Physician Orders LEB PICU Status Epilepticus Plan. [ ] No known allergies
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- Jessie Nicholson
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1 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 [ ] Routine Post Procedure <24hrs [ ] 23 hour OBS [ ] Bed Type: [ ] Med/Surg [ ] Critical Care [ ] Stepdown [ ] Telemetry; Specific Unit Location: [ ] Admit Patient T;N, Bed Type: Critical Care, Admit to Unit: PICU [ ] Notify Physician-Once T;N, of room number on arrival to unit. Primary Diagnosis: Secondary Diagnosis: Vital Signs [ ] Vital Signs T;N, Monitor and Record T,P,R,BP, q2h(std) [ ] Vital signs w/neurochecks T;N, T,P,R,BP, q2h [ ] Arterial Blood Pressure Monitoring T;N, transduce for continuous monitoring [ ] CVP Monitoring T;N, transduce for continuous monitoring Activity [ ] Bedrest T;N [ ] Out Of Bed ( Activity As Tolerated ) T;N, Up Ad Lib, With Assistance Food/Nutrition [ ] NPO Start at: T;N [ ] Breastmilk (Expressed) T;N [ ] Formula Per Home Routine T;N [ ] Formula Orders [ ] Clear Liquid Diet Start at: T;N [ ] Regular Pediatric Diet Start at: T;N Patient Care [ ] Advance Diet As Tolerated T;N, Start clear liquids and advance to regular diet as tolerated. [ ] Isolation Precautions T;N, Type: [ ] Strict I/O T;N, Routine, intake q1h, output q2h or as condition indicates [ ] Daily Weights T;N, Routine, qeve [ ] Elevate Head Of Bed T;N, 30 degrees [ ] O2 Sat Monitoring NSG T;N, q1h(std) [ ] O2 Sat Monitoring NSG T;N, q2h(std) [ ] Cardiopulmonary Monitor T;N Routine, Monitor Type: CP Monitor [ ] Intra-Abdominal Pressure Monitoring T;N [ ] Bedside Glucose Nsg T;N, Frequency: [ ] Measure circumference T;N, Of: Head, measure on admission (for ages <1 and as indicated) [ ] Seizure precautions T;N, routine [ ] Restraint (Protective) MD Order T;N, Site:, For 24 hr, Comment: Based on my assessment of the patient, I have concluded that protective restraint should be initiated/continued as specified until the indications are no longer present or throughout the following calendar day, whichever comes first. [ ] NIRS Monitor T;N [ ] Bispectral Index Monitoring T;N *065* Page 1 of 5
2 Respiratory Care [ ] LEB Critical Care Respiratory Plan see separate sheet [ ] Initiate Pediatric Respiratory Treatment T;N Protocol [ ] Oxygen Delivery T;N, L/min, Special Instructions: Titrate to keep O2 sat at 85% to 93% Continuous Infusions [ ] Sodium Chloride 0.9% 1000 ml, Injection, Intra-ARTERIAL, ml/hr, Routine, T;N, Infuse via ART line, To be performed by RT [ ] Sodium Chloride 0.9% 1000 ml, Injection, Central IV, ml/hr, Routine, T;N, Infuse via CVP line, To be performed by RT [ ] Sodium Chloride 0.9% 1000mL,IV,Routine,T:N, at ml/hr [ ] D5 1/2NS 1000mL,IV,Routine,T:N, at ml/hr [ ] D5 1/4NS 1000mL,IV,Routine,T:N, at ml/hr [ ] D5 1/2NS KCL 20mEq/L 1000mL,IV,Routine,T:N, at ml/hr [ ] D5 1/4NS KCL 20mEq/L 1000mL,IV,Routine,T:N, at ml/hr [ ] PENTobarbital mg, (5 mg/kg),injection,iv,q15min (4 dose),stat, T;N, Loading dose [ ] PENTobarbital drip (pediatric) mg/kg/hr, Injection, IV, Routine, T;N, Reference Range: 1 to 3 mg/kg/hr [ ] albumin, human 5% bolus ml/kg,injection, IV,once,STAT,T:N, Infuse over: 30 min, (Bolus) [ ] Sodium Chloride 3% 500mL,IV,Routine,T:N, at ml/hr Anticoagulants [ ] heparin drip (pediatric) units/kg/hr, Injection, IV, Routine, T;N, Reference Range: 