PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

Transcription

1 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 for brain surgery) Communication Order Initiate ANES Anesthesia Pre-Op Phase Patient Education Instruct patient to bring home CPAP unit Patient Education Pre op. Provide patient with incentive spirometry teaching with return demonstration ***NOTE*** Select the "Transfuse Blood Previously on Hold" order below, to transfuse blood on hold Transfuse Blood Previously on Hold Laboratory GEN Pre-Operative Labs(SUB)* ***Reminder: Order GEN Pre-Operative Labs (SUB) on a separate form.*** Type and Screen Blood ***NOTE*** If wanting to place specific blood products on Hold, select the GEN Blood Administration subphase and select your products with a Transfusion Priority of Hold GEN Blood Administration(SUB)* ***Reminder: Order GEN Blood Administration on a separate form.*** Radiology ***NOTE*** If not done in previous six months at Baptist Health XR Chest *2 view PA and LAT Craniotomy, Pre-op, ONCE Cardiology ***NOTE*** If not done in previous six months at Baptist Health EKG Standard Pre-op, ONCE, Craniotomy Pre-Op Non Categorized Surgical Care Quality Measures Nursing Orders Communication Order Initiate ANES Anesthesia Pre Op Phase Page 1 of 16

2 Sequential Compression Device Bilateral knee high SCDs applied in holding (DEF)* Bilateral thigh high SCDs applied in holding Reason Surgical Care VTE Mechanical Prophylaxis Not Ordered Patient Education Routine. Patient to use home CPAP unit. Confirm that machine has been checked by respiratory department. Patient Education Pre op. Incentive Spirometry teaching with return demonstration Communication Order Verify ALL antibiotics have been given LESS than 60 minutes prior to start of surgery. Communication Order If patient is on beta blocker prior to surgery, give morning (AM) dose day of surgery or document reason for holding and notify physician. ***NOTE*** Select the "Transfuse Blood Previously on Hold" order below, to transfuse blood on hold Transfuse Blood Previously on Hold Medications ***NOTE*** Antibiotics TO BE GIVEN IN SURGICAL HOLDING LESS than 60 minutes prior to the start of surgery(note)* ***NOTE*** Patient weight LESS THAN 80 kg cefazolin (Ancef) 1 g bag IVPB PRE-OP, Duration: 1 dose Comments: *** If the patient is LESS Than 80 kg *** Infuse over 30 minutes. TO BE ADMINISTERED IN Operating Room - SEND WITH PATIENT ***NOTE*** Patient weight is between 80 kg and 120 kg cefazolin (Ancef) 2 g bag IVPB PRE-OP, Duration: 1 dose Comments: *** If the patient is between 80 kg and 120 kg *** Infuse over 30 minutes. TO BE ADMINISTERED IN Operating Room-SEND WITH PATIENT ***NOTE*** Patient weight GREATER THAN 120 kg cefazolin (Ancef) 3 g bag IVPB PRE-OP, Duration: 1 dose Comments: *** If the patient is GREATER than 120 kg *** Infuse over 30 minutes. TO BE ADMINISTERED IN Operating Room-SEND WITH PATIENT ***NOTE*** IF ALLERGIC TO PENICILLIN OR IF PATIENT IS HAVING A VP SHUNT GIVE: Reason for Vancomycin Use ***NOTE*** Patient weight LESS than 100 kg vancomycin 1 g bag IVPB ONCE Comments: If patient weight is LESS THAN 100 kg. Infuse over 60 minutes. To be administered in OR. ***NOTE*** Patient weight GREATER than or EQUAL TO 100 kg vancomycin 1.5 g bag IVPB ONCE Comments: If patient weight is GREATER THAN or EQUAL to 100 kg. Infuse over 90 minutes. To be administered in OR. Page 2 of 16

