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Carroll Shipley Room #1 from 3 - 4 pm 800-501-8979 Access: 6015094# and WindStream Log In

Clinician Quality/Operati Patient Care Services Informatics√ Dr. Kenneth Lee (Co-Chair) Christine Sullivan √ Mary Zell √ Kenny McHugh (Co-Chair)

Dr. Jonathan Thierman Melanie Osley Pat Moloney-Harmon Donna Marquess Natalya MakarevichAmanda Shrout Kathyrn LyleJanice Marlett Min KwonAmelia Dayucos Jacqueline Hartford

√ Lisa Hartle Daniel Fletcher

√ Dr. Sam Smith √ Nancy Brown√ Ron Mendoza √ Kristine Feller Ndubuisi Mbah

Dr. Mark Olszyk Dr. Tim Hsu Stephanie Reid Patricia Kokoski √ Steve GoyetteDr. Jed Rosen √ Dr. Kiran Kuna James Ridge Larry siegel √ Lisa Urie

Ronald SmithGretchen Stiner

✓

Action/Plan *

I.1

Dr. J Tabak

Approved

Cheryle G

3

Clare Gaetani/David N. Tuchman

4

Lisa Hartle

5

Vy Nguyen

Review New Requests: (PP= PowerPlan)

Modify OB Anesthesia: Duramorph (PP138)

Modify OB Induction of Labor (PP139) I want to make a change to PowerPlan: OB Induction of Labor. Penicillin G Potassium - there is one that has detail 2.5 mu IV as directed, but instead of "as directed", change to Q4H.Please call x24952 for any questions.

Approved

b ) Peds Ortho Post Op with PCA (PP104)2

Approved

a) PCA, Peripheral Peds/PICU (PP104) Changes in ordersets:PCA, Peripheral Peds/PICU. Remove order sentence No Oral Narcotics to be given with PCAPeds Ortho Post Op with PCA Powerplan:Under Pain Medications (Can only be ordered for patients NOT receiving PCA0.1 mg/kg, IV, Q3H, pain moderate-severe (pain score 4-10), Inj, maximum 15 mg0.1 mg/kg, IV, Q4H, pain moderate-severe (pain score 4-10), Inj, maximum 15 mgBoth of these order sentences need to include PRN

LBH Hospital PowerPlan Committee AgendaWednesday May 22, 2019

InvitedLBH/Sinai

Dr. Charles AlbrechtPharm/Lab/Rad/Nutrition

Carrol

marks indicate the presence of the Invited Participants

Agenda Topic Request Details / Meeting Notes

NW

Approved

Approved

Approved

Please create a NEW 2-step Peds GIDC PowerPlan that can be planned by a Peds GI provider in the office before procedure (step one) and then initiated/activated in GIDC (step 2) when patient arrives and Pre-admit encounter is converted to the Outpatient Admit visit. Issues of saline lock with IV fluid to be resolved offline

The PACU nurses suggested change to the post anesthesia power plan. Hydralazine should say heart rate less than 85. Currently it says greater than 85.

Request implementation of OB Anesthesia: Duramorph Vital Signs which are highlighted in the uploaded document. Continuous vs. intermittent pulse oximetry as well as VS Q4 H 20 hrs to be resolved offline.

New Peds GIDC PP (PP120)

Modify Anesthesia - PACU PowerPlan (PP107)

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Page 2 of 3

6Brian P. Broomell

7

Jim Ridge8

Jim Ridge9

Heather Greena Approvedb CV Lab 04 TEE Plus Cardioversion Pre Procedure Approvedc CV Lab 05 Cardioversion without TEE Pre Procedure Approvedd CV Lab 07 TEE without Cardioversion Pre Procedure Approvede Approvedf Approvedg Approved

10

Philip Eberhard 11

Dr. Diana Molavi

a Approved

b Approved

c Approved

d Approved

e Approved

f Approved

g Approved

h Approved

i Approved

Straight Catheterization PP / Indications

Met with Drs. Roy, Watkins, and Swenson yesterday afternoon about adding indicators for straight catheters. After reviewing the already established indicators for Foley catheters we came up with the following straight catheter reason for insertion:• Urinary obstruction/retention• Open wounds to sacral perineal area• Comfort care for the terminally ill• Need for sterile specimenUrinary obstruction/retention would be the default reason for insertion with the others as part of the dropdown.Indications drop down already in production and ~30 PP being affected will be modified accordingly.

Approved

Update NICU Medications PP (PP125) Add "NICU Hydrocortisone for ventilated patients" PP as a subphase under the "NICU Medications (Neofax)" PP

Approved

Definity contrast echo (PP128) intra-cardiac shunting contraindications no longer recommended to be confirmed and then removed.

Approved

New PowerPlan to make serial Troponins easy to appropriately order (providers are ordering STAT X 3 and this will NOT work for collection management). Built as below, the first will be collected within ½ hour or sooner. Carroll will not see the Troponin I. Levindale, NW and Sinai will not see Troponin T.

