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 Bedrest Bathroom Privileges Bedrest Up to Bedside Commode Only Ambulate Patient Ambulate in Room Ambulate in Hallway Strict Intake and Output Per Unit Standards Insert Urinary Catheter Foley, To: Dependent Drainage Bag Urinary Catheter Care POC Blood Sugar Check q6h 72 hr q1h 24 hr q1h, Until 2 hrs after Insulin Drip is DC d Continuous Telemetry (Intermediate Care) Intermittent Telemetry Communication Notify Provider/Primary Team of Pt Admit In AM Now Upon Arrival to Unit Dietary Oral Diet Regular Diet AHA Diet Clear Liquid Diet Full Liquid Diet ADA Diet 1800 Calories, AHA 1600 Calories, AHA 1800 Calories 1600 Calories NPO Diet NPO T;2359, NPO After Midnight T;2359, NPO After Midnight, Except Meds T;2359, NPO After Midnight, Except Ice Chips T;2359, NPO After Midnight, Except Meds, Except Ice Chips IV Solutions 1 of 20
CHEST PAIN PLAN UMC Health System PHYSICIAN S 1/2 NS IV, 75 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr D5 1/2 NS IV, 75 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr D5NS IV, 75 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr NS (Normal Saline) IV, 75 ml/hr IV, 125 ml/hr IV, 150 ml/hr IV, 200 ml/hr Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. famotidine 20 mg, PO, tab, BID 20 mg, IVPush, inj, BID morphine 2 mg, IVPush, inj, q10min, PRN chest pain Administer until pain level is less than 4/10. nitroglycerin (nitroglycerin sublingual) 0.4 mg, SL, tab, q5min, PRN chest pain, x 3 dose, for pain level 0 to 4 nitroglycerin 50 mg/250 ml D5W - Titrata (nitroglycerin 50 mg/250 ml D5W - Titratable) IV, Max dose: 200 mcg/min Final concentration = 0.2 mg/ml (200 mcg/ml). Start at rate: mcg/min enoxaparin (enoxaparin for weight 40 kg or GREATER) 1 mg/kg, subcut, syringe, q12h, Pharmacy to Adjust Dose per Renal Function 1 mg/kg, subcut, syringe, q24h, Pharmacy to Adjust Dose per Renal Function 0.75 mg/kg, subcut, syringe, q12h, Pharmacy to Adjust Dose per Renal Function 0.3 mg/kg, IVPush, syringe, ONE TIME, Pharmacy to Adjust Dose per Renal Function 30 mg, IVPush, syringe, ONE TIME, Pharmacy to Adjust Dose per Renal Function Glycoprotein IIb/IIIa Inhibitors ***Patient must be on telemetry while receiving eptifibatide (Integrilin)*** Bolus: eptifibatide 180 mcg/kg, IVPush, inj, ONE TIME, Maximum dose 22.6 mg ***Patient must be on telemetry while receiving eptifibatide (Integrelin)*** Max dose = 22.6 mg Continued on next page... 2 of 20
CHEST PAIN PLAN UMC Health System PHYSICIAN S Maintenance Infusion: eptifibatide 75 mg/100 ml IV, x 18 hr Final concentration = 0.75 mg/ml (750 mcg/ml). Maximum rate 15 mg/hour (20 ml/hr). Notify physician if administered dose (rate) is greater than the usual dose range. ***Patient must be on telemetry while receiving eptifibatide (Integrelin)*** Start at rate: mcg/kg/min Bolus: abciximab 0.25 mg/kg, IVPush, inj, ONE TIME, Infuse over 5 min Maintenance Infusion: abciximab 9 mg/250 ml NS IV, x 12 hr Give 0.25 mg/kg bolus over five minutes, followed by 0.10 mcg/min for 18-24 hours. Final concentration = 36 mcg/ml Start at rate: mcg/min 1 ea, Every Bag Anti Platelets Must be given within 24 hours of arrival per Core Measures. If not given, choose the Contraindications order below and complete Contraindications Aspirin Anticoagulant/Antiplatelet Prescribed Allergy History of GI Bleed Positive Occult Blood in Stool Other (specify below in other reason) aspirin USE FOR AMI, 81 mg, chewed, tab chew, Daily This medication must be given immediately for AMI if not given in the ER. USE FOR AMI, 325 mg, PO, tab, ONE TIME This medication must be given immediately for AMI if not given in the ER. USE FOR AMI, 325 mg, PO, tab, Daily This medication must be given immediately for AMI if not given in the ER. Loading Dose: ticagrelor 180 mg, PO, tab, ONE TIME prasugrel 60 mg, PO, tab, ONE TIME clopidogrel 300 mg, PO, tab, ONE TIME 600 mg, PO, tab, ONE TIME Maintenance Dose: 3 of 20
