Attach patient label here. Physician Orders ADULT: Palliative Care Plan
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- Emily Bailey
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1 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 Inpatient T;N Admitting Physician: Reason for Visit: Bed Type: Specific Unit: Care Team: Anticipated LOS: 2 midnights or more Patient Status Initial Outpatient T;N, Attending Physician: Reason for Visit: Bed Type: Specific Unit: Outpatient Status/Service:OP OBSERVATION Notify Physician-Once T;N, of room number on arrival to unit Vital Signs T;N, Do not perform vital signs Vital Signs T;N, Routine Monitor and Record T,P,R,BP, QDay Vital Signs T;N, Routine Monitor and Record T,P,R,BP, q-shift Activity Activity As Tolerated T;N, Up As Tolerated Bedrest w/brp T;N Bedrest T;N, Routine Food/Nutrition Regular Adult Diet Start at: T;N Mechanical Soft Diet Start at: T;N Pureed Diet Start at: T;N Force Fluids T;N, Offer fluids Tube Feeding Bolus Plan(SUB)* PALL Palliative Care QM1108 PP Ver10 Rev Page 1 of 6 *111*
2 Tube Feeding Continuous/Int Plan(SUB)* Additives/Fortifiers Start at: T;N, Product: Thickening Agent (Nectar), Nectar Consistent Liquids Additives/Fortifiers Start at: T;N, Product: Thickening Agent (Honey), Honey Consistent Liquids Patient Care Code Status Central Line May Use T;N Routine Central Line Care T;N, Routine, q Wednesday. Change dressing PRN to maintain sterility Mouth Care T;N, q4h T;N, Prune juice 4 ounces QAM if no BM the previous two days. T;N, Prune juice 4 ounces QAM Enema is contraindicated if patient is thrombocytopenic (platelets less than 150,000)(NOTE)* Enema T;N, saline enema, if no BM in previous 2 days T;N, No rectal examine or medications given rectally. T;N, Hold sedative medication if respiratory rate less than 10. T;N, Peg Tube Feeding Only Continuous Infusion Sodium Chloride 0.9% 1,000 ml, IV, Routine, ml/hr Clinimix with electrolytes 1,000 ml, IV, 75 ml/hr Clinimix without electrolytes 1,000 ml, IV, 75 ml/hr B.A.D. PCA Pump for Palliative Care (IVS)* NS diluent for B.A.D. PCA Pump PCA Dose: 0 ml, min, ml, IV, Routine, Total Volume 30 diphenhydramine (additive) 150 mg, 3 ml LORazepam (additive) 4 mg, 2 ml dexamethasone (additive) PALL Palliative Care QM1108 PP Ver10 Rev Page 2 of 6 *111*
3 4 mg, 0.4 ml PCA - MorPHINE Protocol Plan (Adult)(SUB)* PCA - HYDROmorphone Protocol Plan (Adult)(SUB)* In addition to this Plan, please use the "Maximally Concentrated Adult PCA Orders - Morphine" if needed for this patient(note)* In addition to this Plan, please use the "Maximally Concentrated Adult PCA Orders - HYDROmorphone" if needed for this patient(note)* Medications Bowel Regimens +1 Hours docusate-senna 50 mg-8.6 mg oral tablet 2 tab, Tab, PO, bid, Routine +1 Hours docusate 100 mg, Cap, PO, bid, Routine +1 Hours senna 17.2 mg, Tab, PO, qam, Routine +1 Hours Milk of Magnesia 30 ml, PO, QDay, PRN Constipation, Routine Comments: per Laxative of Choice Protocol, offer first +1 Hours bisacodyl 10 mg, DR Tablet, PO, once +1 Hours bisacodyl 10 mg, DR Tablet, PO, once Enema is contraindicated if patient is thrombocytopenic (platelets less than 150,000) or if blood is present on rectal exam.(note)* +1 Hours Fleet Enema 1 bottle, Enema, PR, QDay, PRN Constipation, Routine Comments: PRN if no bowel movement the 3rd day +1 Hours polyethylene glycol g, Powder, PO, QDay, PRN Constipation, Routine, If no bowel movement by the 4th day Comments: Dissolve in 8 ounces of water. +1 Hours naloxone 0.6 mg, PO, bid, Routine Comments: Mix with OJ Medications for Mild Pain Select one below for Mild Pain(NOTE)* +1 Hours acetaminophen 650 mg, Tab, PO, q6h, PRN Pain, Mild (1-3), Routine Comments: (max: 4 grams acetaminophen in 24 hrs) +1 Hours ibuprofen 400 mg, Tab, PO, q6h, PRN Pain, Mild (1-3), Routine +1 Hours naproxen 750 mg, Tab, PO, once Medications for Moderate Pain PALL Palliative Care QM1108 PP Ver10 Rev Page 3 of 6 *111*