18 to 28 units/kg/hr Sedatives [ ] midazolam drip (pediatric) mg/kg/hr, Injection, IV, Routine, T;N, Reference Range: 0.05 to 0.2 mg/kg/hr [ ] ketamine drip (Pediatric) mg/kg/hr, Injection, IV, Routine, T;N, Reference Range: 0.5 to 2 mg/kg/hr [ ] fentanyl drip (pediatric) mcg/kg/hr, Injection, IV, Routine, T;N, Reference Range: 0.5 to 2 mcg/kg/hr [ ] propofol drip (Pediatric) mg/kg/hr, Injection, IV, Routine, T;N, Reference Range: 1 to 4 mg/kg/hr Electrolytes [ ] calcium chloride mg,(10 mg/kg), injection, IV, once, STAT,T;N, Max dose = 1 gram [ ] magnesium sulfate mg/kg, injection, IV,once, STAT,T;N, Reference Range: 25 to 75 mg/kg, Max pediatric dose = 2 grams [ ] sodium bicarbonate meq,(1 meq/kg), injection, IV, once, STAT,T;N [ ] tromethamine (THAM) ml/kg,(3 ml/kg), injection, IV, once, STAT,T;N NOTE: consider calcium gluconate if no central line [ ] calcium gluconate mg,(100 mg/kg), injection, IV, once, STAT,T;N Insulins [ ] insulin Drip (pediatric) units/kg/hr, Injection, IV, Routine, T;N, Titrate Instructions: initiate at 0.05 units/kg/hr and increase by 0.01 units/kg/hr to maintain glucose mg/dl Page 2 of 5
3 Medications [ ] Heparin 10 unit/ml Flush 5 ml (10units/mL),Ped Injectable, IVPush, PRN, routine,t;n, peripheral or central line per nursing policy [ ] acetaminophen mg(10 mg/kg), Liq, PO, q4h, PRN Pain or Fever, T;N,Max Dose=90mg/kg/day up to 4 g/day [ ] acetaminophen mg(10 mg/kg), Supp, PR, q4h, PRN Pain or Fever, T;N,Max Dose=90mg/kg/day up to 4 g/day [ ] acetaminophen 80 mg, chew tab, PO, q4h, PRN Pain or Fever, T;N,Max Dose=90 mg/kg/day up to 4 g/day [ ] acetaminophen 325mg, tab, PO, q4h, PRN Pain or Fever, T;N,Max Dose=90 mg/kg/day up to 4 g/day [ ] ondansetron mg(0.1 mg/kg),oral Soln,PO,q8h,PRN nausea/vomiting, routine,t;n, Max dose = 4mg [ ] ondansetron 4mg,Orally Disintegrating Tablet,PO,q8h,PRN nausea/vomiting, routine,t;n [ ] ondansetron mg(0.1 mg/kg),injection,ivpush,q8h,prn nausea/vomiting, routine,t;n, Max dose= 4mg [ ] heparin units, (75 units/kg), Injection, IV, once, Routine, T;N, Give over 10 minutes [ ] enoxaparin mg,(0.5mg/kg), Injection, subcutaneous, q12h, Routine,T;N, Prophylaxis dose, May use subcutaneous catheter [ ] ranitidine mg, (1 mg/kg), Injection, IV, q8h, Routine, T;N, Max dose = 150 mg/day [ ] pantoprazole mg(1mg/kg), Injection, IV Piggyback, q24h, Routine T;N, Max dose = 40 mg/day [ ] LORazepam mg, (0.1 mg/kg), Injection, IV, once, STAT, T;N [ ] midazolam mg, (0.1 mg/kg), Injection, IV, once, STAT, T;N [ ] diazepam 2.5 mg, Gel, PR, once, STAT, T;N [ ] diazepam 5 mg, Gel, PR, once, STAT, T;N [ ] diazepam 10 mg, Gel, PR, once, STAT, T;N [ ] diazepam 12.5 mg, Gel, PR, once, STAT, T;N [ ] diazepam 15 mg, Gel, PR, once, STAT, T;N [ ] diazepam 17.5 mg, Gel, PR, once, STAT, T;N [ ] diazepam 20 mg, Gel, PR, once, STAT, T;N [ ] PHENobarbital mg, (10 mg/kg), Injection, IV, once, STAT, T;N, Loading dose [ ] PHENobarbital mg, (20 mg/kg), Injection, IV, once, STAT, T;N, Loading dose [ ] PHENobarbital mg, (3 mg/kg), Injection, IV Piggyback, q12h, Routine, T;N, For children less than 12 years [ ] PHENobarbital mg, (1 mg/kg), Injection, IV Piggyback, q12h, Routine, T;N, For children greater than or equal to 12 years [ ] fosphenytoin mg, (10 mg/kg), Injection, IV, once, STAT, T;N, Loading dose, Dose [ ] fosphenytoin mg, (20 mg/kg), Injection, IV, once, STAT, T;N, Loading dose, Dose [ ] fosphenytoin mg, (2.5 mg/kg), Injection, IV Piggyback, q12h, Routine, T;N, Dose [ ] levetiracetam (Keppra) mg, (10 mg/kg), Injection, IV Piggyback, once, STAT, T;N, Loading Dose [ ] levetiracetam (Keppra) mg, (10 mg/kg), Injection, IV Piggyback, q12h, routine, T;N Page 3 of 5