3 fosphenytoin 1,000 PE bag IVPB PRE-OP levetiracetam (Keppra) 1,000 mg iv IVPB ONCE, Clinical Instructions: pre-op Comments: pre-op dexamethasone (Decadron) 10 mg inj IV PUSH ONCE, Clinical Instructions: pre-op Comments: pre-op hydrocortisone 100 mg inj IV PUSH ONCE, Clinical Instructions: Pre-op Comments: pre-op Laboratory GEN Pre-Operative Labs(SUB)* ***Reminder: Order GEN Pre-Operative Lavs (SUB) on a separate form.*** Type and Screen Blood ***NOTE*** If wanting to place specific blood products on Hold, select the GEN Blood Administration subphase and select your products with a Transfusion Priority of Hold GEN Blood Administration(SUB)* ***Reminder: Order GEN Blood Administration (SUB) on a separate form.*** Radiology ***NOTE*** If not done in previous six months at Baptist Health XR Chest *2 view PA and LAT Craniotomy, Pre-op, ONCE Cardiology ***NOTE*** If not done in previous six months at Baptist Health EKG Standard Pre-op, ONCE, Craniotomy Intra-Op Nursing Orders Communication Order Extra Small Infuse Bone Graft Kit to sterile field (DEF)* Small Infuse Bone Graft Kit to sterile field Medium Infuse Bone Graft Kit to sterile field Large Infuse Bone Graft Kit to sterile field Sequential Compression Device Bilateral Thigh high at 40 mmhg (DEF)* Bilateral Knee high at 40 mmhg Reason Surgical Care VTE Mechanical Prophylaxis Not Ordered Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley) (SUB) on a separate form.*** Page 3 of 16

4 Medications Local Anesthetic Agents Marcaine 0.25%-Epinephrine 1:200,000 MDV inj 50 ml IRRIGATE PERIOP_ONCE Comments: For intraoperative local injection Xylocaine 1%-epinephrine 1:100,000 MDV inj 50 ml INFILTRATE PERIOP_ONCE Marcaine 0.25%-Epinephrine 1:200,000 MDV inj 50 ml IRRIGATE PERIOP_ONCE Irrigants Vancomycin 1g/Normal Saline 500 ml 500 ml IRRIGATE PERIOP_ONCE Bacitracin 50,000 units/normal Saline 500mL 500 ml IRRIGATE PERIOP_ONCE Hemostatic Agents Surgicel 1 unit TOPICAL PERIOP_ONCE Comments: To sterile field for hemostasis Avitene Ultrafoam 1 dose TOPICAL PERIOP_ONCE Comments: 100cm2 to sterile field Avitene Non-Woven Web 1 each TOPICAL PERIOP_ONCE thrombin topical 5000 u powder for reconstitu 1 dose TOPICAL PERIOP_ONCE Comments: To Sterile Field Surgifoam (Large) 1 dose TOPICAL PERIOP_ONCE Surgifoam (Small) 1 dose TOPICAL PERIOP_ONCE Miscellaneous Intra-Op Medications Bacitracin Topical Ointment 1 dose TOPICAL PERIOP_ONCE Comments: To sterile field Mannitol 20% Iso-Osmotic Solution 500 ml IV PERIOP_ONCE Intra-Op Medication (Strength Medication) Depo-Medrol Acetate 40mg TOPICAL PERIOP_ONCE Comments: For Inflammation Intra-Op Medication (Strength Medication) Cerebyx 250 mg IV PERIOP_ONCE Comments: Administer over 30 minutes prior to surgery for prevention of seizures Intra-Op Medication (Strength Medication) Decadron 4 mg IV PERIOP_ONCE Page 4 of 16