New Troponin Q3H PP (PP129)

ED Adult Abdominal Pain

ED Adult Altered Mental Status

ED Adult Chest Pain high risk track 1 - 2 DM v1

Request is made in concert with Drs. Neil Roy, Chandresh Shelat, and Diana Molavi. Northwest and Carroll ED chiefs were notified by email.

This is part of the initiative to reduce unnecessary testing. Best Practice verbiage for blood culture to be clarified

Approved

Lab Updates to all ED Adult Powerplans (PP123)

Modify CV PPs (PP131-137)

CV Lab 01 Pre Procedure Pre Cath

CV Pacemaker Insertion Pre ProcedureCV Reveal Insertion Pre ProcedureCV Reveal Removal Pre Procedure Orders

Add Saline Lock order to PowerPlan

ED Adult Chest Pain low risk track - 3 DM v1

ED Adult Community Acquired Pneumonia DM v1

ED Adult Ectopic Pregnancy - Rule Out DM v1

ED Adult Female Genitourinary DM (002) v1

ED Adult GI Bleed DM v1

ED Adult Headache DM v1

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Page 3 of 3

j Approved

k Approved

l Approved

m Approved

n Approved

o Approved

p Approved

q Approved

r Approved

s Approved

t Approved

u Approved

v ApprovedII. Next Meeting: Wednesday June 26, 2019 @ Sinai Board Room from 3-4pm* Request Status Update can be followed online by clicking on one of the two options below:

1) Physician/Provider Portal 2) Request Status Update (Old) 3) Request Status Update (New 2019)

Request is made in concert with Drs. Neil Roy, Chandresh Shelat, and Diana Molavi. Northwest and Carroll ED chiefs were notified by email.

This is part of the initiative to reduce unnecessary testing. Best Practice verbiage for blood culture to be clarified

ED Adult Heart Failure DM v1

ED Adult Lab DM v1

ED Adult Nausea Vomiting Diarrhea DM v1

ED Adult Neuro Symptoms Deficit DM v1

ED Adult Syncope and Near Syncope DM v1

ED Adult Upper Respiratory Symptoms with Fever DM v1

ED Non Surgical Spine Service DM v1

ED Suspected Sepsis DM v1

ED Adult Psych Disorder Suicide Attempt DM v1

ED Adult Renal Colic Flank Pain DM v1

ED Adult Respiratory Distress Failure DM v1

ED Adult Seizures DM v1

ED Adult Sickle Cell Crisis DM v1

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5.22.2019 PowerPlan Request Item #1 P 1 of 3

Unique Plan Description: Anesthesia - PACU Orders (CH & NW) Plan Selection Display: Anesthesia - PACU Orders (CH & NW) PlanType: Medical Version: 1 Begin Effective Date: 2/7/2018 1:18 PM End Effective Date: Current Available at: Carroll Hospital NWH Anesthesia - PACU Orders (CH & NW) Patient Care Orders

Vital Signs per Post-Op Routine T;N

NON-INPATIENT UNIT Cardiac Monitor T;N, When in patient care area

Oxygen (NW)(LSH)(CH) T;N, Routine, 3 Liters Liters, via Nasal Cannula, as indicated to maintain Oxygen Saturation >94% or

within 2% of Pre-Op baseline.

Hypothermia Blanket T;N, For Temp less than 35 degrees C

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg

Fingersticks POC T;N, Routine

Miscellaneous Physician Order (NON-Medication) T;N, While patient is in PACU, only anesthesia provider pain management orders to be followed

IV Solutions

Lactated Ringers 1,000 ml, IV, @ 50 ml/hr, Start T;N

Sodium Chloride 0.9% 1,000 ml, IV, @ 50 ml/hr, Start T;N

D5LR 1,000 ml, IV, @ 50 ml/hr, Start T;N

Medications Analgesics: Opioids

Check medications to be administered in PACU(NOTE)*

belladonna-opium 16.2 mg-30 mg rectal suppository 1 supp, rectal, ONCE, PRN, Other, see comments, Supp

Comments: PRN PELVIC DISCOMFORT

hydromorphone 0.2 mg, IV, Q5 mins, PRN, pain mild (pain score 1-3), Inj, Duration = 10 dose(s)

hydromorphone 0.5 mg, IV, Q5 mins, PRN, pain moderate (pain score 4-6), Inj, Duration = 8 dose(s)

Comments: To be given in Phase I only

fentanyl 50 mcg, IV, Q5 mins, PRN, pain severe (pain score 7-10), Inj, Duration = 2 dose(s)

Comments: To be given in Phase I only

oxycodone immediate release 5 mg, PO, ONCE, PRN, pain moderate (pain score 4-6), Tab, Before discharge

Comments: May be given in both Phase I and II

meperidine 12.5 mg, IV, Q5 mins, PRN, rigors, Inj, Duration = 2 dose(s)

Comments: For rigors only

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Analgesics: Non-Opioids

acetaminophen 1,000 mg, PO, ONCE, PRN, pain mild (pain score 1-3), Tab, Duration = 1 dose(s)