4 Anti-infectives [ ] LEB Anti-Infective Orders see separate sheet Laboratory [ ] LEB Transfusion- 4 Months of Age see separate sheet or Greater Plan [ ] LEB Transfusion- Neonate Less see separate sheet than 4 Months of Age Plan [ ] CBC STAT, T;N, once, Type: Blood [ ] Basic Metabolic Panel ( BMP ) STAT, T;N, once, Type: Blood [ ] Comprehensive Metabolic Panel STAT, T;N, once, Type: Blood (CMP) [ ] C-Reactive Protein ( CRP ) STAT, T;N, once, Type: Blood [ ] Prothrombin Time ( PT/INR ) STAT, T;N, once, Type: Blood [ ] Partial Thromboplastin Time ( PTT) STAT, T;N, once, Type: Blood [ ] Fibrinogen Level STAT, T;N, once, Type: Blood [ ] D-Dimer Quantitative STAT, T;N, once, Type: Blood [ ] Triglyceride STAT, T;N, once, Type: Blood [ ] Ammonia Level STAT, T;N, Type: Blood, Comment: immediately place specimen on ice [ ] Phenobarbital Level T;N, STAT, blood,once [ ] Phenytoin Level T;N, STAT, blood,once [ ] Carbamazepine Level T;N, STAT, blood,once [ ] Topiramate Level T;N, STAT, blood,once [ ] Glucose level T;N, STAT, blood,once [ ] BUN T;N, STAT, blood,once [ ] CreatiNINE T;N, STAT, blood,once [ ] Calcium Level T;N, STAT, blood,once [ ] Magnesium Level T;N, STAT, blood,once [ ] Phosphorus Level T;N, STAT, blood,once [ ] Albumin Level T;N, STAT, blood,once [ ] AST (SGOT) T;N, STAT, blood,once [ ] ALT (SGPT) T;N, STAT, blood,once [ ] GGT T;N, STAT, blood,once [ ] Blood Culture STAT, T;N, once, Specimen Source: Line, Central [ ] Blood Culture STAT, T;N+5, once, Specimen Source: Peripheral Blood [ ] Unknown Drug by GC/MS T;N, STAT, type:other,once [ ] Drug Screen Blood T;N, STAT, blood,once [ ] Drug Screen stat, Urine T;N, STAT, urine,once, nurse collect [ ] Urinalysis w/reflex Microscopic Exam T;N, STAT, urine,once, nurse collect Diagnostic Tests [ ] EEG T;N, routine, Type: EEG at bedside, Reason: Seizures [ ] Epilepsy Monitoring T;N, routine, Type: EEG with video, Comment: Reason/Clinical Hx: Seizures, Status epilepticus [ ] CT Brain W/WO Plan T;N, routine, Reason:, Transport: wheelchair [ ] CT Brain WO T;N, routine, Reason:, Transport: wheelchair Page 4 of 5
5 Consults/Notifications [ ] Notify Physician For Vital Signs Of T;N, For: BP Systolic <, BP diastolic <, mean BP <, Celsius Temp <, Celsius Temp >, HR >,HR <, Resp Rate >, Resp Rate <, O2 Sat <, UOP <, Glucose >, Glucose <, ICP > [ ] Notify Physician-Continuing T;N, Mental status changes, increased oxygen requirements, O2 sats less than % [ ] Notify Resident-Continuing T;N, For:, Who: [ ] Notify Resident-Once T;N, For:, Who: [ ] Consult MD Group T;N, Consult Who:,Reason: Neurology [ ] Consult MD Group T;N, Consult Who:,Reason: [ ] Consult MD T;N, Consult Who:,Reason: [ ] Dietitian Consult T;N, Type: [ ] Lactation Consult T;N,Reason: [ ] Consult Child Life T;N,Reason: [ ] Consult Pastoral Care T;N,Reason: [ ] LCAP Consult T;N,Reason: [ ] Medical Social Work Consult T;N,Reason: [ ] Pharmacy Consult for PCA T;N,Reason: Date Time Physician's Signature MD Number Page 5 of 5
Physician Orders: Pediatric. Title: LEB PICU Asthma Plan [X or R] = will be ordered unless marked out.