CHEST PAIN PLAN UMC Health System PHYSICIAN S ticagrelor 90 mg, PO, tab, BID prasugrel 10 mg, PO, tab, Daily 5 mg, PO, tab, Daily clopidogrel 75 mg, PO, tab, Daily Beta Blockers Must be given per Core Measures. If not given, choose the Contraindications Order below and complete Contraindications Beta Blocker Allergy or Sensitivity Bradycardia or Heart Block Chronic Lung Disease -- Asthma Severe Hypotension Other (specify below in other reason) metoprolol 25 mg, PO, tab, BID 50 mg, PO, tab, BID 100 mg, PO, tab, BID carvedilol 6.25 mg, PO, tab, BID Administer with breakfast and dinner. 12.5 mg, PO, tab, BID Administer with breakfast and dinner. 25 mg, PO, tab, BID Administer with breakfast and dinner. Ace Inhibitors If Ejection fraction is less than 40%, Give ACE Inhibitor or ARB per Core Measures. If ACE Inhibitor or ARB not given, choose the Contraindications Order below and complete. Contraindications ACEI or ARB Allergy to Both Allergy to One-Must Try the Other Angioedema Caused by an ACE or ARB Hyperkalemia Hypotension Moderate or Severe Aortic Stenosis Renal Artery Stenosis Worsening Renal Function Other (specify below in other reason) captopril 6.25 mg, PO, tab, TID Administer 1 hour before meals 12.5 mg, PO, tab, TID Administer 1 hour before meals 25 mg, PO, tab, TID Administer 1 hour before meals 4 of 20
CHEST PAIN PLAN UMC Health System PHYSICIAN S lisinopril 2.5 mg, PO, tab, Daily 5 mg, PO, tab, Daily 10 mg, PO, tab, Daily 20 mg, PO, tab, Daily ramipril 2.5 mg, PO, cap, Daily 5 mg, PO, cap, Daily 10 mg, PO, cap, Daily Angiotensin Receptor Blockers If ejection fraction is less than 40%, give ACE Inhibitor or ARB per Core Measures. If ACE Inhibitor or ARB not given, choose the Contraindications order below and complete. Contraindications ACEI or ARB Allergy to Both Allergy to One-Must Try the Other Angioedema Caused by an ACE or ARB Hyperkalemia Hypotension Moderate or Severe Aortic Stenosis Renal Artery Stenosis Worsening Renal Function Other (specify below in other reason) losartan 25 mg, PO, tab, Daily 50 mg, PO, tab, Daily 100 mg, PO, tab, Daily Statins Contraindications Statins Hypersensitivity Intolerance(myopathy, myalgia, myositis) Liver disease or elevated transaminases Pregnancy or breastfeeding Other atorvastatin 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly 80 mg, PO, tab, Nightly pravastatin 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly 80 mg, PO, tab, Nightly rosuvastatin 5 mg, PO, tab, Nightly 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly simvastatin 5 mg, PO, tab, Nightly 10 mg, PO, tab, Nightly 20 mg, PO, tab, Nightly 40 mg, PO, tab, Nightly 80 mg, PO, tab, Nightly Laboratory CBC with Differential Prothrombin Time with INR PTT should be ordered as baseline only and not for Heparin monitoring. PTT Basic Metabolic Panel 5 of 20
CHEST PAIN PLAN UMC Health System PHYSICIAN S Comprehensive Metabolic Panel Lipid with Calculated LDL CK Routine, T;N, q8h for 3 times Troponin T Routine, T;N, q8h for 3 times Urinalysis Diagnostic Tests DX Chest Portable EKG-12 Lead Every AM for 2 days, Perform EKG PRN for Chest Pain. Chest MUST be marked appropriately Echo Transthoracic (TTE) with contrast i (Echo Transthoracic (TTE) with contrast if needed) Respiratory Respiratory Care Plan Guidelines Oxygen Therapy Via: Nasal cannula, Keep sats greater than: 92% Continuous Pulse Oximetry For 12 hr, DC when sats consistently greater than 92% IS Instruct Consults/Referrals Consult Cardiac Rehab Cardiac Rehab for Inpatient Phase I evaluation and treatment. Arrange Outpatient Cardiac Rehab Phase II evaluation and treatment. Consult Case Management...Additional Orders 6 of 20