Comments: HOLD if patient has recieved any acetaminophen product For Age > 65 yrs:(NOTE)*

ketorolac 15 mg, IV, ONCE, PRN, pain moderate (pain score 4-6), Inj, Duration = 1 dose(s)

Comments: HOLD if patient has recieved any NSAID product and as long as approved by surgeon

For Age < or = 65 yrs:(NOTE)*

ketorolac 30 mg, IV, ONCE, PRN, pain moderate (pain score 4-6), Inj, Duration = 1 dose(s)

Comments: HOLD if patient has recieved any NSAID product and as long as approved by surgeon

midazolam 0.5 mg, IV, Q5 mins, PRN, agitation, Inj, Duration = 4 dose(s)

Miscellaneous PRN Medications Check medications to be administered in PACU(NOTE)*

albuterol neb 2.5mg 1 neb, inhaled, ONCE, STAT, PRN, wheezing, Neb, Treatment

atropine 0.4 mg, IV, ONCE, PRN, bradycardia (see comments), Inj

Comments: For heart rate less than 40 beats / minute ; anesthesia notified prior to administration

metoclopramide 10 mg, IV, ONCE, PRN, nausea/vomiting, Inj

Comments: If ineffective in 30 minutes give Ondansetron 4 mg IV.

ondansetron 4 mg, IV, ONCE, PRN, nausea/vomiting, Inj

Comments: If ineffective, notify Surgical PA. ephedrine / vistaril - combination linked orders:(NOTE)*

ephedrine 25 mg, IM, ONCE, PRN, nausea/vomiting (severe), Inj, max 150mg/24hrs

Comments: max 150mg/24hrs

hydrOXYzine 25 mg, IM, ONCE, PRN, nausea/vomiting (severe), Inj

metoclopramide 10 mg, IV, ONCE, STAT, PRN, nausea/vomiting, Inj

diphenhydrAMINE 25 mg, IV, ONCE, PRN, itching, Inj

ephedrine 5 mg, IV, ONCE, PRN, Other, see comments, Inj, Duration = 3 dose(s), may repeat in 5-10min prn

Comments: PRN for rapid and symptomatic hypotention, may repeat x 2 for a total of 15 mg

labetalol 5 mg, IV, Q15 mins, PRN, hypertension (see comments), Inj, Duration = 2 dose(s), MUST enter hold

parameters in order comments Comments: PRN SBP > 180 and DBP > 100 , HR > 85 May repeat x 1 in 15 minutes

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hydrALAzine 5 mg, IV, Q15 mins, PRN, hypertension (see comments), Inj, Duration = 2 dose(s)

Comments: PRN SBP > 180 and DBP > 100 , HR < 85 May repeat x 1 in 15 minutes This is a change from HR>85

Diagnostic Tests

EKG. T;N, Stat

EKG T;N, Stat

Other

Powerplan entered by Anesthesia Provider-Nurse may initiate T;N, Nurse may initiate as written/CPOE order

Discharge from PACU T;N, when discharge criteria met

Discontinue Anesthesia PACU plan on discharge from the PACU T;N

*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

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5.22.2019 PowerPlan Request Item #2a P 1 of 2

Unique Plan Description: PCA, Peripheral Peds/PICU Plan Selection Display: PCA, Peripheral Peds/PICU PlanType: Medical Version: 3 Begin Effective Date: 5/22/2018 9:59 AM End Effective Date: Current Available at: Peds Hem/Onc SHB PCA, Peripheral Peds/PICU Patient Alerts

Stop PCA T;N, If Respiratory Rate is <10 /min (15 yrs & older) or <12/min (8-14 years old) or <14/min (2-8

years old), <18/min (1-2 years old), or Patient is obtunded/unarousable, or POSS>=3

Give Narcan per order T;N, If Respiratory Rate is <10 /min (15 yrs & older) or <12/min (8-14 years old) or <14/min (2-8


Page Respiratory Therapy T;N, If Respiratory Rate is <10 /min (15 yrs & older) or <12/min (8-14 years old) or <14/min (2-8


Oxygen Therapy T;N, Non Rebreather Mask, 100 percent, PRN, If Respiratory Rate is <10 /min (15 yrs & older) or

<12/min (8-14 years old) or <14/min (2-8 years old), <18/min (1-2 years old), or Patient is obtunded/unarousable, or POSS>=3

Notify MD if If Respiratory Rate is <10 /min (15 yrs & older) or <12/min (8-14 years old) or <14/min (2-8 years

old), <18/min (1-2 years old), or Patient is obtunded/unarousable, or POSS>=3, T;N Vital Signs

Vital Signs with Pulse Oximetry T;N

End Tidal CO2 Monitoring - continuous T;N

Patient Care Orders

Cardio-Respiratory Monitoring T;N, For PCA basal rate.