5 Intra-Op Medication (Strength Medication) Triamcinolone 40mg/mL 40 mg PERIOP_ONCE Anticoagulants Heparin 1000 units/ml 2500 units MISC PERIOP_ONCE Comments: Mix 2500 units(2.5 ml) heparin with 10 ml of injectable normal saline to sterile field for Healos bone graft Contrast Media Ionic Contrast Media (Conray) IV PERIOP_ONCE Comments: To Sterile Field Post-Op Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Intensive Care (8), Requested Location: Neuro ICU Place in Observation Patient Status: Outpatient- Refer for Observation Status, 23 hour observation Day stay Transfer Patient Level of Care (WCH and Downtown) Vital Signs Vital Signs Q15MINS Int, 4 times, then Q30mins x 4 then Q1h x 2 then Q2hrs for reminder of 24 hours (19 hours ) (DEF)* Q1H Int, Every hour x 24 hours, then Q2H Neuro Checks Q1H Int, 24 hour +24 Hours Neuro Checks Q2H Activity Activity Bedrest (DEF)* Up with assistance Elevate Head of Bed 30 Degrees (DEF)* 45 Degrees Head of Bed Flat Diet NPO No exceptions, Until fully awake, then advance diet as tolerated Nursing Orders Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley) (SUB) on a separate form.*** Intake and Output Strict Seizure Precaution Monitoring Page 5 of 16

6 Sequential Compression Device Knee high bilateral (DEF)* Thigh high bilateral Reason Surgical Care VTE Mechanical Prophylaxis Not Ordered Blood Glucose Monitor POC Q4H GEN Correction Insulin (Sliding Scale)(SUB)* ***Reminder: Order GEN Correction Insulin (Sliding Scale) (SUB) on a separate form.*** Arterial Blood Pressure (ABP) Central Venous Pressure (CVP) Monitor and Palpation of Bypass Graft Site T;N, Q15MINS Int, 4, times, Extracranial to Intracranial bypass graft; Q15mins x 4 then Q30mins x 4 then Q1h x 2 then Q2 for reminder of 24 hours (19 hours ). If unable to palpate, Doppler bypass graft. If unable to palpate or Doppler, notify Neurosurgeon Intra Cranial Pressure Monitoring Q1H, Additional Instructions: Notify if is greater than or equal to 20 cm/h2o. If sustained GREATER than 10 minutes, notify neurosurgeon (DEF)* Q1H, Additional Instructions: Notify if is greater than or equal to 20 mmhg. If sustained GREATER than 10 minutes, notify neurosurgeon EV/Lumbar Drain Care EV/LD Drain Type: External Ventricular Drain, Zero Point: External Auditory Canal, Drip Chamber Height: 15, Above/Below Zero Point: cmh2o above Zero Point, Pressure Monitor Scale: cm/h20, Special Instructions: Monitor ventriculostomy continuously; open an (DEF)* EV/LD Drain Type: External Ventricular Drain, Zero Point: External Auditory Canal, Drip Chamber Height: 10, Above/Below Zero Point: cmh2o above Zero Point, Pressure Monitor Scale: cm/h20, Special Instructions: Monitor ventriculostomy continuously; open an EV/LD Drain Type: External Ventricular Drain, Zero Point: External Auditory Canal, Drip Chamber Height: 20, Above/Below Zero Point: cmh2o above Zero Point, Pressure Monitor Scale: cm/h20, Special Instructions: Monitor ventriculostomy continuously; open an EV/LD Drain Type: External Ventricular Drain, Zero Point: Tragus, Drip Chamber Height: 15, Above/Below Zero Point: mmhg above Zero Point, Pressure Monitor Scale: mmhg, Special Instructions: Monitor ventriculostomy continuously; open and drain less than or EV/LD Drain Type: External Ventricular Drain, Zero Point: Tragus, Drip Chamber Height: 10, Above/Below Zero Point: mmhg above Zero Point, Pressure Monitor Scale: mmhg, Special Instructions: Monitor ventriculostomy continuously; open and drain less than or EV/LD Drain Type: External Ventricular Drain, Zero Point: Tragus, Drip Chamber Height: 20, Above/Below Zero Point: mmhg above Zero Point, Pressure Monitor Scale: mmhg, Special Instructions: Monitor ventriculostomy continuously; open and drain less than or Convert IV to INT when patient taking GREATER than 500 ml PO per 8 hours Notify Provider Vital Signs/Urine Output Temperature > 101 degrees, Temperature < 96.8 degrees, HR > 120, HR < 60, SBP > 160, SBP < 80, DBP > 100, DBP < 60, RR > 28, RR < 8, SpO2 < 92, Urine output > 200 ml/hour x 2 hours or 400 ml/hour x 1 hour, Urine Output < 30 ml/hour x 2 hours, Special Inst Page 6 of 16

