Physician Orders ADULT: LEB Asthma Admit Plan. Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N Attending Physician:
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1 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 Add To Problem List Admission/Transfer/Discharge Patient Status Initial Inpatient Admitting Physician: Reason for Visit: Bed Type: Specific Unit: Care Team: _ Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient Attending Physician: Reason for Visit: Bed Type: Specific Unit: Outpatient Status/Service: [ ] Ambulatory Surgery, [ ] OP Diagnostic Procedure [ ] OP OBSERVATION Services Notify Physician-Once, of room number on arrival to unit Vital Signs Vital Signs, Monitor and Record T,P,R,BP, q4h(std) Activity Bedrest Out Of Bed, Up Ad Lib Activity As Tolerated, Up Ad Lib, Patient to remain on unit until respiratory treatment frequency is q3h or more Food/Nutrition NPO Start at: Breastfeed Page 1 of 5
2 LEB Formula Orders Plan(SUB)* Regular Pediatric Diet Start at: Clear Liquid Diet Start at: Patient Care Advance Diet As Tolerated, start clear liquids and advance to regular diet as tolerated Isolation Precautions Intake and Output, Routine, q2h(std) Daily Weights, Routine, qeve Cardiopulmonary Monitor Routine, Monitor Type: CP Monitor Smoking Cessation Advice/Counseling, for patient/family O2 Sat Continuous Monitoring NSG, Consider moving to Spot Check if not on O2. O2 Sat Spot Check-NSG Restraint Medical/Surgical(non-violent, non-self-destructive) Respiratory Care Initiate Pediatric Asthma Treatment q2h(std), Special Instructions: Starting treatment Oxygen Delivery, Special Instructions: Titrate to keep O2 sat =/>90%, Wean to room air Peak Flow Asthma Education, Topic: Asthma RT Assess and Call, Routine, Special Instructions: Assessment Protocol Continuous Infusion Page 2 of 5
3 D5 1/2NS D5 1/4 NS ) D5 1/2 NS KCl 20 meq/l D5 1/4 NS KCl 20 meq/l Medications +1 Hours acetaminophen 10 mg/kg, Liq, PO, q4h, PRN Pain or Fever, Routine, Max Dose = 75 mg/kg/day up to 4 g/day (DEF)* 10 mg/kg, Supp, PR, q4h, PRN Pain or Fever, Routine, Max Dose = 75 mg/kg/day up to 4 g/day 325 mg, Tab, PO, q4h, PRN Pain or Fever, Routine, Max Dose = 75 mg/kg/day up to 4 g/day +1 Hours montelukast 4 mg, Chew tab, PO, qpm, Routine (DEF)* 4 mg, Granule, PO, qpm, Routine 5 mg, Chew tab, PO, qpm, Routine 10 mg, Tab, PO, qpm, Routine Steroids +1 Hours prednisone 1 mg/kg, Tab, PO, bid, Routine, Max dose = 60 mg/day +1 Hours prednisolone 1 mg/kg, Liq, PO, bid, Routine, Max dose = 60 mg/day, (1 ml = 3 mg) +1 Hours methylprednisolone 1 mg/kg, Ped Injectable, IV Piggyback, q12h, Routine, To be used if patient can not tolerate oral medication Comments: Max daily dose = 80 mg/day +1 Hours dexamethasone 0.6 mg/kg, Ped Injectable, IV Push, once, STAT, Max dose= 16 mg (DEF)* 0.6 mg/kg, Ped Injectable, IM, once, STAT, Max dose = 16 mg 0.6 mg/kg, Tab, PO, once, STAT, Max dose = 16 mg Bronchodilators +1 Hours albuterol (MDI) puff, MDI, INH, q2h, Routine, (1 puff = 90 mcg) (DEF)* Page 3 of 5
4 puff, MDI, INH, q4h, Routine, (1 puff = 90 mcg) Inhaled Corticosteroids budesonide DPI indicated for patients equal to or greater than 6 years of age(note)* +1 Hours budesonide flexhaler 90 mcg, MDI, INH, bid, Routine, ( 90 mcg = 1 puff ) (DEF)* 180 mcg, MDI, INH, bid, Routine, (180 mcg = 1 puff) budesonide Low dose: 0.5 mg/day Medium dose: 1 mg/day High dose: 2 mg/day(note)* +1 Hours budesonide 0.25 mg, Inh Soln, NEB, bid, Routine, (2 ml = 0.25 mg) (DEF)* 0.5 mg, Inh Soln, NEB, bid, Routine, (2 ml = 0.5 mg) 1 mg, Inh Soln, NEB, bid, Routine, (4 ml = 1 mg) Consider steroid inhaler for children greater than 2 years Low dose: 88 to 176 mcg/day Med dose: 176 to 440 mcg/day High dose: greater than 440 mcg/day(note)* +1 Hours fluticasone CFC free 44 mcg/inh inhalation aerosol 44 mcg, MDI, INH, bid, Routine, (1 puff = 44 mcg) +1 Hours fluticasone CFC free 110 mcg/inh inhalation aerosol 110 mcg, MDI, INH, bid, Routine, (1 puff = 110 mcg) +1 Hours fluticasone CFC free 220 mcg/inh inhalation aerosol 220 mcg, MDI, INH, bid, Routine, (1 puff = 220 mcg) +1 Hours beclomethasone 40 mcg/inh inhalation aerosol 40 mcg, MDI, INH, bid, Routine, (1 puff = 40mcg) +1 Hours beclomethasone 80 mcg/inh inhalation aerosol 80 mcg, MDI, INH, bid, Routine, (1 puff = 80mcg) Consider combination therapy, ICS plus LABA for children 5 years of age and greater who are not well controlled on inhaled steroid alone.