DISCOMFORT MED PLAN PHYSICIAN S Patient Care Perform Bladder Scan Scan PRN, If more than 250, Then: Call MD, Perform as needed for patients complaining of urinary discomfort and/or bladder distention present OR 6 hrs post Foley removal and patient has not voided. Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. benzocaine-menthol topical (Chloraseptic 6 mg-10 mg mucous membrane lozenge) 1 lozenge, mucous membrane, lozenge, q4h, PRN sore throat dextromethorphan-guaifenesin (dextromethorphan-guaifenesin 20 mg-200 mg/10 ml oral liquid) 10 ml, PO, liq, q4h, PRN cough dexamethasone-diphenhydramin-nystatin-ns (Fred s Brew) 15 ml, swish & spit, liq, q2h, PRN mucositis While awake Analgesics acetaminophen 500 mg, PO, tab, q6h, PRN pain-mild (scale 1-3) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:***** 1,000 mg, PO, tab, q4h, PRN pain-mild (scale 1-3) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:***** 650 mg, rectally, supp, q4h, PRN pain-mild (scale 1-3) ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen ineffective/contraindicated, USE ibuprofen if ordered:***** ibuprofen 400 mg, PO, tab, q6h, PRN pain-mild (scale 1-3) ***Do not exceed 3,200 mg of ibuprofen from all sources in 24 hours***. Give with food. Select either HYDROcodone-acetaminophen or acetaminophen-codeine #3, but not both HYDROcodone-acetaminophen (HYDROcodone-acetaminophen 5 mg-325 mg oral tablet) 1 tab, PO, tab, q4h, PRN pain-moderate (scale 4-7) Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours ****IF HYDROcodone-acetaminophen ineffective/contraindicated or the patient is NPO, USE ketorolac if ordered**** 2 tab, PO, tab, q4h, PRN pain-moderate (scale 4-7) Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours ****IF HYDROcodone-acetaminophen ineffective/contraindicated or the patient is NPO, USE ketorolac if ordered**** Continued on next page... 7 of 20
DISCOMFORT MED PLAN PHYSICIAN S acetaminophen-codeine (acetaminophen-codeine (Tylenol with Codeine) 300 mg-30 mg oral tablet) 1 tab, PO, tab, q4h, PRN pain-moderate (scale 4-7) Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours.***** If acetaminophen-codeine #3 ineffective/contraindicated or NPO, USE ketorolac if ordered.***** 2 tab, PO, tab, q4h, PRN pain-moderate (scale 4-7) Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours.***** If acetaminophen-codeine #3 ineffective/contraindicated or NPO, USE ketorolac if ordered.***** ketorolac 15 mg, IVPush, inj, q6h, PRN pain-moderate (scale 4-7), x 48 hr ***May give IM if no IV access*** 30 mg, IVPush, inj, q6h, PRN pain-moderate (scale 4-7), x 48 hr ***May give IM if no IV access*** morphine 2 mg, Slow IVPush, inj, q4h, PRN pain-severe (scale 8-10) *****IF morphine is ineffective/contraindicated, USE HYDROmorphone if ordered***** 4 mg, Slow IVPush, inj, q4h, PRN pain-severe (scale 8-10) *****IF morphine is ineffective/contraindicated, USE HYDROmorphone if ordered***** HYDROmorphone 0.2 mg, Slow IVPush, inj, q4h, PRN pain-severe (scale 8-10) 0.4 mg, Slow IVPush, inj, q4h, PRN pain-severe (scale 8-10) 0.6 mg, Slow IVPush, inj, q4h, PRN pain-severe (scale 8-10) Antiemetics promethazine 25 mg, PO, tab, q4h, PRN nausea/vomiting *****IF promethazine is ineffective/contraindicated or patient is NPO, USE ondansetron if ordered***** ondansetron 4 mg, IVPush, soln, q8h, PRN nausea/vomiting Gastrointestinal Agents docusate 100 mg, PO, cap, Nightly, PRN constipation *****IF docusate is contraindicated or ineffective after 12 hours, USE bisacodyl if ordered***** bisacodyl 10 mg, rectally, supp, Daily, PRN constipation *****IF bisacodyl is contraindicated or ineffective after 6 hours, USE Fleet Enema if ordered***** sodium biphosphate-sodium phosphate (Fleet Enema) 1 ea, rectally, enema, Daily, PRN constipation loperamide 4 mg, PO, cap, ONE TIME, PRN diarrhea Initial dose after first loose stool 4 mg, PO, liq, ONE TIME, PRN diarrhea Initial dose after first loose stool 8 of 20