![Physician Orders: Pediatric. Title: LEB PICU Asthma Plan [X or R] = will be ordered unless marked out.](/thumbs/71/65974412.jpg "Physician Orders: Pediatric. Title: LEB PICU Asthma Plan [X or R] = will be ordered unless marked out.")
Height: cm Weight: kg Allergies: [ ] No known allergies [ ]Medication allergy(s): [ ] Latex allergy [ ]Other: Uncategorized [X] Initiate Powerplan Phase T;N, Phase: LEB PICU Asthma Phase When to Initiate:
Physician Orders PEDIATRIC: LEB Stroke Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Stroke Admit Phase. When to Initiate: LEB Stroke Admit Phase Admission/Transfer/Discharge Patient Status Initial
Physician Orders. 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](/thumbs/90/102440183.jpg "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
Physician Orders PEDIATRIC: LEB Oral Maxillofacial Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Oral Maxillofacial Postop Phase, When to Initiate: LEB Oral Maxillofacial Post Op Phase Admission/Transfer/Discharge
Physician Orders PEDIATRIC: LEB NEURO Epilepsy Monitoring Unit Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Neuro Epilepsy Monitoring Unit Admit Phase, When to Initiate: LEB Neuro Epilepsy Monitor Unit Admit Phase Non Categorized
Physician Orders PEDIATRIC: LEB Kidney Transplant Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Kidney Transplant Post Op Phase, When to Initiate: LEB Kidney Transplant Post Op Phase Admission/Transfer/Discharge
Physician 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 PEDIATRIC: LEB DKA Diabetes Mellitus Admit Plan
Initiate Orders Phase Non Categorized R Powerplan Open Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Admit DKA Two-Bag Calculations Phase, When to Initiate: Initiate Powerplan Phase Phase:
Physician Orders ADULT: LEB Asthma Admit Plan. Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N Attending Physician:
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: LEB Asthma Admit Phase, When to Initiate: LEB Asthma Admit Phase Non Categorized Add To Problem List Problem: Asthma
Physician Orders ADULT Order Set: Respiratory Failure Orders
[R] = will be ordered Height: cm Weight: kg Allergies: [ ] No known allergies [ ]Medication allergy(s): [ ] Latex allergy [ ]Other: Admission/Transfer/Discharge [ ] Patient Status Initial Inpatient Attending
Physician Orders PEDIATRIC: LEB ED Hx of DKA with Hyperglycemia Plan
LEB ED Triage Hx of DKA w Hyperglycemia Non Categorized Criteria for use: Patients less than 18 years of age with known or suspected Diabetes Mellitus and blood glucose greater than 300mg/dL.(NOTE)* Vital
Physician Orders PEDIATRIC: : LEB ED Trauma (Major) Plan
LEB ED Standing Orders Trauma (Major) Ph Non Categorized Criteria: Patients between 0-18 years of age that present with a Major Trauma that meet LeBonheur Trauma stat or Trauma Alert Guidelines.(NOTE)*
Physician Orders. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.
![Physician Orders. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.](/thumbs/77/75931338.jpg "Physician Orders. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.")
