV Fluids Bolus Lactated Ringers 1,000 milliliter if urine output is less than **If patient is diabetic, please use the Diabetic Insulin Management Order Set Medications pantoprazole IV 40 milligram intravenously once If patient on an oral B-blocker at home, SELECT: metoprolol IV 5 milligram intravenously every 6 hours. Hold for SPB <100 or HR <60 Page 2 of 5
3 Hypoglycemia Treatment Post Operative Bariatric Surgery Patient Blood Glucose mg/dl SELECT: Glucose Gel 1 tube=15 grams carbs. Recheck capillary blood glucose in 15 minutes and if less than 70 mg/dl follow treatment again. Blood Glucose 50 mg/dl or less SELECT: Glucose Gel 2 tube=30 grams carbs. Recheck capillary blood glucose in 15 minutes and if less than 70 mg/dl follow treatment again. Analgesics (PCA): Select one morphine range recommendations: demand dose: milligram; demand dose lock out: 5-10 minutes; doses(milligram)/hour: 5-10 milligram/hour morphine in normal saline 1 mg/ml (PCA) Demand dose: 1 milligram; Demand dose: milligram Demand dose lock out: minutes MAX doses/hour: 7 doses/hour MAX doses/hour: doses/hour Continuous rate: milligrams/hour (initial rate should not be greater than 1 milligram/hour in opioid naive patients) Clinician bolus: milligrams (max = doses/hour HYDRomorphone (DILAUDID) range recommendations: demand dose: milligram; demand dose lock out: 5-10 minutes; doses(milligram)/hour: milligram/hour HYDROmorphone normal saline 0.2 mg/ml (DILAUDID - PCA) Demand dose: 0.2 milligram; Demand dose: milligram Demand dose lock out: minutes Maximum doses/hour: 7 doses/hour Maximum doses/hour: doses/hour Continuous rate: milligrams/hour (initial rate should not be greater than 0.15 milligram/hour in opioid naive patients) Clinician bolus: milligrams (max = doses/hour) fentanyl range recommendations: demand dose:10-50 microgram; demand dose lock out: 5-10 minutes; doses(microgram)/hour: microgram/hour fentanyl in normal saline 10 micrograms/ml (PCA) Demand dose: 10 micrograms; Demand dose: micrograms Demand dose lock out: minutes Maximum doses/hour: 7 doses/hour Maximum doses/hour: doses/hour Continuous rate: micrograms/hour (initial rate should not be greater than 10 micrograms/hour in opioid naive patients) Clinician bolus: micrograms (max = doses/hour) Page 3 of 5
4 Analgesics: Oral/Rectal acetaminophen 500 mg tablet (TYLENOL) 1,000 milligram orally every 6 hours oxycodone 5 mg tablet 1-2 tablets orally every 4 hours as needed for moderate pain HYDROcodone/acetaminophen 5/325mg tablet (NORCO) 1-2 tablets orally every 4 hours as needed for moderate pain acetaminophen 650 mg rectal suppository (TYLENOL) 650 milligram suppository rectally every 4 hours as needed for pain or temperature greater than F (Do NOT order if scheduled acetaminophen is ordered) Analgesics: Intravenous FentaNYL IV micrograms slow intravenous push every 3 hours as needed for severe break-through pain HYDROmorphone IV milligram intravenously every 3 hours as needed for severe break-through pain Morphine IV 1-4 milligrams intravenously every 2 hours as needed for severe break-through pain Antiemetics Injectable ondansetron (ZOFRAN) 4 milligram intravenously every 4 hours as needed for nausea/vomiting promethazine (PHENERGAN) 25 milligram intravenously every 6 hours as needed for nausea/vomiting, if no response to ondansetron VTE Prophylaxis Nursing Order Sequential compression device (SCD) Medications enoxaparin (LOVENOX) 40 milligram subcutaneously once a day Laboratory CBC/AUTO DIFF six hours post op Morning Draw: CBC/AUTO DIFF Morning draw x 2 (POD #1 & #2) BASIC METABOLIC PANEL Morning draw x 2 (POD #1 & #2) Radiology and Diagnostic Tests XR Upper GI in AM Page 4 of 5
5 Consult Department PT Physical Therapy Eval & Treat Reason for consult: OT Occupational Therapy Eval & Treat Reason for consult: * Provider_Signature: Date: Time: Page 5 of 5
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
Hip Hemiarthroplasty Post Op Version 2 4/20/17
Patient Name: Diagnosis: Allergies with reaction type: Hip Hemiarthroplasty Post Op Version 2 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro PCU ICU General
Orthopedic Admission Hip Fracture Version 2 1/25/2017