7 Notify Provider Lab Results Sodium > 150, Sodium < 136 Reason Referral for Addictions Treatment Not Provided Medications Reason Alcohol/Substance Abuse Medication Not Prescribed Reason Tobacco Cessation Med Not Given + 24 Hours heparin (subcutaneous) 5,000 unit inj SUBCUT Q8H, Clinical Instructions: Start 24 hours post-op (DEF)* 5,000 unit inj SUBCUT Q12H, Clinical Instructions: Start 24 hours post-op Reason Surgical Care VTE Pharmacological Prophylaxis Not Ordered Maalox Plus Extra Strength 30 ml PO susp Q6H, PRN Other (see comment) (DEF)* Comments: dyspepsia 30 ml NG TUBE susp Q6H, PRN Other (see comment) Comments: dyspepsia pantoprazole (Protonix) 40 mg tab EC PO DAILY ***NOTE*** Give antibiotics for 24 hours unless any drain is present. If drain is present, continue for 24 hours after drain is removed Reason for Extending PostOp Antibiotics Past 24 Hours gentamicin 80 mg bag IVPB Q8H ***NOTE*** If patient weight LESS than or equal to 80 kg cefazolin (Ancef) 1 g bag IVPB Q8H ***NOTE*** If patient weight GREATER than 80 kg cefazolin (Ancef) 2 g bag IVPB Q8H ***NOTE*** If patient allergic to PCN or cephalosporins choose Vancomycin Reason for Vancomycin Use vancomycin 1 g bag IVPB Q12H, Clinical Instructions: Infuse over 1 hour ***NOTE*** To order both Zofran and Phenergan, choose BOTH orders below ondansetron (Zofran) 4 mg inj IV PUSH Q8H, PRN Nausea/Vomiting Comments: If not effective in 15 minutes, administer Phenergan as ordered. Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. promethazine (Phenergan) 12.5 mg inj IV PUSH Q6H, PRN Nausea/Vomiting (DEF)* Comments: ** If patient has running IV, dilute promethazine dose in 20 ml of normal saline and administer slowly over at least 3 minutes at the port furthest from the IV insertion site. If the patient does not have an IV running, dilute the promethazine in 50 ml normal saline and administer over 15 minutes **Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. Page 7 of 16

8 12.5 mg tab PO Q6H, PRN Nausea/Vomiting Comments: Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. ***NOTE*** Use Inapsine with caution if patient has cardiac conditions or QTc interval GREATER than or EQUAL to 450 msec droperidol (Inapsine) mg inj IV PUSH Q6H, PRN Nausea/Vomiting ***NOTE*** To order both Inapsine and Phenergan, choose BOTH orders below ***NOTE*** Use Inapsine with caution if patient has cardiac conditions or QTc interval GREATER than or EQUAL to 450 msec droperidol (Inapsine) mg inj IV PUSH Q6H, PRN Nausea/Vomiting Comments: If ineffective in 15 minutes, administer Phenergan promethazine (Phenergan) 12.5 mg inj IV PUSH Q6H, PRN Nausea/Vomiting (DEF)* Comments: ** If patient has running IV, dilute promethazine dose in 20 ml of normal saline and administer slowly over at least 3 minutes at the port furthest from the IV insertion site. If the patient does not have an IV running, dilute the promethazine in 50 ml normal saline and administer over 15 minutes **Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic mg tab PO Q6H, PRN Nausea/Vomiting Comments: Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. lorazepam (Ativan) 0.5 mg inj IV PUSH Q4H, PRN Other (see comment) Comments: nausea and vertigo levetiracetam (Keppra) 500 mg iv IVPB Q12H (DEF)* 500 mg tab PO Q12H 500 mg soln NG TUBE Q12H 1,000 mg tab PO Q12H dexamethasone (Decadron) 6 mg inj IV PUSH Q6H (DEF)* Comments: Slow IV push over 5 minutes 10 mg inj IV PUSH Q6H Comments: Slow IV push over 5 minutes 4 mg inj IV PUSH Q6H Comments: Slow IV push over 5 minutes phenytoin (Dilantin Kapseals) 300 mg cap PO BEDTIME fosphenytoin (Cerebyx) 100 PE inj IV PUSH Q8H phenytoin (Dilantin) 100 mg susp NG TUBE Q8H (DEF)* 100 mg susp PO Q8H Page 8 of 16