DISCOMFORT MED PLAN PHYSICIAN S loperamide 2 mg, PO, cap, as needed, PRN diarrhea 2 mg after each loose stool, up to 16 mg per day 2 mg, PO, liq, as needed, PRN diarrhea 2 mg after each loose stool, up to 16 mg per day Antacids Al hydroxide-mg hydroxide-simethicone (aluminum hydroxide-magnesium hydroxide-simethicone 200 mg-200 mg-20 mg/5 ml oral suspension) 30 ml, PO, susp, q4h, PRN indigestion Administer 1 hour before meals and nightly. simethicone 80 mg, PO, tab chew, q4h, PRN gas 160 mg, PO, tab chew, q4h, PRN gas Sedatives ALPRAZolam 0.25 mg, PO, tab, TID, PRN anxiety *****IF ALPRAZolam is ineffective/contraindicated or patient is NPO, USE LORazepam if ordered***** LORazepam 1 mg, IVPush, inj, q6h, PRN anxiety 0.5 mg, IVPush, inj, q6h, PRN anxiety zolpidem 5 mg, PO, tab, Nightly, PRN insomnia may repeat x1 in one hour if ineffective Antihistamines diphenhydramine 25 mg, PO, cap, q4h, PRN itching *****IF diphenhydramine PO is ineffective or patient is NPO, USE diphenhydramine inj if ordered***** diphenhydramine 25 mg, IVPush, inj, q4h, PRN itching Anti-pyretics acetaminophen 500 mg, PO, tab, q4h, PRN fever ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen is ineffective/contraindicated, USE ibuprofen if ordered***** 1,000 mg, PO, tab, q4h, PRN fever ***Do not exceed 4,000 mg of acetaminophen from all sources in 24 hours*** *****IF acetaminophen is ineffective/contraindicated, USE ibuprofen if ordered***** Continued on next page... 9 of 20
DISCOMFORT MED PLAN PHYSICIAN S ibuprofen 200 mg, PO, tab, q4h, PRN fever Do not exceed 3,200 mg in 24 hours. Give with food. 400 mg, PO, tab, q4h, PRN fever Do not exceed 3,200 mg in 24 hours. Give with food. Anorectal Preparations witch hazel-glycerin topical (witch hazel-glycerin 50% topical pad) 1 app, topical, pad, as needed, PRN hemorrhoid care Wipe affected area *****IF witch hazel-glycerin ineffective/contraindicated, USE phenylephrine ointment if ordered***** phenylephrine topical (phenylephrine 0.25%-3% rectal ointment) 1 app, rectally, oint, q6h, PRN hemorrhoid care Apply to affected area *****IF phenylephrine ointment ineffective/contraindicated, USE hydrocortisone-pramoxine foam if ordered***** hydrocortisone-pramoxine topical (hydrocortisone-pramoxine 1%-1% rectal foam) 1 app, rectally, foam, q8h, PRN hemorrhoid care apply to affected area 10 of 20
HEPARIN INFUSION MED PLAN PHYSICIAN S Patient Care Heparin Infusion Guidelines ***See Reference Text*** Communication Notify Nurse (DO NOT USE FOR MEDS) Obtain Xa Heparin (Anti-Xa) Level 6 hours after starting infusion and 6 hours after every rate change. Notify Provider (Misc) Reason: 2 consecutive Xa Heparin (Anti-Xa) levels are greater than 0.9 or less than 0.2 Notify Provider (Misc) Reason: If platelet count decreases by 50% of baseline or drops below 100,000 (100 K/uL) Notify Provider (Misc) Reason: If Hemoglobin decreases by 2 g/dl or more. Notify Provider (Misc) Reason: If signs of bleeding occur. Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed..medication Management Start date T;N Discontinue all other orders for heparin products (i.e. heparin subcutaneous, enoxaparin). Venous Thromboembolic Disorder Deep Vein Thrombosis, Pulmonary Embolism heparin 80 units/kg, IVPush, inj, ONE TIME For Bolus. Recommended maximum dose is 10,000 units. heparin 25,000 units/250 ml D5W IV Initiate at rate of 18 units/kg/hr. Initial maximum rate is 18 ml/hr (1,800 units/hr). Final concentration = 100 unit/ml. Refer to heparin protocol for specific dosing instructions. Start at rate: units/kg/hr Cardiac Unstable angina, ST elevation MI, non-st elevation MI heparin 60 units/kg, IVPush, inj, ONE TIME For Bolus. Recommended maximum dose is 5,000 units, or 4,000 units for ST elevation MI with thyrombolytics. heparin 25,000 units/250 ml D5W IV Initiate at rate of 12 units/kg/hr. Initial maximum rate is 10 ml/hr (1,000 units/hr). Final concentration = 100 unit/ml. Refer to heparin protocol for specific dosing instructions. Continued on next page... 11 of 20