Patient Name: Initial each page and Sign/Date/Time last page Diagnosis: Allergies with reaction type: Orthopedic Admission Hip Fracture Version 2 1/25/2017 Patient Placement Patient Status If the physician
Total Hip Replacement Post Op Version 4 4/20/17
Patient Name: Diagnosis: Allergies with reaction type: Total Hip Replacement Post Op Version 4 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro General Medical
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
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
(Page 1 of 5) Diagnosis: Procedure: Right Total Knee Replacement Unicompartmental Knee Left Total Hip Revision Total Shoulder
(Page 1 of 5) Allergies/Sensitivities/Reactions: Height: Inches cm Weight: Kg Pounds = Automatic = Physician s option, Check off to Order Diagnosis: Procedure: Right Total Knee Replacement Unicompartmental
1. Attending Physician: Dr Syn Pager: Cell: Co-Morbidities:
BARIATRIC SURGERY IMMEDIATE POST-OP PLAN (Includes Post Op Day 1) Denotes order requirement Antibiotic administered in the OR at: 1. Attending Physician: Dr Syn Pager: 740-6545 Cell: 438-9415 2. To remain
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
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***
(30689) PROT Pain PCA Adult Patient Controlled Analgesia
Diagnosis Allergies Nursing Assess and Document PCA: 1. Assess and document pain rating, sedation level and respiratory rate every 2 hours; assess and document pain rating, sedation level and respiratory
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
Diagnosis: Allergies with reaction type:
Patient Name: Initial each page and Sign/Date/Time last page Diagnosis: Allergies with reaction type: ICU Admission Comprehensive Version 3 4/10/17 Patient Placement Patient Status If the physician cannot
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
General. Code Status (Single Response) ( ) Full Code Details ( ) Full code - unverified Details ( ) DNRCC Allow additional therapies?
Post Operative Above and Below Knee Amputation Admission [3041300028] Consider adding Insulin Adult -- Subcutaneous Insulin and Hypoglycemia Management [3041300000] General Admission (Single Response)
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
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
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](/thumbs/96/128298591.jpg "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:
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
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
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
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
1 of 5. Integrated Order Set Inpatient, Adult. Gynecological Surgery Enhanced Recovery Orders apply to patients 18 years and older.
Orders apply to patients 18 years and older. All preprinted doses are based on normal renal and hepatic function and must be assessed for adjustment against the individual patient s renal and hepatic function
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 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
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
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,
ST. DOMINIC-JACKSON MEMORIAL HOSPITAL JACKSON, MISSISSIPPI
Date & Time Post-Op Inpatient General Orthopedic Page 1 of 5 Pharmacy Mnemonic: POIGOP1 1. Admit as inpatient to Dr. 2.Diagnosis: 3.Admit to PACU and then to floor ICU 4.Radiology: AP Pelvis in PACU AP
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
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:
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
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
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
r*po1004*r PHYSICIAN S ORDERS Page 1 of 7 HOUR THORACOTOMY POSTOPERATIVE ORDERS General x Admit to Inpatient Status x Admitting Physician: Admit to:
PHYSICIAN S ORDERS Page 1 of 7 General x Admit to Inpatient Status x Admitting Physician: Admit to: SICU Telemetry Med/Surg room x Resuscitation status: see Resuscitation Status Order Activity x Bed rest
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.
morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice
PATIENT CONTROLLED ANALGESIA (PCA) PLAN Allergies: Medication Selection: morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice HYDROmorphone (Dilaudid ) 6 mg/ 30 ml (0.2 mg/ml) fentanyl 300 mcg/ 30 ml (10 mcg/ml)
Assessment. Consults & Referrals
University of Virginia Health System Clinical Pathway: Whipple Enhanced Recovery After () LOS: 4-5 days Date of Origin/Revision: June 29, 2016/September 6, 2017/January 31, 2018 : SAS : : : D1 D2 D 3/
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
LYSIS OF ADHESIONS POST-OP PLAN - Phase: PACU Phase
- Phase: PACU Phase PHYSICIAN S Diagnosis Weight Allergies Communication Place Device at Bedside Confirm there are 3 x Aliquots of 0.2% Ropivacaine. 2 x Medfusion Infusion pumps. Confirm 3 x PF Aliquots
GENERAL SURGERY POST-OP PLAN
GENERAL SURGERY POST-OP PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom
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
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
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
Sample. Fractured Hip Post-Operative Orders. Legend < Mandatory fields o Optional fields. Height Allergies: List or o Up to date in electronic system
Legend Mandatory fields o Optional fields Height Allergies: List or o Up to date in electronic system cm Weight Diagnosis kg Date (yyyy-mon-dd) Time (hh:mm) Anticipated Date Of Discharge (ADOD) o Greater
* * FORM REV. 02/2019 Page 1 of 4. TNKASE (tenecteplase) / ACUTE STEMI ORDERS SCHEDULED MEDICATIONS:
1. Is this a CMS inpatient only procedure? Yes, admit as inpatient, proceed to # 3 No, proceed to # 2 2. Do you expect that the patient s condition will require a hospital stay that will cross two midnights
UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards q12h q12h, Temperature Only - Every Shift and PRN Patient Activity Assist as Needed, Bed Position: As Tolerated, elevate to patient
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
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
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
IR Central Venous Access [ ] Pre Procedure
![IR Central Venous Access [ ] Pre Procedure](/thumbs/90/104119758.jpg "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
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
Davis s Drug Guide Scavenger Hunt 15 th Edition
Davis s Drug Guide Scavenger Hunt 15 th Edition This handout is designed to assist you in locating information in the Davis s Drug Guide. Take advantage of the many resources in this text!! Locate the
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:
EPIDURAL / INTRATHECAL POST-OP PLAN
EPIDURAL / INTRATHECAL POST-OP PLAN Diagnosis Weight PHYSICIAN S Allergies Patient Care Vital Signs Per Unit Standards, PLUS check and record RR q1h x 12, then q2h x 6, until 24h following narcotic administration.
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
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 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
Allergies: Weight: kg Diagnosis: Procedure Performed Describe Procedure:
Page 1 of 11 Allergies: Weight: kg Diagnosis: Service: Admission Admit to Inpatient Admit to Daypatient Place on Outpatient Observation Status Hospital Attending: Attending Physician Attending Provider:
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
UMC Health System Patient Label Here PHYSICIAN ORDERS
Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards q12h q12h, Temperature Only - Every Shift and PRN Patient Activity Assist as Needed, Bed Position: As Tolerated, elevate to patient
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT PACE Vital Signs Vital Signs PRE-OP, On arrival Nursing Orders Initiate ANES Anesthesia PACE PowerPlan Weigh Patient PRE-OP Pre op. Provide patient with incentive spirometry teaching
ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP ADMIT PLAN - Phase: Begin Immediately/PACU
- Phase: Begin Immediately/PACU Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Pt Status:
Chest Pain Acute Coronary Syndrome Version 4 4/10/17 This order set is designed to be used with an admission set or for a patient already admitted
Patient Name: Diagnosis: Allergies with reaction type: Chest Pain Acute Coronary Syndrome Version 4 4/10/17 This order set is designed to be used with an admission set or for a patient already admitted
GENERAL SURGERY PLAN - Phase:.
