PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
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- Jodie Lindsey
- 6 years ago
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1 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, Level of Care: Med/Surg with Telemetry (3) Patient Status: Inpatient, Level of Care: Progressive Care (4) Patient Status: Inpatient, Level of Care: Intensive Care (8) Place in Observation MED Adult Resuscitation Code Status(SUB)* ***Reminder: Order MED Adult Resuscitation Code Status (SUB) as a separate form*** Vital Signs Vital Signs Q4H (DEF)* Q8H Q2H Q1H Int Activity Activity Ambulate in Hall (DEF)* Bedrest with BRP Up as tolerated Bedrest Diet Diet Order Standard Renal--adult menu, FLUID RESTRICTION: 1500 ml (DEF)* 2 gm Sodium Restricted ADA Renal ADA Renal Cardiac Regular--adult menu Diabetic/ADA without HS Snack Diabetic/ADA with HS Snack Cardiac NPO NPO except for medications Nursing Orders Weigh Patient DAILY06 Page 1 of 6
2 DRUG AND TREATMENT Intake and Output Strict Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley) (SUB) as a separate form*** Condom Catheter Bladder Scan ONCE, Post void residual. Straight Cath for a residual GREATER than 250 ml Medications ***(NOTE)***Use with caution: potentially nephrotoxic agents due to acute renal failure (eg,, aminoglycosides,, IV radiocontrast, NSAIDs) Solu-Medrol 1 g iv IVPB DAILY (DEF)* Comments: Administer over 60 minutes 250 mg iv IVPB Q12H 250 mg iv IVPB Q6H 250 mg iv IVPB Q8H 250 mg iv IVPB DAILY 500 mg iv IVPB Q12H 500 mg iv IVPB Q6H 500 mg iv IVPB Q8H 500 mg iv IVPB DAILY furosemide (Lasix) 80 mg inj IV PUSH DAILY (DEF)* 40 mg inj IV PUSH DAILY 80 mg inj IV PUSH BID 40 mg inj IV PUSH BID bumetanide (Bumex) 2 mg inj IV PUSH DAILY (DEF)* 2 mg inj IV PUSH Q8H 2 mg inj IV PUSH Q12H 1 mg inj IV PUSH DAILY 1 mg inj IV PUSH Q8H 1 mg inj IV PUSH Q12H Page 2 of 6
3 DRUG AND TREATMENT sodium polystyrene sulfonate (Kalexate) 15 g susp PO Q4H, Duration: 2 dose (DEF)* Comments: times one, repeat in 4 hours times 1 30 g susp PO Q4H, Duration: 2 dose Comments: times one, repeat in 4 hours times 1 60 g susp PR Q4H, Duration: 2 dose Comments: times one, repeat in 4 hours times 1 IV Solutions Dextrose 5% in Water IV bag 100 ml/hour (DEF)* IV bag 75 ml/hour IV bag 125 ml/hour IV bag 150 ml/hour IV bag 200 ml/hour IV bag 250 ml/hour Sodium Chloride 0.9% IV bag 100 ml/hour (DEF)* IV bag 75 ml/hour IV bag 125 ml/hour IV bag 150 ml/hour IV bag 200 ml/hour IV bag 250 ml/hour Sodium Chloride 0.45% (1/2 NS) IV bag 75 ml/hour (DEF)* IV bag 100 ml/hour IV bag 125 ml/hour IV bag 150 ml/hour IV bag 200 ml/hour IV bag 250 ml/hour Laboratory CHEM 7 Renal Function Panel CMP CBC with Differential. Magnesium Level Phosphorus Page 3 of 6
4 DRUG AND TREATMENT Liver Profile Antineutrophil Cytoplasmic AB Anti Glomerular Base Membrane Routine, Blood Anti-Streptolysin O Routine, Blood ANA Screen ANA Screen w/reflex ANA COMR Anti DNA Doublestranded C3 Complement C4 Complement Renal Profile Comments: (Albumin and Phosphorus) Anti GBM Antibodies GEN Hepatitis Screening(SUB)* ***Reminder: Order GEN Hepatitis Screening (SUB) as a separate form*** Misc Reference Lab Test Routine, Cryoglobulin, ONCE RPR Adult GEN HIV Screening(SUB)* ***Reminder: Order GEN HIV Screening (SUB) as a separate form*** Immunofixation Serum Immunofixation Urine Hgb A1C Routine, Blood Urinalysis with Microscopic Urine Random Eosinophil Urine Random Na Page 4 of 6
5 DRUG AND TREATMENT Urine Random K Urine Random Chloride Urine Random Creatinine Urine Random Osmolality Urine Random Protein Urine Random Microalbumin Urine 24 Hr Microalbumin Urine 24 Hr Protein Urine 24 Hr Creatinine Urine 24 Hr Creat Clear Fibrinogen Level PT INR PTT ESR Blood Culture Timed Study, BLOOD - PERIPHERAL, Q15MINS Int, 2 times (DEF)* Comments: 2 sets Timed Study, BLOOD - LINE, Q15MINS Int, 2 times Comments: 2 sets Radiology US Retroperitoneal Complete Acute Renal Failure, Routine, Pending Discharge - No CXR *2 view PA and LAT Routine, Pending Discharge - No XP Chest Routine, Pending Discharge - No Respiratory ABG/VBG Notification Routine Page 5 of 6
6 DRUG AND TREATMENT Oxygen Therapy. Nasal Cannula, 2, Liter Pulse Oximetry (Continuous) Special Instructions: Routine Comments: Q8H sensor site must be inspected. IF circulatory condition or skin integrity has changed, the sensor should be applied to a different site. Cardiology ECG Standard Consults Social Work Consult Routine, Physician ordered, Nephrology, Acute Renal Failure Consult Dietitian Physician ordered, Renal diet. Consult Physician Nephrology, Acute Renal Failure Page 6 of 6
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 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***
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
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
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 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
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
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
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
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: 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
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,
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
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
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