Miscellaneous Nursing Order (NON-Medication) T;N, Any increase in basal rate, increased level of sedation, or respiratory depression must return to

most frequent monitoring schedule

Miscellaneous Nursing Order (NON-Medication) T;N, Monitor and record BP, pulse, RR, pulse ox and EtCo2 Q1H X 4, Q2H X 8, then Q4H until PCA

pump discontinued

Notify Notify Provider for Respiratory Rate <10 /min (15 yrs & older) or <12/min (8-14 years old) or <14/min

(2-8 years old), <18/min (1-2 years old), SPO2<95%, POSS>3, Pain Score>5 cannot be maintained, EtCO2>50 and <20

Respiratory Therapy

Oxygen T;N, setup at bedside

IV Solutions

Sodium Chloride 0.9% 1,000 ml, IV, KVO

Comments: Begin if primary IV fluid discontinued for IV PCA without basal rate; while on PCA

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Medications PCA

All breakthrough pain control while on PCA must be administed by PCA bolus versus a PRN opioid dose; narcotic medications may, however, be ordered to be given on a regularly scheduled round-the-clock basis to be administered orally or intravenously, but NOT on a PRN or as needed basis.(NOTE)* Please refer to Reference Text Information above for guidance on initial dosing recommendations per Pain Management PCA Policy and Procedure(NOTE)* Basal rates are NOT recommended for opioid naive patients(NOTE)* Removed the order below in the red box= No Oral Narcotics to be given with PCA

morphine 5mg/ml PCA syringe (IVS)* morphine 5mg/ml PCA

mg, mg, mg/hour, mg/hour, IV

hydromorphone 1mg/ml PCA syringe (IVS)* hydromorphone 1mg/ml PCA

mg, mg, mg/hour, mg/hour, IV

fentanyl 10mcg/ml PCA syringe (IVS)* fentanyl 10mcg/ml PCA

mcg, mcg, mcg/hour, mcg/hour, IV Emergency Response

naloxone 0.1 mg, IV, as directed, PRN, Other, see comments, Inj

Comments: if respiratory rate < 12 /minute for 8-14 years old, < 14/minute for 2-8 year old, < 18/minute for 1-2 year old or if POSS <or = 3, May Repeat dose every 1-2 minutes based on patient assessment for a total of 4 doses.

Bowel Management

senna 2.5 ml, PO, BID, Liq, for ages 2-5 years old (DEF)* 5 ml, PO, BID, Liq, for ages 6-12 years old 10 ml, PO, BID, Liq, for ages > 12 years old

senna 2 tab(s), PO, BID, Tab, adult dose


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5.22.2019 PowerPlan Request Item #2b P 1 of 6

Unique Plan Description: Peds Ortho Post Op, with PCA Powerplan Plan Selection Display: Peds Ortho Post Op, with PCA Powerplan PlanType: Medical Version: 1 Begin Effective Date: 5/16/2012 11:38 AM End Effective Date: 4/10/2019 10:43 AM Available at all facilities Peds Ortho Post Op, with PCA Powerplan Admit/Diagnosis

Admit T;N

Start Observation T;N, Pediatrics Non-Telemetry, Semi Private, None

Diagnosis T;N

Procedure (Patient Care) T;N

Admitting Physician. T;N

Attending Physician. T;N

Code Status

Code Status T;N, Full Resuscitation (DEF)* T;N, Do Not Resuscitate, Refer to paper DNR form.

Patient Alerts

Isolation T;N

Vital Signs

Vital Signs with Pulse Oximetry T;N, Q1H for 4 hr

Vital Signs with Pulse Oximetry T;N+240, Q2H for 8 hr

Vital Signs with Pulse Oximetry T;N+720, Q4H, PACU routine, then Q4 until PCA pump is discontinued. Any increase in basal rate

or administration of a bolus dose must return to most frequent monitoring schedule.

Notify Provider for VS's of: T;N

Neuro Checks T;N, Q4H for 24 hr

Neuro Checks T+1;N, Q8H

Activity

Activity as Tolerated T;N

Bedrest T;N, Bathroom Privileges, strict bedrest (DEF)* T;N, supine without log roll T;N, supine with log roll

OOB

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T;N, to chair, POD #1 (DEF)* T;N, ambulate in hall, POD #1

Weight Bearing Status T;N, LE: Weight Bearing as Tolerated, Left (DEF)* T;N, LE: Weight Bearing as Tolerated, Right T;N, LE: Partial Weight Bearing, Left T;N, LE: Partial Weight Bearing, Right T;N, LE: Touch Toe Weight Bearing, Left T;N, LE: Touch Toe Weight Bearing, Right T;N, LE: No Weight Bearing., Left T;N, LE: No Weight Bearing., Right

Elevate T;N, Head of Bed

Flat in Bed T;N, when brace is off

Diet

Dietitian to Manage Medical Nutrition Therapy T;N

NPO T;N, No exceptions (DEF)* T;N, NPO except for medications T;N, NPO except for medications