(note)* +1 Hours Advair HFA 45 mcg-21 mcg/inh inhalation aerosol puff, MDI, INH, bid, Routine, (1 puff = 45 mcg fluticasone/21 mcg salmeterol) +1 Hours Advair HFA 115 mcg-21 mcg/inh inhalation aerosol puff, MDI, INH, bid, Routine, (1 puff = 115 mcg fluticasone/21mcg salmeterol) +1 Hours Advair HFA 230 mcg-21 mcg/inh inhalation aerosol puff, MDI, INH, bid, Routine, (1 puff = 230 mcg fluticasone/21mcg salmeterol) +1 Hours budesonide-formoterol 80 mcg-4.5 mcg/inh inhalation aerosol puff, MDI, INH, bid, Routine, (1 puff = 80mcg budesonide/4.5 mcg formoterol) +1 Hours budesonide-formoterol 160 mcg-4.5 mcg/inh inhalation aerosol puff, MDI, INH, bid, Routine, (1 puff = 160mcg budesonide/ 4.5 mcg formoterol) Page 4 of 5
5 Consults/Notifications/Referrals Notify Resident-Continuing, increasing respiratory distress, decreased O2 sats less than 90%, respiratory rate greater than 65, apnea, temperature greater than 38.5 degrees Celsius, cardiac arrhythmia Medical Social Work Consult, Routine, Reason: Assistance at Discharge CHAMP Referral, Add Qualifiers for Program. Date Time Physician s Signature MD Number *Report Legend: DEF - This order sentence is the default for the selected order GOAL - This component is a goal IND - This component is an indicator INT - This component is an intervention IVS - This component is an IV Set NOTE - This component is a note Rx - This component is a prescription SUB - This component is a sub phase, see separate sheet R-Required order Page 5 of 5
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 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 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 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 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 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 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 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 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: 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: 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
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: 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,
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
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 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
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
Physician Orders ADULT: Kidney-Panc/PancTransplant Post Op Plan
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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
Physician Orders PEDIATRIC: : LEB ED Trauma (Major) Plan
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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. 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
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: PCI Post Procedure Plan
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Physician Orders PEDIATRIC: LEB ED Hx of DKA with Hyperglycemia Plan
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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
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.
![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: Ortho Total Joint Plan
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Physician Orders ADULT: ANES Enhanced Recovery After Surgery (ERAS) Plan
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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,
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 ADULT: Vascular Surgery AAA Endovascular Post Op Plan
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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
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AT TRIAGE. Alberta Acute Childhood Asthma Pathway: Evidence based* recommendations For Emergency / Urgent Care
1 1 Should the child be placed into the Pathway? Asthma Clinical Score (PRAM) Inclusion Children 1 year and 18 years of age who present with wheezing and respiratory distress, and have been diagnosed by
*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
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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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
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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
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DRUG ALLERGIES WT: KG
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