4 Select one below for Moderate Pain(NOTE)* +1 Hours oxycodone 5 mg, Tab, PO, q4h, PRN Pain, Moderate (4-7), Routine +1 Hours acetaminophen-hydrocodone 325 mg-5 mg oral tablet 1 tab, Tab, PO, q4h, PRN Pain, Moderate (4-7), Routine Medications for Severe Pain - Scheduled A scheduled medication should be selected for patients undergoing chronic or continual pain.(note)* +1 Hours MS Contin 15 mg, ER Tablet, PO, q12h, Routine +1 Hours OxyCONTIN 10 mg, ER Tablet, PO, q12h, Routine +1 Hours fentanyl 25 mcg/hr transdermal film, extended release 1 patch, Patch, TD, q72h +1 Hours methadone 5 mg, Tab, PO, q12h, Routine Medications for Severe Pain - PRN Select one below for Severe Pain.(NOTE)* +1 Hours morphine 15 mg, Tab, PO, q4h, PRN Pain, Severe (8-10), Routine +1 Hours morphine 20 mg, Oral Soln, PO, q4h, PRN Pain, Severe (8-10), Routine +1 Hours morphine 20 mg/ml oral concentrate 20 mg, Conc, SL, q4h, PRN Pain, Severe (8-10), Routine +1 Hours morphine 2 mg, Injection, IV Push, q2h, PRN Pain, Severe (8-10), Routine +1 Hours HYDROmorphone 2 mg, Tab, PO, q4h, PRN Pain, Severe (8-10), Routine +1 Hours HYDROmorphone 2 mg, Injection, IV Push, q2h, PRN Pain, Severe (8-10), Routine Neuropathic Pain +1 Hours nortriptyline 25 mg, Tab, PO, hs, Routine +1 Hours gabapentin 300 mg, Cap, PO, tid, Routine +1 Hours Lyrica 50 mg, Cap, PO, hs, Routine +1 Hours Cymbalta 30 mg, Cap, PO, hs, Routine Anti-Anxiety For anxiety Choose one order below:(note)* +1 Hours LORazepam 1 mg, Tab, PO, q8h, PRN Anxiety, Routine PALL Palliative Care QM1108 PP Ver10 Rev Page 4 of 6 *111*
5 +1 Hours LORazepam 1 mg, Injection, IV Push, q8h, PRN Anxiety, Routine +1 Hours ALPRAZolam 0.5 mg, Tab, PO, q8h, PRN Anxiety, Routine +1 Hours OLANZapine 5 mg, DIS Tablet, PO, QDay, PRN Anxiety, Routine +1 Hours haloperidol 5 mg, Injection, IM, q4h, PRN Agitation, Routine Anti-Emetics For nausea/vomiting choose up to ONE PO and ONE IV order below:(note)* +1 Hours promethazine 12.5 mg, Tab, PO, q4h, PRN Nausea/Vomiting, Routine +1 Hours promethazine 12.5 mg, Injection, IV Push, q4h, PRN Nausea/Vomiting, Routine, If patient unable to take PO. Comments: IV should absolutely NOT be infused into a hand or wrist vein. Dilute with normal saline to achieve a final volume of 10 mls. +1 Hours prochlorperazine 5 mg, Tab, PO, q4h, PRN Nausea/Vomiting, Routine +1 Hours prochlorperazine 5 mg, Injection, IV Push, q4h, PRN Nausea/Vomiting, Routine, If patient unable to take PO. +1 Hours ondansetron 4 mg, Orally Disintegrating Tab, PO, q6h, PRN Nausea/Vomiting +1 Hours ondansetron 4 mg, Injection, IV Push, q6h, PRN Nausea/Vomiting, Routine, If patient unable to take PO. Insomnia For insomnia choose ONE order below:(note)* +1 Hours SEROquel 25 mg, Tab, PO, hs, PRN Other, specify in Comment, Routine Comments: Insomnia/Anxiety +1 Hours temazepam 15 mg, Cap, PO, hs, PRN Insomnia, Routine Comments: may repeat x1 in 1 hour if ineffective +1 Hours zolpidem 5 mg, Tab, PO, hs, PRN Insomnia, Routine Comments: may repeat x1 in 1 hour if ineffective Other Medications dexamethasone 4 mg, Tab, PO, bid, Routine famotidine 20 mg, Tab, PO, q12h, Routine famotidine PALL Palliative Care QM1108 PP Ver10 Rev Page 5 of 6 *111*
6 20 mg, Injection, IV Push, q12h, Routine, If patient unable to take PO Maalox Advanced Maximum Strength 10 ml, Oral Susp, PO, q6h, PRN Indigestion, Routine guaifenesin 10 ml, Liq, PO, q6h, Routine guaifenesin 10 ml, Liq, PO, q6h, PRN Cough, Routine scopolamine 1.5 mg, Patch, TD, q3day, Routine glycopyrrolate 0.4 mg, Injection, Subcutaneous, q4h, PRN excess secretions, Routine Consults/Notifications/Referrals Notify Physician-Continuing T;N, If sedative medication held for respiratory rate less than 10. Consult MD Group T;N, Group: Hospice and Palliative Care xcov 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 PALL Palliative Care QM1108 PP Ver10 Rev Page 6 of 6 *111*
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: 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 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
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
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,
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 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 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
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
LYSIS OF ADHESIONS POST-OP PLAN - Phase: PACU Phase
- Phase: PACU Phase PHYSICIAN S Diagnosis Weight Allergies Communication Place Device at Bedside Confirm there are 3 x Aliquots of 0.2% Ropivacaine. 2 x Medfusion Infusion pumps. Confirm 3 x PF Aliquots
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:
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.