Restricted Diet T;N, Room Service, Pediatric

Restricted Diet T;N, Room Service, Pediatric

Breast Milk T;N

Tube Feedings

Enteral Feedings(SUB)* Patient Care Orders

Intake and Output T;N, Q12H

Intake and Output Strict T;N, Q12H

Cardio-Respiratory Monitoring T;N

Drain Maintenance T;N, Drain type: Hemovac, empty and record amount q12h (DEF)* T;N, Drain type: JP, empty and record amount q12h

Elevate T;N, Left Upper Extremity on one pillow, under elbow (DEF)* T;N, Right Upper Extremity on one pillow, under elbow

Dressing Change / Wound Care T;N, to the Other, Dry Sterile Dressing, QDay, PRN, to operative site; first dressing change to be

performed by surgery

Pin Care T+1;N, to the Arm, Other, After 24 hours; routine pin care. (DEF)* T+2;N, to the Arm | Leg, Other, After 24 hours; routine pin care.

Ice Packs T;N, to affected extremity

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Urinary Catheter Maintenance T;N, To straight drainage, Discontinue orders: Remove per nursing protocol (DEF)* T;N, To straight drainage, Discontinue orders: When epidural is out, discontinue 1 hour after epidural

removed T;N, To straight drainage, discontinue when patient is ambulatory

Straight Catheterize T;N, If no void in next, and notify H.O.

VTE Prophylaxis

TEDs (Pt Care) T;N, Bilateral Lower Extremities (DEF)* T;N, Left Lower Extremity T;N, Right Lower Extremity

Foot Pumps T;N, Both (DEF)* T;N, Left T;N, Right

SCDs (Pt Care) T;N, Bilateral Lower Extremities (DEF)* T;N, Left Lower Extremity T;N, Right Lower Extremity

Equipment

Consult Orthopedic Technician T;N, Routine, peds post-op

Trapeze T;N, perform safety checks every shift

CPM 0 Degrees - T;N, BID

Elastic Back Support T;N

MAFO T;N

AFO T;N, Routine

Respiratory Therapy

Oxygen Therapy T;N, Maintain Sp02 > 94, Wean to Room Air, Discontinue oxygen on POD#1 if saturation is greater

than 94% on room air.

Cough and Deep Breathe T;N, encourage

Incentive Spirometry (Pt Care) T;N, q1h, while awake

Bronchial Hygiene T;N

Suction T;N

IV Solutions

Dextrose 5% & 0.45% NaCl 1000ml & KCL 20 meq (IVS)* Premix Diluent D5&0.45NaCl

1,000 ml, Inj, IV Dextrose 5% w/ 0.45%NaCl and KCl 20mEq/L

20 mEq, Every Bag

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Lactated Ringers 1,000 ml, IV, ml/hr

Heparin Lock with Routine Flushes T;N

Central Line Care with Routine Flushes per Protocol T;N

Medications

Surgical Site Infection Prophylaxis, Peds Post Op(SUB)*

PCA, Peripheral Peds/PICU(SUB)* Analgesics: Opioids

PAIN Medications (Can only be ordered for patients NOT receiving PCA)(NOTE)*

morphine (pediatrics) 0.1 mg/kg, Inj, IV, Q2H, PRN, pain moderate-severe (pain score 4-10), maximum 15mg (DEF)* 0.1 mg/kg, IV, Q3H, pain moderate-severe (pain score 4-10), Inj, maximum 15mg 0.1 mg/kg, IV, Q4H, pain moderate-severe (pain score 4-10), Inj, maximum 15mg

Antacids

Maalox 5 ml, PO, QID, PRN, indigestion, Susp, For children < 2 years old (DEF)* 15 ml, PO, QID, PRN, indigestion, Susp, For children 2-12 years old 30 ml, PO, QID, PRN, indigestion, Susp, For children > 12 years old

Antiemetics

ondansetron (pediatrics) 0.1 mg/kg, IV, Q8H, PRN, nausea/vomiting, Inj, x 2 doses

Comments: x 2 doses

ondansetron 4 mg, Inj, IV, Q8H, PRN, nausea/vomiting, x 2 doses

Comments: x 2 doses, adult dose Bowel Management

docusate (pediatrics) 2.5 mg/kg, Liq, PO, BID, PRN, constipation

docusate 100 mg, Capsule, PO, BID, PRN, constipation

Comments: adult dose

Fleet Enema 1 enema, rectal, PRN, constipation, if no BM

Dietary Supplements

MVI with minerals 1 tab(s), Tab, PO, QDay

Comments: adult dose

Centrum Jr 1 tab(s), Chewable Tab, PO, QDay

ferrous sulfate (pediatrics) 2 mg/kg, Liq, PO, BID

ferrous sulfate 325 mg, Tab, PO, TIDwithMeals

Comments: adult dose GI Prophylaxis

famotidine (pediatrics) 0.4 mg/kg, IV, BID, Inj Syringe

famotidine

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20 mg, Inj, IV, BID (DEF)* Comments: adult dose

20 mg, IV, QDay, Inj, for CrCl < 50 ml/min Comments: adult dose

Laboratory Hematology

CBC RT collect Venous Bld, T+1;0400, daily, 3 day(s) (DEF)* RT collect Venous Bld, T+1;0400

