PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
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- Hortense Reynolds
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1 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 Orders(SUB)* ***The above suphase is available at the end of the plan*** ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form*** Orthostatic Nursing Orders Pelvic Exam ED Cardiac Monitor Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley)(SUB) as a separate form*** Medications acetaminophen (Tylenol) 650 mg tab PO ED_ONCE (DEF)* 650 mg supp PR ED_ONCE ranitidine (Zantac) 50 mg inj IV PUSH ED_ONCE pantoprazole (Protonix) 40 mg inj IV PUSH ED_ONCE Al hydroxide/mg hydroxide/simethicone (Maalox Plus Extra Strength) 30 ml PO susp ED_ONCE, Clinical Instructions: GI Cocktail Substitution Comments: P&T approved substitution of Maalox Plus Extra Strength for GI Cocktail Antiemetics promethazine (Phenergan) 12.5 mg inj IV PUSH ED_ONCE Comments: If the patient has an IV infusing, the promethazine should be mixed in 20 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV infusing, the promethazine should be mixed in 50 ml bag of saline and administered over 15 minutes. Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. ondansetron (Zofran) 4 mg inj IV PUSH ED_ONCE Comments: Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. ondansetron (Zofran ODT) 4 mg tab soluble SUBLING ED_ONCE Comments: Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. metoclopramide (Reglan) 10 mg inj IV PUSH ED_ONCE Page 1 of 5
2 DRUG AND TREATMENT Analgesics: Opioids hydromorphone (Dilaudid) 0.5 mg inj IV PUSH ED_ONCE (DEF)* 1 mg inj IV PUSH ED_ONCE morphine 2 mg inj IV PUSH ED_ONCE (DEF)* 4 mg inj IV PUSH ED_ONCE ketorolac (Toradol) 15 mg inj IV PUSH ED_ONCE (DEF)* 30 mg inj IV PUSH ED_ONCE 15 mg inj IM ED_ONCE 30 mg inj IM ED_ONCE 60 mg inj IM ED_ONCE IV Solutions Sodium Chloride 0.9% (Normal Saline Bolus) 1,000 ml IVPB bag ED_ONCE (DEF)* 500 ml IVPB bag ED_ONCE 250 ml IVPB bag ED_ONCE Sodium Chloride 0.9% (NS) IV bag 250 ml/hour (DEF)* IV bag 150 ml/hour IV bag 100 ml/hour ***(NOTE)***If the extra blood tubes have been ordered use the add on blood in lab order below ED Add on Blood in Lab Amylase, Specimen in Lab ***(NOTE)***If Labs or extra blood tubes have not been ordered use this subphase SUB ED Abdominal Pain Lab Orders(SUB)* ***The above subphase is available at the end of the plan*** ***(NOTE)***If the protocol lab tests have been ordered use the subphase below SUB ED Abdominal Pain Additional Labs(SUB)* ***The above suphase is available at the end of the plan*** HCG Screen Urine URINE, ED_ONCE Comments: Pregnancy Screen Urine Urine Culture URINE, CLEANCATCH, ED_ONCE (DEF)* URINE, CATHETER Comments: Females - cath if vaginal bleeding or discharge Page 2 of 5
3 DRUG AND TREATMENT GC CH Screen by PCR ED_ONCE Radiology XR Abd 2 view with Chest Abdominal Pain, Pending Discharge - No, ED_ONCE, Obstructive Series CT ABD w/ Contrast CT ABD Limited w/o Contrast CT ABD Limited w/ Contrast CT ABD w/o Contrast CT ABD w/wo Contrast CT Abd/Chest w/o Contrast CT Abd/Pelvis w/o Con CT Abd/Pelvis w/con CT Renal w/ Contrast CT Renal w/o Contrast CT Renal w/wo Contrast CT Renal/Pel w/o Con US Abdomen Limited Abdominal Pain, Pending Discharge - No, ED_ONCE US Abdomen Complete Abdominal Pain, Pending Discharge - No, ED_ONCE US Pelvis (Non-Obstetric) Limited OB Us Comments: If unable to view ovarian flow, perform US Transvaginal if needed US Transvaginal Page 3 of 5
4 DRUG AND TREATMENT SUB ED Abdominal Pain Protocol Q2H, 1 day Diet NPO ED Nursing Orders Initiate Protocol SUB ED Abdominal Pain Protocol ***(NOTE)***ED Urine Pregnancy POC for females of child-bearing age and capacity ED Urine Pregnancy POC ED_ONCE Start IV/INT ED Notify Provider Temperature > 101.5, Temperature < 98, HR > 110, HR < 60, SBP > 180, SBP < 90, RR > 20, RR < 8, SpO2 < 94 Urinalysis with Microscopic URINE, ED_ONCE Comments: Females-cath if vaginal bleeding or discharge. Obtain urines within 1 hour of arrival Respiratory Pulse Oximetry (Continuous) Special Instructions: If oxygen saturation less than 94%, initiate O2 Therapy order, 1, day Comments: Q8H sensor site must be inspected. IF circulatory condition or skin integrity has changed, the sensor should be applied to a different site. O2 Therapy. Nasal Cannula, 2, Titrate to maintain oxygen saturation equal to or greater than 94% SUB ED Abdominal Pain Protocol Lab Order Complete Blood Count Basic Metabolic Panel Liver Profile Amylase Level Page 4 of 5
5 DRUG AND TREATMENT SUB ED Abdominal Pain Lab Orders Complete Blood Count Basic Metabolic Panel Liver Profile Amylase Level CMP Cardiac Enzymes Creatine Kinase Total STAT, Creatine Kinase MB STAT, Troponin STAT, SUB ED Abdominal Pain Additional Labs CMP Cardiac Enzymes Creatine Kinase Total STAT, Creatine Kinase MB STAT, Troponin STAT, Page 5 of 5
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***
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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
More informationALL 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
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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.
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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
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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
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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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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
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DRUG AND TREATMENT Diet Diet NPO After Midnight NPO except for meds with sip of water NPO NPO except for meds with sip of water Diet Message Clear liquids until 0800 if surgery after 1400 (except for CV
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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
More informationDOWNTIME 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
More informationInitials * Page 1 of 6. (place patient label here) Patient Name: Diagnosis: Allergies with reaction type:
Patient Name: Diagnosis: Allergies with reaction type: Orthopedic Upper Ext Post Op Version 3 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro General Medical
More informationAttach 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
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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,
More informationINPATIENT 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
More informationGENERAL 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
More informationPhysician 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
More informationUMC Health System Patient Label Here PHYSICIAN ORDERS
Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards q12h q12h, Temperature Only - Every Shift and PRN Patient Activity Assist as Needed, Bed Position: As Tolerated, elevate to patient
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GENERAL UROLOGY PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Strict Intake and Output Per Unit Standards q4h q12h Patient Activity Assist as Needed Up in Chair,
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- 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
More informationGENERAL 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
More information(30689) PROT Pain PCA Adult Patient Controlled Analgesia
Diagnosis Allergies Nursing Assess and Document PCA: 1. Assess and document pain rating, sedation level and respiratory rate every 2 hours; assess and document pain rating, sedation level and respiratory
More informationDiagnosis: 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
More informationPHYSICIAN 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
More informationST. DOMINIC-JACKSON MEMORIAL HOSPITAL JACKSON, MISSISSIPPI
Date & Time Post-Op Inpatient General Orthopedic Page 1 of 5 Pharmacy Mnemonic: POIGOP1 1. Admit as inpatient to Dr. 2.Diagnosis: 3.Admit to PACU and then to floor ICU 4.Radiology: AP Pelvis in PACU AP
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