Physician Orders ADULT: ANES Enhanced Recovery After Surgery (ERAS) Plan
Initiate Orders Phase Non Categorized R Powerplan Open Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: Anes (ERAS) Pre-insertion Phase, When to Initiate: Other-See Special Instructions,
ENT THYROIDECTOMY/PARATHYROIDECTOMY POST OP PLAN - Phase: Begin Immediately/PACU
- Phase: Begin Immediately/PACU PHYSICIAN S Diagnosis Weight Allergies Laboratory Calcium Level STAT Outpatient/PACU, T;N PTH Intact STAT Outpatient/PACU, T;N 1 of 7 - Phase: When Patient Arrives to Room
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 Orders ADULT: PCI Post Procedure Plan
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,
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 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 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
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
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
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 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 ADULT: Vascular Surgery AAA Endovascular Post Op Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase Phase: AAA Endovascular PACU Phase, When to Initiate: Initiate Powerplan Phase Phase: Mechanically Ventilated Patients Phase,
GENERAL SURGERY POST-OP PLAN
GENERAL SURGERY POST-OP PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom
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
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
(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
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
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
morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice
PATIENT CONTROLLED ANALGESIA (PCA) PLAN Allergies: Medication Selection: morphine 30 mg/ 30 ml (1 mg/ml) Opioid of choice HYDROmorphone (Dilaudid ) 6 mg/ 30 ml (0.2 mg/ml) fentanyl 300 mcg/ 30 ml (10 mcg/ml)
UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
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
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
UMC 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
ADMIT GENERAL MEDICINE PLAN - Phase: Begin Immediately
- 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
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,
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
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)*
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COPD PLAN UMC Health System PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest
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
ORTHO TOTAL KNEE REPLACEMENT POST-OP PLAN - Phase: PACU Ortho Phase
- Phase: PACU Ortho Phase PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Patient Condition Acuity Level Floor Status Acuity Level Critical Acuity Level Intermediate
GENERAL 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
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 Orders Pediatric: LEB ED Asthma Plan
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PICU ADMIT DKA PLAN - Phase: Begin Immediately
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OB/GYN CESAREAN SECTION POST-OP PLAN - Phase: General Orders
- Phase: General Orders DETAILS Patient Care Vital Signs Per Unit Standards Patient Activity Up Ad Lib/Activity as Tolerated Assist as Needed Bedrest Bedrest Bathroom Privileges Bedrest Up to Bedside Commode
TRAUMA AND SURGICAL ICU PLAN
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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
OPEN AAA/MAJOR ABDOMINAL POST-OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Maintain Gastric Tube Maintain Nasogastric - NG, Low Intermittent Suction Maintain Nasogastric - NG, Low Constant
Physician Orders ADULT: Cardiac Surgery Post Op Plan
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
PHYSICIAN ORDERS Diagnosis
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,
A UMC Health System Performance Improvement Initiative for use in all units where cardiac/surgical patients are admitted.