- Phase:. 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 Privileges
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,
***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
Physician Orders LEB PICU Status Epilepticus Plan. [ ] No known allergies
![Physician Orders LEB PICU Status Epilepticus Plan. [ ] No known allergies](/thumbs/80/82315048.jpg "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
GENERAL SURGICAL ADULT POST-OPERATIVE ORDERS 1 of 4
down ADULT POST-OPERATIVE 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Admit to: Post Anesthesia Care Unit (PACU),
1. Attending Physician: Resident/Fellow: 2. Admit: MEDICAL/SURGICAL ICU Other: Designation: In Patient Out Patient. 5.
UROLOGY POST OPERATIVE PLAN Patient Label Here A UMC Health System Performance Improvement Initiative for use in all units where surgical patients receive care in support of Surgical Care Improvement Program
OB/GYN CESAREAN SECTION POST-OP PLAN - Phase: General Orders
- Phase: General Orders DETAILS Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom Privileges Bedrest Up to Bedside Commode
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
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
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
LIBERTYHEALTH. Jersey City Medical Center Department of Patient Care Services. Approved by Policy Committee:
LIBERTYHEALTH Jersey City Medical Center Department of Patient Care Services Guidelines: CRITICAL CARE INSULIN PROTOCOL (MICU/SICU, CCU, ED) Developed by: Pharmacy Dept Approved by: Rita Smith, DNP Senior
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
ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP PLAN - Phase: Begin Immediately/PACU
- Phase: Begin Immediately/PACU PHYSICIAN S Diagnosis Weight Allergies Laboratory Calcium Level STAT Outpatient/PACU, T;N PTH Intact STAT Outpatient/PACU, T;N 1 of 7 - Phase: When Patient Arrives to Room
PHYSICIAN ORDERS Diagnosis
PICU PROCEDURE PLAN PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Patient Care
Procedure: Laser Transurethral Resection of Prostate or Transurethral Resection of Prostate
Laser Transurethral Resection Of Prostate Or Transurethral Resection Of Prostate Post-Operative Plan Patient Label Here A UMC Health System Performance Improvement Initiative for use in all units where
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S PACE Vital Signs Vital Signs PRE-OP, On arrival Nursing Orders Initiate ANES Anesthesia PACE PowerPlan Weigh Patient PRE-OP Pre op. Provide patient
Pediatric Intensive Care Unit (PICU) Pediatric Diabetic Ketoacidosis (DKA) Admission Order Set
Discontinue all previous orders Weight: kg DKA admit order set is for initial management Ongoing management required based on frequent reassessment of TFI, fluid balance and lab results. Admit to PICU
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
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
A UMC Health System Performance Improvement Initiative for use in all units where patients with are admitted for Surgical Care Improvement Project.
ENDOLUMINAL AAA POST-OP PLAN A UMC Health System Performance Improvement Initiative for use in all units where patients with are admitted for Surgical Care Improvement Project. *Denotes guideline requirement
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,
Sample. Affix patient label within this box.
Instructions for completing orders: Determine PRAM Clinical Score as per the Alberta Acute Childhood Asthma Pathway for Emergent/Urgent Care and select orders based on PRAM Score. Custom orders can be
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
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: 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,
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
USD Healthcare Center
Sally Nelson DOB: 11/29/1941 HCP: Dr. Winters Age: 68 yrs. Height: 67 in. (170 cm) Weight: 145 lbs. (65.9 kg.) MR# PCS62800 Gender: F No Known Allergies Allergies & Sensitivities PCN, Sulfa Diagnosis:
1. Diagnosis: 2. Co-Morbidities: Allergies: NKDA Allergic to:
BMT NON -HODGKIN S LYMPHOMA Autologous Stem Cell Transplant Routine Plan 1. Diagnosis: 2. Co-Morbidities: Allergies: NKDA Allergic to: 3. Attending Physician: Notify on call Resident/Fellow Consult: Social
SHINE Study PowerChart Order Set CONTROL
SHINE Study PowerChart Order Set CONTROL Orders Patient Care Component Blood Glucose Details Hypoglycemia: For BG
DKA Adult ICU Powerplan
DKA Adult ICU Powerplan Key Points for ED to ICU DKA power plan In addition to NS fluids and maintenance the regular insulin drip will either already be infusing from ED or needs to be initiated. Regular
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,
STROKE NEUROINTERVENTION PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Notify Nurse (DO NOT USE FOR MEDS) Right Lower Extremity-Check peripheral pulse distal to the cath site. If
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
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)*
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)
Standardized Nurse Activated Protocols (SNAPs)
SNAPs by presenting complaint/problem help nurses initiate care before the patient is seen by a physician. SNAPs should be approved by ED team consensus If patient unstable in any way, immediately notify
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