Auto Differential RT collect Venous Bld, T+1;0400, MUST ORDER CBC WITH THIS, daily, 3 day(s)

Chemistry

BMP RT collect Venous Bld, T+1;0400

POC Testing

Guaiac Stools POC T;N, Routine, guaiac all stools; notify provider if positive

Urine Dipstick POC T;N, Routine, q void (DEF)* T;N, Routine, q4h T;N, Routine, q8h

Diagnostic Tests

EKG POC T;N, Stat

EKG. T;N, Stat

Imaging

Notify RIAO Tech T;N

XR-Chest 2V T+1;0500 Routine, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

XR-Chest Portable T+1;0500 Routine, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

Consults

Care Mgmt RIAO Peds Consult T;N

Care Mgmt Peds Inpt Consult T;N

Child Life Specialist Consult T;N, Routine

Nutrition Consult T;N

OT Consult / Evaluate and Treat-Acute Hosp T;N

PT Consult / Evaluate and Treat-Acute Hosp T;N

Rehab MD Consult / General Rehab T;N, For: General Rehab Consult

Inpatient Psyc Consult Peds T;N

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Other

Patient Teaching T;N, Instruct on: Post-OP, active ankle exercises

Patient Education-Smoking Cessation T;N


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Unique Plan Description: PEDS GI Outpatient Endoscopy Orders Plan Selection Display: PEDS GI Outpatient Endoscopy Orders PlanType: Medical Version: 1 Begin Effective Date: 5/16/2019 10:15 AM End Effective Date: Current Available at: SHB Peri-Procedure Labs Patient Care Orders

Powerplan entered by Attending or Hospitalist - Nurse may initiate T;N, Nurse may initiate as written/CPOE order

Laboratory

CMP Lab Urgent collect Venous Bld, T;N

Sed Rate Lab Urgent collect Venous Bld, T;N

CRP Lab Urgent collect Venous Bld, T;N

Tissue Transglutaminase Antibody IgA Lab Urgent collect Venous Bld, T;N

IGA, Serum Lab Urgent collect Venous Bld, T;N

QuantiFERON TB Gold Lab Urgent collect Venous Bld, T;N

TSH Third Generation Lab Urgent collect Venous Bld, T;N

Free T4 Lab Urgent collect Venous Bld, T;N

Iron level Lab Urgent collect Venous Bld, T;N

TIBC Lab Urgent collect Venous Bld, T;N

Hepatitis A Antibody Total Lab Urgent collect Venous Bld, T;N

Hepatitis B Surface Antibody Lab Urgent collect Venous Bld, T;N

Hepatitis B Surface Antigen Lab Urgent collect Venous Bld, T;N

Hepatitis C Antibody Lab Urgent collect Venous Bld, T;N

Chicken Pox Varicella IgG Antibody Lab Urgent collect Venous Bld, T;N

Vitamin D 25 - Hydroxy level Lab Urgent collect Venous Bld, T;N

Disaccharide Biopsy Profile Biopsy, Lab Urgent collect, T;N

Urine HCG POC T;N, Stat

Hcg Qualitative Test ST collect Venous Bld, T;N

Post-Procedure Orders

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Admit/Diagnosis

Discharge Patient T;N, D/C home when tolerating PO

Vital Signs

Vital Signs T;N

For patients 0-2 yrs(NOTE)*

Notify Provider for VS's of: T;N, Temp > 38.5 or < 36.9, HR> 150, HR< 80, SBP> 110/70, SBP< 80/50, RR> 60, RR< 20,

abdominal pain, rectal bleeding, or vomiting For patients 2-7 yrs(NOTE)*


abdominal pain, rectal bleeding, or vomiting For patients 7 yrs and above(NOTE)*


abdominal pain, rectal bleeding, or vomiting Activity

Activity as Tolerated T;N, BR until awake and alert

Diet

NPO T;N, until awake/alert and advance as tolerated, D/C IV when tolerating PO


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Unique Plan Description: OB Anesthesia: Duramorph Plan Selection Display: OB Anesthesia: Duramorph PlanType: Medical Version: 1 Begin Effective Date: 5/01/2019 9:53 AM End Effective Date: Current Available at: Carroll Hospital SHB OB Anesthesia: Duramorph Vital Signs

Vital Signs with Pulse Oximetry T;N, Q1H 4 hr



+1 Days Vital Signs with Pulse Oximetry Q8H until discharge

Patient Care Orders

PCA/Epidural Emergency Response T;N, If RR < 8 or patient is obtunded/unarousable/POSS >3, give Narcan per order, administer 100%

O2 by non-rebreather face mask, place STAT page for Respiratory Therapy, STAT page Anesthesia overhead, and notify provider

Notify T;N, Notify anesthesia provider for RR < 10, SPO2 < 90%, Ramsey Sedation Scale > 4, Pain Score