Height: cm Weight: kg Allergies: [ ] No known allergies [ ] Latex allergy [ ]Other: [ ] Initiate Powerplan Phase, Phase: LEB NICU Sepsis Phase Admission/Transfer/Discharge [ ] Patient Status Initial Inpatient
Physician Orders ADULT: Kidney-Panc/PancTransplant Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Kidney-Panc/Panc Transp Post Op Phase, When to Initiate: Kidney-Panc/Panc Transp Post Op Phase Vital Signs Vital
Physician Orders ADULT: Head and Neck Postoperative Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Head and Neck Postoperative Phase, When to Initiate: Head and Neck Post Operative Phase, Monitor and Record T,P,R,BP,
Physician Orders PEDIATRIC: LEB Eating Disorder Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Eating Disorder Admit Phase, When to Initiate: When patient arrives to unit LEB Eating Disorder Admit Phase Admission/Transfer/Discharge
PHYSICIAN ORDERS 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
Physician Orders ADULT: Asthma and Bronchitis Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Asthma and Bronchitis Phase, When to Initiate: Asthma and Bronchitis Phase Non Categorized Problem: Asthma Problem:
Physician Orders ADULT: Sickle Cell Inpatient Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Sickle Cell Inpatient Phase, When to Initiate: When patient arrives to unit Sickle Cell Inpatient Phase Admission/Transfer/Discharge
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 Orders ADULT: Renal Transplant Admit Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase, Phase: Renal Transplant Admit Phase, When to Initiate: Renal Transplant Admit Phase Non Categorized Initiate Powerplan Phase,
Physician Orders 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
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
Physician Orders ADULT: Atrial Fib/Flutter Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Atrial Fib/Flutter Phase, When to Initiate: Atrial Fib/Flutter Phase Non Categorized Problem: Atrial fibrillation Problem:
Physician Orders 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,
Physician Orders Pediatric: LEB ED Asthma Plan
LEB ED Triage Standing SOB/Wheeze Asthma Non Categorized Criteria: Patients greater than 2 years of age with a history of asthma or airway active disease or two or more previous illnesses treated with
Physician Orders ADULT: Vascular Surgery AAA Endovascular Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: AAA Endovascular PACU Phase, When to Initiate: Initiate Powerplan Phase Phase: Mechanically Ventilated Patients Phase,
UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
PICU GENERAL PLAN UMC Health System PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Bedrest Up Ad Lib/Activity as Tolerated Strict Intake
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
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
*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
PICU Therapeutic Hypothermia Post Cardiac Arrest Re Warming Phase
Arrest Re Warming Phase Weight Allergies Patient Care ***After 24 hours initiate re warming (or after 72 hours for an infant less than one month old)*** PICU Re Warming Protocol ***See Reference Text***
Physician Orders ADULT: Ortho Total Joint Plan
Initiate Orders Phase Non Categorized R Powerplan Open Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Ortho Total Joint Preop Phase, When to Initiate: Other-See Special Instructions, initiate
PEDIATRIC LIFEGIFT BRAIN DEATH PLAN
PHYSICIAN S 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
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
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
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:
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
ALL orders are active unless: 1. Order is manually lined through to inactivate 2. Orders with check boxes ( ) are unchecked DRUG AND TREATMENT ORDERS
Available at: ALL Adult Facilities Non Categorized SUB Protocol(SUB)* SUB Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form*** Nursing Orders
Physician s Order Form. Physician s Order Form. Telemetry/Progressive Care Orders. Continued on next page. >>>>>>> Continued on next page.
DATE: TIME: DATE TIME INTRAVENOS FLID and MEDICATION Status: Admit to Telemetry Admit to Progressive Care nit Transfer to Progressive Care nit Note: Discontinue Previous Orders Transfer to Telemetry nit
Physician Orders ADULT: Routine Deceased Donor Adult Plan
Initiate Orders Phase Non Categorized NOTE: Nurse - confirm PM Discharge disposition set to "Donor and or Life Support" on hospital encounter. Enter these orders on new OP encounter created by Access/Registration
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
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
PICU BRONCHIOLITIS PLAN
PICU BRONCHIOLITIS PLAN Diagnosis Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Patient Care Code
Physician Orders PEDIATRIC: LEB Ortho Accelerated Posterior Spinal Fusion Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: LEB Ortho Accelerated PSF Post Op Initial Phase, When to Initiate: Initiate Powerplan Phase Phase: LEB Ortho Accelerated
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
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:
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
Therapeutic Hypothermia for Post Cardiac Arrest Plan Initial Orders
Arrest Plan Initial Orders Weight Allergies Therapeutic Hypothermia Guidelines ***Required to continue with ordering Plan.*** Strict Intake and Output q1h, throughout cooling and re warming. Set Up for
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 PEDIATRIC: LEB Critical Care Respiratory Plan
