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

IDPH ESF-8 Plan: Pediatric and Neonatal Surge Annex Shock Care Guideline 2017

Purpose: To provide guidance to practitioners caring for pediatric patients during a disaster. Disclaimer: This guideline is not meant to be all inclusive, replace an existing policy and procedure at a

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

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

Standardized Nurse Activated Protocols (SNAPs)

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PEDIATRIC ACUTE ASTHMA SCORE (P.A.A.S.) GUIDELINES. >97% 94% to 96% 91%-93% <90% Moderate to severe expiratory wheeze

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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

PICU ADMIT DKA PLAN - Phase: Begin Immediately

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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,

Emergency Department Protocol Initiative

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

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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. LEB NICU Sepsis Plan [X or R] = will be ordered unless marked out.

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

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

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Asthma Care in the Emergency Department Clinical Practice Guideline

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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 PEDIATRIC: LEB Stroke Admit Plan

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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

Physician Orders ADULT: Asthma and Bronchitis Plan

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Neurosurgery Pre-Op [1710] Patient Name MRN. General. Nursing. Case Request [ ] Case request operating room Scheduling/ADT, Scheduling/ADT [ ] Other

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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 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

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

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 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

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

10/6/2014. Tommy s Story: An Overview of Asthma Mangement. Disclosure. Objectives for this talk.

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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 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***

SCVMC RESPIRATORY CARE PROCEDURE

Page 1 of 8 Rev. - 11/99, 11/05, 4/11 R-NC - 08/99,08/00, 04/03,10/08,04/09, 07/11, 6/12 B7180-43 OBJECTIVE Continuous Nebulization allows for continuous, controlled drug delivery to the lung, avoiding

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

PICU BRONCHIOLITIS PLAN

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Fever in neonates (age 0 to 28 days)

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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

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

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

ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP ADMIT PLAN - Phase: Begin Immediately/PACU

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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

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

Physician Orders ADULT: Sickle Cell Inpatient Plan

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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

ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP PLAN - Phase: Begin Immediately/PACU

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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

(Page 1 of 5) Diagnosis: Procedure: Right Total Knee Replacement Unicompartmental Knee Left Total Hip Revision Total Shoulder

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Children ARE just small adults

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Pediatric Outpatient Surgery Plan - Diagnostic/Pre-Op Orders

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EFFECTIVE DATE: 01/2007 REVISED: 07/2008, 6/11, 3/12, 8/12, 1/15. Purpose:

1 TITLE/DESCRIPTION: DEPARTMENT: PERSONNEL: Rapid Response Team (RRT) Patient Care Services RN s and RT s EFFECTIVE DATE: 01/2007 REVISED: 07/2008, 6/11, 3/12, 8/12, 1/15 Purpose: A group of select health

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

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

Emergency Department Guideline. Asthma

Emergency Department Guideline Inclusion criteria: Patients 2 years old with: o Known history of asthma or wheezing responsive to bronchodilators presenting to the ED with cough, wheeze, shortness of breath,

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

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

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

Emergency Department Chest Pain, Suspected Cardiac Adult Order Set

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UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis

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Division of Acute Care Surgery Clinical Practice Policies, Guidelines, and Algorithms: Admission Criteria Clinical Practice Policy

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GENERAL SURGERY POST-OP PLAN

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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

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:

morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice

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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)

Management of acute asthma in children in emergency department. Moderate asthma

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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

OBSERVATION UNIT ASTHMA PATHWAY OUTLINE Westmoreland Hospital PAGE 1 OF 5

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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 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

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,

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

1. Introduction Algorithm: Infant with Fever 0-28 Days Algorithm: Infant with Fever Days...3

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AT TRIAGE. Alberta Acute Childhood Asthma Pathway: Evidence based* recommendations For Emergency / Urgent Care

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Physician Orders ADULT: Head and Neck Postoperative Plan

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

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Simulation 01: Two Year-Old Child in Respiratory Distress (Croup)

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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 Order Set 0 through 16 yrs age Addressograph Stamp

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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:

INPATIENT ASTHMA CARE PROTOCOL

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IDPH ESF-8 Plan: Pediatric and Neonatal Surge Annex Pandemic Care Guidelines 2017

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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. 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:

Sample. Fractured Hip Post-Operative Orders. Legend < Mandatory fields o Optional fields. Height Allergies: List or o Up to date in electronic system

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Wheezy? Easy Peasy! The Emergent Management of Asthma & Bronchiolitis. Maneesha Agarwal MD Assistant Professor of Pediatrics & Emergency Medicine

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Physician Orders PEDIATRIC: LEB NEURO Epilepsy Monitoring Unit Admit Plan

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Pediatric Asthma. Concepts (in order of emphasis) Jared, 10 years old

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WEIGHT: KG HEIGHT: CM ALLERGY CAUTION sheet reviewed Code Status Full code

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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

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DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES

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ST. DOMINIC-JACKSON MEMORIAL HOSPITAL JACKSON, MISSISSIPPI

Date & Time TAVR Pre-Op Admission Clinical Pathway Page 1 of 3 1. Admit as INPATIENT to Dr.. For Surgery Today or Tomorrow 3. Diagnosis: 4. Allergies: Pharmacy Mnemonic: PRETAVR 5. Vital signs on arrival.

Routine, Every 2 hours, Starting today, If temperature greater than 38.5 C initiate Evaluation for Possible Sepsis Physician Order #829

Height Weight Allergies General Vital Signs [X] Frequent vital signs Indication: Q15 minutes x (# of occurrences): 4 Q30 minutes x (# of occurrences): 4 Q1 hour x (# of occurrences): Q2 hours x (# of occurrences):

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

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