9 docusate-senna (Peri-Colace) 2 tab PO tab BID Comments: Hold for loose stools. If ineffective by POD #2, increase dose to 3 tabs BID ANES Patient Controlled Analgesia (PCA)(SUB)* ***Reminder: Order ANES Patient Controlled Analgesia (PCA) (SUB) on a separate form.*** morphine 2 mg inj IV PUSH Q1H, PRN Other (see comment), Clinical Instructions: breakthrough pain Comments: If ineffective in 15 minutes may repeat dose.use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. hydromorphone (Dilaudid) 0.5 mg inj IV PUSH Q30MINS Int, PRN Pain Severe Comments: Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. hydromorphone (Dilaudid) 0.5 mg inj IV Q1H, PRN Other (see comment) Comments: Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. hydromorphone (Dilaudid) 1 mg inj IV Q4H, PRN Other (see comment) Comments: Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. ***NOTE*** Check only one box. If more than one box is checked, order is null and void oxycodone (Roxicodone) 5 mg tab PO Q4H, PRN Pain Moderate/Severe, Clinical Instructions: Once tolerating oral route. (DEF)* Comments: If ineffective in 1 hour, may give an additional 5 mg PO. If a second dose is required in 1 hour, may begin next scheduled dose at 10 mg. Not to exceed 10 mg in a four hour period. 10 mg tab PO Q2H, PRN Pain Moderate/Severe, Clinical Instructions: Once tolerating oral route. acetaminophen-hydrocodone (Vicodin 5 mg/325 mg) 1 tab PO tab Q6H, PRN Pain Moderate Comments: If pain not relieved in 1 hour, may give additional 1 tab for a total of no more than 2 tabs every 6 hours. ***NOTE*** If allergic to codeine, give Meperidine (DEMEROL) meperidine (Demerol HCl) 50 mg tab PO Q4H, PRN Pain Moderate Comments: If pain not relieved in 1 hour, may give additional 1 tab for a total of no more than 2 tabs every 4 hours ketorolac (Toradol) 30 mg inj IV PUSH Q6H, PRN Pain Mild (DEF)* 15 mg inj IV PUSH Q6H, PRN Pain Mild acetaminophen (Tylenol) 650 mg tab PO Q4H, PRN Other (see comment) (DEF)* Comments: PRN pain mild OR temperature GREATER than 99.5 degrees Fahrenheit. 650 mg supp PR Q4H, PRN Other (see comment) Comments: PRN pain mild OR temperature GREATER than 99.5 degrees Fahrenheit. methocarbamol (Robaxin) 750 mg tab PO QID Reason Beta Blocker Not Administered Peri-Operatively Page 9 of 16