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TRANSCATHETER AORTIC VALVE REPLACEMENT POST- OP PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies DETAILS Patient Care Vital Signs Per Unit Standards, q15min x 4, q30min x 2, then q1h x 4 until sheath discontinued. Per Unit Standards Perform Neurovascular
1. Attending Physician: Dr Syn Pager: Cell: Co-Morbidities:
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Admit Heart Failure Plan - Begin Immediately
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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
UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
GI BLEED PLAN UMC Health System Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Notify Provider of VS Parameters Daily Weight Patient Activity Up Ad Lib/Activity as Tolerated Assist
ADMIT STROKE NEUROINTERVENTION PLAN - Phase: Begin Immediately
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TRANSCATHETER AORTIC VALVE REPLACEMENT POST- OP ADMIT PLAN - Phase: Begin Immediately/PACU Phase
- Phase: Begin Immediately/PACU Phase PHYSICIAN S Diagnosis Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Requested Location: CICU Patient Condition Acuity Level Critical Acuity Level
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Gabapentin Research Pain Study for Ortho Total Knee Replacement Post Op Plan PACU Ortho Phase
Total Knee Replacement Post Op Plan PACU Ortho Phase PHYSICIAN S Weight Allergies DETAILS Admit/Discharge/Transfer Request Patient Bed Requested Location: 3W, Pt Status: Inpatient (LOS > 2 midnights),
NEUROSURGERY ICU PLAN
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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
PAIN. TREATMENT TABLES Analgesics. NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose
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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
ISCHEMIC STROKE/TIA PLAN
ISCHEMIC STROKE/TIA PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards, Every 15 min x 2 hrs; then every 30 min x 6 hrs; then every 1 hr x 16 hrs Perform Neurological
ADMIT CHEST PAIN PLAN - Phase: Begin Immediately
- Phase: Begin Immediately PHYSICIAN S Diagnosis Weight Allergies Admit/Discharge/Transfer Patient Status Requested Location: CICU, Pt Status: Observation (LOS < 2 midnights) Requested Location: 5E / IMCU,
Physician Orders PEDIATRIC: LEB ED Hx of DKA with Hyperglycemia Plan
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Physician Orders ADULT: Medical Response Team Standing Orders Protocol Plan
Initiate Orders Phase Care Sets/Protocols/PowerPlans Initiate Powerplan Phase When to Initiate: Other-See Special Instructions, If MRT is notified per MD, Condition H or any associate, review and Initiate
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: Routine Deceased Donor Adult Plan
Initiate Orders Phase Non Categorized NOTE: Nurse - confirm PM Discharge disposition set to "Donor and or Life Support" on hospital encounter. Enter these orders on new OP encounter created by Access/Registration
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
STROKE NEUROINTERVENTION PLAN - Phase:.
- Phase:. PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Notify Nurse (DO NOT USE FOR MEDS) Right Lower Extremity-Check peripheral pulse distal to the cath site. If
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,
CARD POST CARDIAC CATHETERIZATION PLAN
CARD POST CARDIAC CATHETERIZATION PLAN Diagnosis Weight PHYSICIAN S Allergies DETAILS Patient Care Intermittent Telemetry Continuous Telemetry (Intermediate Care) Vital Signs Per Unit Standards POC ACT
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
Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017
Patient Name: Diagnosis: Allergies with reaction type: Bariatric Surgery Post Op Day Version 2 Approved 11/13/2017 Diagnosis Preferred Location/Unit Surgical ICU Code Status: Full Code Activity Ambulate
WHS POSTOPERATIVE POWERPLAN CHANGES
Medications simplified and standardized to improve safety and effectiveness in the management of pain, itching, nausea/vomiting. Management: o The Anesthesiologist will continue to manage pain in the PACU.
SEPSIS PLAN - Phase:.
- Phase:. UMC Health System PHYSICIAN S Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards Patient Activity Bedrest Bedrest Bathroom Privileges Bedrest Up to Bedside Commode Only Up
UMC Health System Patient Label Here PHYSICIAN ORDERS
Dx Weight PHYSICIAN S Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Code Status Code Status: Full Code Code
CARD POST CARDIAC CATHETERIZATION PLAN
CARD POST CARDIAC CATHETERIZATION PLAN PHYSICIAN S Diagnosis Weight Allergies Patient Care Intermittent Telemetry Continuous Telemetry (Intermediate Care) Vital Signs Per Unit Standards POC ACT If arterial
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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
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UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis
CHEST PAIN PLAN UMC Health System 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
ISCHEMIC STROKE/TIA PLAN
ISCHEMIC STROKE/TIA PLAN PHYSICIAN S Weight Allergies DETAILS Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Code Status Code
A UMC Health System Performance Improvement Initiative for use in all units where patients with are admitted for Surgical Care Improvement Project.
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Hip Hemiarthroplasty Post Op Version 2 4/20/17
Patient Name: Diagnosis: Allergies with reaction type: Hip Hemiarthroplasty Post Op Version 2 4/20/17 Patient Placement General Diagnosis/Procedure: Preferred Location/Unit Ortho/Neuro PCU ICU General
COMMON MEDS FOR COMMON COMPLAINTS, AND VALUABLE TIPS TO KEEP INTERN YEAR GOING SMOOTHLY
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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
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
(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
ST. 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
Initials * 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
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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