LEB Critical Care Respiratory Plan Patient Care Cardiopulmonary Monitor T;N Routine, Monitor Type: End Tidal Co2 (DEF)* T;N Routine, Monitor Type: Transcutaneous Co2 Respiratory Care Initiate Pediatric
Physician Orders ADULT
Physician Orders ADULT attach patient label here Order Set: ED Non-STEMI Unstable Angina Orders Height: cm Weight: kg Allergies: No known allergies Medication allergy(s): Latex allergy Other: Admission/Transfer/Discharge
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
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
Attach patient label here. Physician Orders ADULT: Palliative Care Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase T;N, Phase: Palliative Care Phase, When to Initiate: Palliative Care Phase Admission/Transfer/Discharge Patient Status Initial
Physician Orders 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
Physician Orders ADULT: Cardiac Surgery Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Cardiac Surgery Post Op Phase, When to Initiate: Initiate Powerplan Phase Phase: Mechanically Ventilated Patients (Vent
PEDIATRIC PICU TRAUMA PLAN EKM - Phase: PICU Trauma Plan
- Phase: PICU Trauma Plan Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards Daily Weight Perform Neurological Checks q15min q30min q1h Special Instructions, with Vital Signs
Hypothermia Short Set-Critical Care HYPOTHERMIA SS- CRITICAL CARE
Hypothermia Short Set-Critical Care HYPOTHERMIA SS- CRITICAL CARE Inclusion Criteria all must be present Cardiac arrest with return of spontaneous circulation (ROSC) ROSC within 60 mins of witnessed arrest;
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,
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,
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
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
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
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)
* * 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
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 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
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,
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:
NonConvulsive Seizure
Sample Protocol #5: Management of status epilepticus and seizures in hospitalized patients nconvulsive Seizure Patient presents with alteration of consciousness unexplained by other etiologies AND suspicious
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,
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
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
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
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
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
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
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
INPATIENT INTERVENTIONAL RADIOLOGY PLAN - Phase: Pre-Procedure Orders
- Phase: Pre-Procedure Orders DETAILS Patient Care Obtain Consent If one is not present on chart today. Vital Signs Per Policy Insert Peripheral Line T;N, Start IV on right side If left radial access is
PEDIATRIC ARGININE CLONIDINE STIMULATION TEST PLAN
Diagnosis Weight Allergies Patient Care Arginine Clonidine Stimulation Test Guid (Arginine Clonidine Stimulation Test Guidelines) See Reference Guidelines. Vital Signs Routine, q1h, With BP, During the
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
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
Study Orders Center for Clinical Investigation
Please indicate if this visit is an INPATIENT admission or an OUTPATIENT visit Subject Legal Name: D.O.B.: Age: Medical Record #: Gender: Ethnicity: Race: Admitting Information INPATIENT or OUTPATIENT
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,
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
Refractory Status Epilepticus in Children: What are the Options?
Refractory Status Epilepticus in Children: What are the Options? Weng Man Lam, PharmD, BCPS, BCPPS PICU Clinical Pharmacy Specialist Memorial Hermann Texas Medical Center November 11, 2017 Objectives 1.
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
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 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
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
(31189) Hypothermia Initiation Phase One
Hypothermia Initiation Phase One Diagnosis Allergies For hypothermia tracking purposes only. Please do not uncheck.- Required Cardiac Emergency Tracking For hypothermia tracking purposes only. Consults
TRANSCATHETER AORTIC VALVE REPLACEMENT POST- OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards, q15min x 4, q30min x 2, then q1h x 4 until sheath discontinued. Per Unit Standards Perform Neurovascular
Standardize comprehensive care of the patient with severe traumatic brain injury
Trauma Center Practice Management Guideline Iowa Methodist Medical Center Des Moines Management of Patients with Severe Traumatic Brain Injury (GCS < 9) ADULT Practice Management Guideline Contact: Trauma
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
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
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
ST. DOMINIC-JACKSON MEMORIAL HOSPITAL JACKSON, MISSISSIPPI. CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) HEPARIN ANTICOAGULATION Page 1 of 5
HEPARIN ANTICOAGULATION Page 1 of 5 Pharmacy Mnemonic: CRRTHEP1 PATIENT DATA: DIAGNOSIS: AKI ESRD Other: WEIGHT: Today: kg Admission Weight:: kg Dry Weight: kg Access TYPE: Temporary Dialysis Catheter
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