10 hydralazine (Apresoline) 10 mg inj IV PUSH Q6H, PRN Other (see comment) Comments: Systolic Blood Pressure GREATER than 160 nicardipine 50 mg / NS 250 ml pre-mix IV bag Begin at 5 mg/hour Comments: Start at 5 mg/hour and titrate by 2.5 mg/hr every 15 minutes to max dose of 15 mg/hr for systolic blood pressure GREATER than Goal labetalol (Trandate) 5 mg inj IV PUSH Q10MINS Int, PRN Other (see comment) Comments: Systolic blood pressure GREATER than 160 Administer over 2 MIN ***NOTE*** If above Labetalol (Trandate) is ineffective, give: Trandate 500 mg/100 ml IV drip (undiluted) IV bag 20 mg/hour Comments: Start at 20 mg/hour and titrate by 5mg/hour every 5 minutes until systolic blood pressure LESS than or EQUAL to 160. DO NOT EXCEED 300 MG/DAY. Hold for HR LESS than 60. Communication Order Do NOT administer Epinephrine or norepinephrine to this patient without Neuro Surgery approval IV Solutions LR IV bag 75 ml/hour (DEF)* IV bag 50 ml/hour IV bag 100 ml/hour D5NS + KCl 20 meq IV bag 75 ml/hour (DEF)* IV bag 50 ml/hour IV bag 100 ml/hour D5W IV bag 75 ml/hour (DEF)* IV bag 50 ml/hour IV bag 100 ml/hour NS IV bag 75 ml/hour SUB Hypertonic (3%) Sodium Chloride(SUB)* ***Reminder: The above subphase is available at the end of this subphase.*** Laboratory Chem 12 Early AM, Blood, ONCE CBC with Differential. Early AM, Blood, ONCE PT INR Early AM, Blood, ONCE PTT Early AM, Blood, ONCE Page 10 of 16

11 Dilantin Level Early AM, Blood, ONCE Radiology CT Head w/o Contrast Status Post Craniotomy, Stat, ONCE CT Head w/o Contrast Status Post Craniotomy, Early AM, ONCE MRI Brain w/o Contrast Stat, ONCE (DEF)* Routine, ONCE MRI Brain w/wo Contrast Stat, ONCE (DEF)* Routine, ONCE IAC MRI w/wo Contrast Stat, ONCE (DEF)* Routine, ONCE MRI Brain Pituitary w/wo contrast Stat, ONCE (DEF)* Routine, ONCE Respiratory Patient Education Provide incentive spirometry teaching with return demonstration Incentive Spirometry Routine, 10 times per hour while awake (DEF)* Routine, 4 times per hour while awake Consults Consult PT Consult OT Consult Speech Therapy Consult Social Work Discharge Planning Consult Social Work Rehab Facility Placement Consult Social Work Discharge Planning, and Rehabilitation placement Progressive Condition/Status Transfer Patient Level of Care (WCH and Downtown) Med/Surg with Telemetry (3), Requested Unit: Neuroscience Unit at WCH Transfer Patient Level of Care (WCH and Downtown) Med/Surg with Telemetry (3), Requested Unit: Neuroscience Unit at Downtown Page 11 of 16

12 Vital Signs Vital Signs Q4H Activity Activity Out of Bed to Chair, with assistance (DEF)* Up Ad Lib Bedrest Diet Diet Order Regular--adult menu (DEF)* Clear Liquid, Advance as Tolerated to Regular--adult menu Comments: Advance as Tolerated Nursing Orders Neuro Checks Q4H Seizure Precaution Monitoring Discontinue Indwelling Urinary Catheter Special Instructions: Do bladder scan if patient unable to void within 6 hours of removal of urinary catheter UNLESS other instructions are specified. If residual is GREATER than than 300 ml, contact physician for further orders. AVOID urinary catheter reinsertion if possible. Discontinue Arterial Line Discontinue Central Venous Access Device Intake and Output Q4H Sequential Compression Device Knee high, bilateral (DEF)* Thigh high, bilateral Reason Surgical Care VTE Mechanical Prophylaxis Not Ordered Blood Glucose Monitor POC Q4H Notify Provider Vital Signs/Urine Output Temperature > 101 degrees F, Temperature < 96.8 degrees F, HR > 120, HR < 55, SBP > 160, SBP < 90, DBP > 100, DBP < 60, RR > 28, RR < 10, SpO2 < 92, Urine Output < 240 ml in 8 hours, Special Instructions: Change in mental status or neuro exam Reason Referral for Addictions Treatment Not Provided Medications Reason Alcohol/Substance Abuse Medication Not Prescribed Reason Tobacco Cessation Med Not Given Reason Surgical Care VTE Pharmacological Prophylaxis Not Ordered Page 12 of 16