>5 (after administration of ordered medications), mental status change

Miscellaneous Nursing Order (NON-Medication) T;N, Monitor pain level, sedation level, motor and sensory level with vital signs

Respiratory Therapy

Oxygen T;N, Setup at bedside

Oxygen Therapy T;N, Routine, Nasal Cannula, Maintain Sp02 > 94%, Wean to Room Air

Medications Epidural Morphine(NOTE)*

Duramorph PF 3 mg, epidural, ONCE, Inj

No Narcotics x 24 Hrs - Post Duramorph OB T;N, 24, hr, unless approved by anesthesia

Intrathecal Morphine(NOTE)*

Duramorph PF 0.25 mg, intrathecal, ONCE, Inj

No Narcotics x 24 Hrs - Post Duramorph OB T;N, 24, hr, unless approved by anesthesia

Opioid-Induced Itching

diphenhydrAMINE 25 mg, PO, Q6H, PRN, itching, Capsule, Duration = 24 hr

page 17 of 110


Comments: when patient able to tolerate PO

diphenhydrAMINE 25 mg, IV, Q6H, PRN, itching, Inj, Duration = 24 hr

nalbuphine 2.5 mg, IV, ONCE, Inj (DEF)*

Comments: as needed for itching from Duramorph 5 mg, IV, ONCE, Inj

Comments: as needed for itching from Duramorph 10 mg, IV, ONCE, Inj

Comments: as needed for itching from Duramorph If needed, select only ONE drip:(NOTE)*

nalbuphine standard drip (IVS)* Sodium Chloride 0.9%

1,000 ml, Inj, IV, Duration = 12 hr Comments: as needed for itching from Duramorph

nalbuphine 10 mg, 1.25, mg/hour

naloxone 1mg & D5W 1/2NS 1000ml (IVS)* Dextrose 5% with 0.45% NaCl

1,000 ml, Inj, IV, Duration = 24 hr, @ 84 ml/hr Comments: as needed for severe itching not responsive to diphenhydramine, while on epidural

naloxone 1 mg

Antiemetics

ondansetron 4 mg, IV, Q6H, PRN, nausea/vomiting, Inj, Duration = 24 hr

prochlorperazine 5 mg, IV, Q6H, PRN, nausea/vomiting, Inj, Duration = 24 hr

Comments: if nausea and vomiting not relieved with ondansetron Analgesics: Opioids

oxycodone immediate release 5 mg, PO, Q3H, PRN, pain moderate (pain score 4-6), Tab, Duration = 24 hr

Comments: hold for RR < 10 or O2 Sat < 95%

oxycodone immediate release 10 mg, PO, Q3H, PRN, pain severe (pain score 7-10), Tab, Duration = 24 hr

Comments: hold for RR < 10 or O2 Sat < 95% Emergency Response

naloxone 0.1 mg, IV, as directed, PRN, Other, see comments, Inj

Comments: STAT and repeat every 2 minutes x 4 doses prn for RR < 8, patient unarousable or obtunded


page 18 of 110


Unique Plan Description: OB Induction of Labor Plan Selection Display: OB Induction of Labor PlanType: Medical Version: 1 Begin Effective Date: 5/31/2012 10:57 AM End Effective Date: Current Available at: SHB See red in medication section for change OB Induction of Labor Admit/Diagnosis

Start Obstetric Observation T;N, Non-Telemetry

Diagnosis T;N, Induction of Labor

Admitting Physician. T;N

Attending Physician. T;N

OB-Consulting Physician. T;N

Code Status

Resuscitation Status T;N, Full Resuscitation

Resuscitation Status T;N, Do Not Resuscitate, PLEASE COMPLETE PAPER DNR ORDER FORM

Vital Signs

Vital Signs T;N, per protocol

Vital Signs with Pulse Oximetry T;N, per protocol

Notify Provider for VS's of: Temp > 38.0, HR> 120, HR< 50, SBP> 140, SBP< 90, RR> 24, RR< 8, 02 Sat< 92%

Activity

Bedrest T;N

Bedrest T;N, Bathroom Privileges

OOB T;N, to chair

Diet

Dietitian to Manage Medical Nutrition Therapy T;N

Restricted Diet T;N

NPO T;N

NPO T;N, NPO except for ice chips

Patient Care Orders

Intake and Output

page 19 of 110


T;N, Q8H

Weight T;N, QDay

Electronic Fetal Monitoring T;N

Toco Transducer T;N

May Have Epidural T;N, RN to obtain epidural premixed bag containing 0.125% Bupivicaine with 1.67mcg/ml Fentanyl

from Acudose.