HEPARIN INFUSION MED PLAN PHYSICIAN S Start at rate: units/kg/hr Neurological Ischemia/strokes with a suspected embolic source in which thrombolytics have NOT been given and a CT has confirmed NO cerebral hemorrhage No intial heparin bolus recommended. heparin 25,000 units/250 ml D5W IV Initiate at rate of 12 units/kg/hr. Initial maximum rate is 12 ml/hr (1,200 units/hr). Final concentration = 100 unit/ml. Refer to heparin protocol for specific dosing instructions. Start at rate: units/kg/hr Antidote See heparin infusion guidelines reference text for dosing. protamine mg, IVPush, inj, ONE TIME, PRN Laboratory Baseline Labs CBC STAT PTT STAT Prothrombin Time with INR STAT Daily Labs CBC Next Day in AM, T+1;0300, Every AM for 3 days Therapeutic Monitoring Anti Xa Level 12 of 20
SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S Patient Care POC Blood Sugar Check Per Sliding Scale Insulin Frequency AC & HS AC & HS 3 days TID BID q12h q6h q6h 24 hr q4h q2h Sliding Scale Insulin Regular Guidelines Follow SSI Regular Reference Text Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. insulin regular (Low Dose Insulin Regular Sliding Scale) 0-10 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 0-10 units, subcut, inj, BID, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... 13 of 20
SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S 0-10 units, subcut, inj, TID, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 0-10 units, subcut, inj, q6h, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 0-10 units, subcut, inj, q4h, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... 14 of 20
SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S 0-10 units, subcut, inj, q2h, PRN glucose levels - see parameters Low Dose Insulin Regular Sliding Scale 140-180 mg/dl - 2 units subcut 181-240 mg/dl - 3 units subcut 241-300 mg/dl - 4 units subcut 301-350 mg/dl - 6 units subcut 351-400 mg/dl - 8 units subcut If blood glucose is greater than 400 mg/dl, administer 10 units subcut, notify provider, and repeat POC blood sugar check in 1 insulin regular (Moderate Dose Insulin Regular Sliding Scale) 0-12 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 0-12 units, subcut, inj, BID, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... 15 of 20
SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S 0-12 units, subcut, inj, TID, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 0-12 units, subcut, inj, q6h, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 0-12 units, subcut, inj, q4h, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... 16 of 20
SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S 0-12 units, subcut, inj, q2h, PRN glucose levels - see parameters Moderate Dose Insulin Regular Sliding Scale 140-180 mg/dl - 3 units subcut 181-240 mg/dl - 4 units subcut 241-300 mg/dl - 6 units subcut 301-350 mg/dl - 8 units subcut 351-400 mg/dl - 10 units subcut If blood glucose is greater than 400 mg/dl, administer 12 units subcut, notify provider, and repeat POC blood sugar check in 1 insulin regular (High Dose Insulin Regular Sliding Scale) 0-14 units, subcut, inj, AC & nightly, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 0-14 units, subcut, inj, BID, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... 17 of 20
SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S 0-14 units, subcut, inj, TID, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 0-14 units, subcut, inj, q6h, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 0-14 units, subcut, inj, q4h, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 Continued on next page... 18 of 20
SLIDING SCALE INSULIN REGULAR PLAN PHYSICIAN S 0-14 units, subcut, inj, q2h, PRN glucose levels - see parameters High Dose Insulin Regular Sliding Scale 140-180 mg/dl - 4 units subcut 181-240 mg/dl - 6 units subcut 241-300 mg/dl - 8 units subcut 301-350 mg/dl - 10 units subcut 351-400 mg/dl - 12 units subcut If blood glucose is greater than 400 mg/dl, administer 14 units subcut, notify provider, and repeat POC blood sugar check in 1 insulin regular (Blank Insulin Sliding Scale) See Comments, subcut, inj, PRN glucose levels - see parameters If blood glucose is less than mg/dl, initiate hypoglycemia guidelines and notify provider. 70-139 mg/dl - units 140-180 mg/dl - units subcut 181-240 mg/dl - units subcut 241-300 mg/dl - units subcut 301-350 mg/dl - units subcut 351-400 mg/dl - units subcut If blood glucose is greater than 400 mg/dl, administer units subcut, notify provider, and repeat POC blood sugar check in 1 hour. Continue to repeat units subcut and POC blood sugar checks every 1 hour until blood glucose is less than 300 mg/dl, then HYPOglycemia Guidelines HYPOglycemia Guidelines ***See Reference Text*** glucose 15 g, PO, gel, as needed, PRN glucose levels - see parameters Use if patient is symptomatic and able to swallow. See hypoglycemia guidelines. glucose (D50) 25 g, IVPush, syringe, as needed, PRN glucose levels - see parameters Use if patient is symptomatic and unable to swallow / NPO with IV access. See hypoglycemia guidelines. glucagon 1 mg, IM, inj, as needed, PRN glucose levels - see parameters Use if patient is symptomatic and unable to swallow / NPO WITHOUT IV access. See hypoglycemia guidelines. 19 of 20
VTE PROPHYLAXIS PLAN PHYSICIAN S Patient Care VTE Guidelines See Reference Text for Guidelines ***If VTE Pharmacologic Prophylaxis not given, choose the Contraindications for VTE below and complete reason contraindi cated*** Contraindications VTE Active/high risk for bleeding Treatment not indicated Patient or caregiver refused Other anticoagulant ordered Anticipated procedure within 24 hours Intolerance to all VTE chemoprophylaxis Apply Elastic Stockings Apply to: Bilateral Lower Extremities, Length: Knee High Apply to: Left Lower Extremity (LLE), Length: Knee High Apply to: Right Lower Extremity (RLE), Length: Knee High Apply to: Bilateral Lower Extremities, Length: Thigh High Apply to: Left Lower Extremity (LLE), Length: Thigh High Apply to: Right Lower Extremity (RLE), Length: Thigh High Apply Sequential Compression Device Apply to Bilateral Lower Extremities Apply to Left Lower Extremity (LLE) Apply to Right Lower Extremity (RLE) Apply Pedal Pump Apply to Bilateral Feet Apply to Left Foot Apply to Right Foot Medications Medication sentences are per dose. You will need to calculate a total daily dose if needed. ***Recommended Trauma Dose = 30 mg, subcut, q12h*** ***Recommended Dose for Morbidly Obese Patients = 40 mg, subcut, q12h*** enoxaparin (enoxaparin for weight 40 kg or GREATER) 40 mg, subcut, syringe, q24h, Pharmacy to Adjust Dose per Renal Function 30 mg, subcut, syringe, q12h, Pharmacy to Adjust Dose per Renal Function 30 mg, subcut, syringe, q24h, Pharmacy to Adjust Dose per Renal Function 40 mg, subcut, syringe, q12h, for BMI greater than 39, Pharmacy to Adjust Dose per Renal Function heparin 5,000 units, subcut, inj, q12h 5,000 units, subcut, inj, q8h fondaparinux 2.5 mg, subcut, syringe, q24h rivaroxaban 10 mg, PO, tab, In PM 20 mg, PO, tab, In PM warfarin 5 mg, PO, tab, In PM aspirin 81 mg, PO, tab chew, Daily 325 mg, PO, tab, Daily 20 of 20