13 heparin (subcutaneous) 5,000 unit inj SUBCUT Q8H (DEF)* 5,000 unit inj SUBCUT Q12H Al hydroxide/mg hydroxide/simethicone (Maalox Plus Extra Strength) 15 ml PO susp Q4H, PRN Heartburn (DEF)* 15 ml NG TUBE susp Q4H, PRN Heartburn 30 ml PO susp Q4H, PRN Heartburn 30 ml NG TUBE susp Q4H, PRN Heartburn pantoprazole (Protonix) 40 mg tab EC PO DAILY GEN Correction Insulin (Sliding Scale)(SUB)* ***Reminder: Order GEN Correction Insulin (Sliding Scale) (SUB) on a separate form.*** ***NOTE*** Continue antibiotics for 24 hours after drain is removed. Reason for Extending PostOp Antibiotics Past 24 Hours gentamicin 80 mg bag IVPB Q8H cefazolin (Ancef) 1 g bag IVPB Q8H, Clinical Instructions: If patient weight LESS than or equal to 80 kg (DEF)* 2 g bag IVPB Q8H, Clinical Instructions: If patient weight GREATER than 80 kg ***NOTE*** If patient allergic to PCN OR IF HAVING VP SHUNT: Reason for Vancomycin Use vancomycin 1 g bag IVPB Q12H Comments: Infuse over 1 hour ondansetron (Zofran) 4 mg inj IV PUSH Q8H, PRN Nausea/Vomiting (DEF)* Comments: If ineffective in 30 minutes, may give Phenergan if orderedunless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. 4 mg soln PO Q8H, PRN Nausea/Vomiting Comments: If ineffective in 30 minutes, may give Phenergan if orderedunless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. promethazine (Phenergan) 12.5 mg tab PO Q6H, PRN Nausea/Vomiting (DEF)* Comments: Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. 25 mg tab PO Q6H, PRN Nausea/Vomiting Comments: Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic mg inj IV PUSH Q6H, PRN Nausea/Vomiting Comments: **If patient has running IV, dilute promethazine dose in 20mL of normal saline and administer slowly over at least 3 minutes at the port furthest from the IV insertion site. If the patient does not have an IV running, dilute the promethazine in 50 ml normal saline and administer over 15 minutes.**unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. lorazepam (Ativan) 0.5 mg inj IV PUSH Q4H, PRN Other (see comment) Comments: nausea and vertigo Page 13 of 16

14 levetiracetam (Keppra) 500 mg iv IVPB Q12H (DEF)* 500 mg tab PO Q12H 500 mg soln NG TUBE Q12H 1,000 mg tab PO Q12H SUB Decadron (Oral) Taper(SUB)* ***Reminder: Order SUB Decadron (Oral) Taper (SUB) on a separate form.*** SUB Decadron (IV) Taper(SUB)* ***Reminder: Order SUB Decadron (IV) Taper (SUB) on a separate form.*** fosphenytoin (Cerebyx) 100 PE inj IV PUSH Q8H phenytoin (Dilantin Kapseals) 300 mg cap PO BEDTIME phenytoin (Dilantin) 100 mg susp NG TUBE Q8H (DEF)* 100 mg susp PO Q8H docusate-senna (Peri-Colace) 2 tab PO tab BID Comments: Hold for loose stools. If ineffective, increase dose to 3 tabs BID. hydromorphone (Dilaudid) 0.5 mg inj IV Q30MINS Int, PRN Pain Severe oxycodone (Roxicodone) 5 mg tab PO Q4H, PRN Pain Moderate/Severe (DEF)* Comments: PRN once tolerating oral route. If ineffective in 1 hour, may give an additional 5 mg PO. If a second dose is required in 1 hour, may begin next scheduled dose at 10 mg. Not to exceed 10 mg in a four hour period. 10 mg tab PO Q2H, PRN Pain Moderate/Severe acetaminophen-oxycodone (Percocet 5 mg/325 mg) 1 tab PO Q4H, PRN Pain Moderate/Severe Comments: If pain not relieve in one hour, may give additional 1 tab for a total of no more than 2 tabs every 4 hours. acetaminophen-hydrocodone (Norco 325 mg-5 mg oral tablet) 1 tab PO Q4H, PRN Pain Moderate/Severe Comments: If pain not relieved in 1 hour, may give additional 1 tab for a total of no more than 2 tabs every 4 hours. ***NOTE***: If allergic to Codeine, choose Demerol meperidine (Demerol HCl) 50 mg tab PO Q4H, PRN Pain Moderate/Severe Comments: If pain not relieved in 1 hour, may give additional 1 tab for a total of no more than 2 tabs every 4 hours. acetaminophen (Tylenol) 650 mg tab PO Q4H, PRN Other (see comment) (DEF)* Comments: Mild pain (1-3), headache, or temp GREATER than 99.5 degrees Fahrenheit Page 14 of 16