CBC with Differential. PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Non Categorized SUB ED Snakebite Protocol (SUB)* Non Categorized ***(NOTE)*** This plan is designed to be used as part of a larger plan, not independently. Please do NOT order individually.
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
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available ONLY at: BMC-A BMC-B BMC-C BMC-D BMC-N BMC-S BMC-T Non Categorized SUB (SUB)* SUB Alert Protocol(SUB)* SUB Alert Protocol Lab Tests(SUB)* Quality Measure Sepsis Bundle Nursing
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available ONLY at: BMC-B BMC-D BMC-N BMC-S Non Categorized Quality Measure Sepsis Bundle Admit to Inpatient Patient Status: Inpatient, Level of Care: Intensive Care (8), Diagnosis: Please
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
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 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 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
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:
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
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 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 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
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
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
Level 1: Acute CHF with Hypotension (SBP < 90 torr)
PENNSYLVANIA HOSPITAL ED ACUTE CONGESTIVE HEART FAILURE STANDING DERS Level 1: Acute CHF with Hypotension (SBP < 90 torr) Intake: Vital signs Pulse oximetry Weight Allergies: Obtain old chart Obtain old
*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 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
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
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
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)
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
PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available at: BMC-A BMC-B BMC-C BMC-D BMC-N BMC-S BMC-T BMC-W PACE Nursing Orders Patient Education Instruct patient to bring corresponding films to surgery (e.g. back films for back surgery, brain films
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
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
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
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 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
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
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
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
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,
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
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)*
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
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 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
DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Available at ALL facilities Condition/Status Place in Outpatient to a Bed Status Requested Location: PCU H3S (DEF)* Requested Location: CCU - Heart Hospital Requested Location: Heart
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
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
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
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 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
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Bedrest STRICT Bedrest Up to
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN
OB/GYN POSTPARTUM VAGINAL DELIVERY PLAN PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Discharge Anticipated in 24 Hour (Patient Discharge Anticipated in 24 Hours) Patient
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
(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
Pediatric Outpatient Surgery Plan - Diagnostic/Pre-Op Orders
Pediatric Outpatient Surgery Plan - Diagnostic/Pre-Op Orders Diagnosis Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Request for Outpatient Services Location: Outpatient Surgery Communication Misc
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. 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
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:
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 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 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 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
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
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.
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
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
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: 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 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
OB/GYN ANTEPARTUM PLAN
OB/GYN ANTEPARTUM PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Bedrest STRICT Bedrest Up to Bedside Commode Only
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
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
***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
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
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
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:
EFFECTIVE DATE: 01/2007 REVISED: 07/2008, 6/11, 3/12, 8/12, 1/15. Purpose:
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