15 650 mg supp PR Q4H, PRN Other (see comment) Comments: Mild pain (1-3), headache, or temp GREATER than 99.5 degrees Fahrenheit methocarbamol (Robaxin) 750 mg tab PO Q6H, PRN Muscle Spasms ketorolac (Toradol) 15 mg inj IV PUSH Q6H, PRN Pain Mild Clinical Instructions: if unable to tolerate PO (DEF)* 30 mg inj IV PUSH Q6H, PRN Pain Mild Clinical Instructions: if unable to tolerate PO Reason Beta Blocker Not Administered Peri-Operatively hydralazine (Apresoline) 10 mg inj IV PUSH Q6H, PRN Blood Pressure Comments: Administer if Heart Rate LESS than or equal to 80 bpm and to maintain SBP LESS than 160 mmhg; administer over 2 minutes labetalol (Trandate) 10 mg inj IV PUSH Q10MINS Int, PRN Blood Pressure Comments: Administer if Heart Rate GREATER than 80 bpm and to maintain SBP LESS than 160 mmhg; administer for 2 minutes ************************************************************************************************** SUB Hypertonic (3%) Sodium Chloride(SUB)* Available ONLY at: BMC-B BMC-D BMC-N BMC-S SUB Hypertonic (3%) Sodium Chloride Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Intensive Care (8), Hypertonic Sodium (3%) (DEF)* Patient Status: Inpatient, Level of Care: Progressive Care (4), Hypertonic Sodium (3%) Place in Observation Vital Signs Vital Signs Q1H Int (DEF)* Q4H Activity Activity Bedrest Nursing Orders Neuro Checks Q1H Int (DEF)* Q4H Page 15 of 16

16 Notify Provider Notify physician ordering Sodium Chloride 3% of any ordered changes to IV fluids or diuretics IV Solutions +3 Hours Sodium Chloride 3% 250 IV bag 50 ml/hour, Duration: 5 hour, Clinical Instructions: Total dose 250 ml (DEF)* Comments: Infuse over a maximum of 5 hours for total dose of 250 ml 150 IV bag 30 ml/hour, Duration: 5 hour, Clinical Instructions: Total dose 150 ml Comments: Infuse over a maximum of 5 hours for total dose 150 ml 200 IV bag 40 ml/hour, Duration: 5 hour, Clinical Instructions: Total dose 200 ml Comments: Infuse over a maximum of 5 hours for total dose of 200 ml 300 IV bag 60 ml/hour, Duration: 5 hour, Clinical Instructions: Total dose 300 ml Comments: Infuse over a maximum of 5 hours for total dose of 300 ml 350 IV bag 70 ml/hour, Duration: 5 hour, Clinical Instructions: Total dose 350 ml Comments: Infuse over a maximum of 5 hours for total dose of 350 ml Page 16 of 16