Urinary Catheter Insert

Urinary Catheter Maintenance

Straight Catheterize T;N, If bladder scan greater than

Rationale for Induction T;N

Gestational Age T;N

Patient Teaching T;N, Instruct on: Smoking cessation

OB VTE Prophylaxis(SUB)* Respiratory Therapy

Oxygen Therapy T;N

Pulse Ox (Pt Care) T;N

IV Solutions

Dextrose 5% with LR 1,000 ml, IV

IV fluid with epidural placement:(NOTE)*

Lactated Ringers (Bolus) 750 ml, IV, as directed, PRN, Other, see comments, Inj

Comments: bolus prior to epidural

Lactated Ringers 1,000 ml, IV, per protocol

Comments: begin with epidural placement and discontinue other maintenance IV fluids

oxytocin 30 units/500ml NS drip standard (L & D) (IVS)* premix diluent oxytocin infusion 30 units/ 500 mL Medications

Cervidil 10 mg, vaginal, ONCE, Vag Supp

Cytotec 25 mcg, vaginal, ONCE, Tab

Cytotec 50 mcg, vaginal, ONCE, Tab

Cytotec 25 mcg, vaginal, Q3H, Tab

Cytotec 25 mcg, vaginal, Q4H, Tab

page 20 of 110


For after delivery of placenta: run ONE bag of oxytocin 30 units/500 ml(NOTE)*

oxytocin 30 units/500ml NS drip standard (IVS)* premix diluent

500 ml, Inj, IV, Duration = 30 min(s), @ 1,000 ml/hr Comments: 1000 ml/hr for 30 mins, Postpartum Oxytocin

oxytocin infusion 30 units/ 500 mL. 30 units

terbutaline 0.25 mg, subQ, as directed, PRN, Other, see comments, Inj, as needed for hypertonic uterine

activity Comments: as needed for hypertonic uterine activity

For episiotomy if necessary:(NOTE)*

lidocaine 1% injectable solution 30 ml, subQ, as directed, Inj, for episiotomy if needed

Comments: for episiotomy if needed Antibiotics

If patient is GBS positive:(NOTE)*

penicillin G potassium 5 MU, IV, as directed, site of infection = Uterus, Suspected Organism = Strep-Group B, Inj

Comments: begin when in active labor or when membranes have ruptured

penicillin G potassium—frequency was as directed. Changed to Q4H 2.5 MU, IV, Q4H, Indication = Uterus, Suspected Organism = Strep-Group B, Inj

Comments: until delivery

ampicillin (inj) 2 gm, IV, as directed, site of infection = Uterus, Suspected Organism = Gram positive cocci, Inj


ampicillin (inj) 1 gm, IV, Q6H, site of infection = Uterus, Suspected Organism = Gram positive cocci, Inj


cefazolin 2 gm, IV, as directed, site of infection = Uterus, Suspected Organism = Gram positive cocci, Inj


cefazolin 1 gm, IV, Q8H, site of infection = Uterus, Suspected Organism = Gram positive cocci, Inj


clindamycin 900 mg, IV, Q8H, site of infection = Uterus, Suspected Organism = Gram positive cocci, Inj

Comments: until delivery Long-Acting Reversible Contraceptives

Mirena Intrauterine Device 1 each, intrauterine, as directed, Implant, Duration = 1 dose(s)

Comments: Certified physician to place intrauterine; RN to document insertion/administration time.Please complete reimbursement form if medication packaging was opened but medication could not be used (i.e. expelled, contaminated, or damaged). Please hand-deliver medication to pharmacy ONLY if medication did NOT come in contact with patient.Dispose unused drug in black container

ParaGard Intrauterine Device 1 each, intrauterine, as directed, Implant, Duration = 1 dose(s)

Comments: Certified physician to place intrauterine; RN to document insertion/administration time.Please complete reimbursement form if medication packaging was opened but medication could not be used (i.e. expelled, contaminated, or damaged). Please hand-deliver medication to pharmacy ONLY if medication did NOT come in contact with patient.Dispose

page 21 of 110


unused drug in black container Laboratory

Syphilis EIA w/ Reflex RPR ST collect Venous Bld, T;N

CBC ST | Venous Bld, T;N, If not obtained by 36 weeks.

Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS

HBSAG

Toxicology Screen Urine OB ONLY (In House / DRAB) T;N, Urine, ST collect

DRABS Not Done Blood Bank

ABO/Rh ST | Venous Bld, T;N, *must also order Antibody Screen-Gel

Antibody Screen-Gel ST | Venous Bld, T;N, *must also order ABO/Rh

Diagnostic Tests

OB Ultrasound, Limited (Pt Care) T;N

MFM AFI Only (Pt Care) T;N

MFM Amniocentesis (Pt Care) T;N

MFM Detailed Anatomincal Survey (Pt Care) T;N

MFM Doppler Velocimetry (Pt Care) T;N

MFM Fetal ECHO (Pt Care) T;N

MFM First Trimester Ultrasound (Pt Care) T;N

MFM Transvaginal Sonogram (Pt Care) T;N

EKG POC T;N, Stat

EKG. T;N, Stat

XR-Chest 2V T+1;0500 Routine, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: OB - Induction of

Labor

XR-Chest Portable T+1;0500 Routine, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: OB - Induction of

Labor Consults

Care Mgmt OB Inpt, L&D, Nursery Consult T;N

WOC Nurse Consult T;N

page 22 of 110


Nutrition Consult T;N

OT Consult / Evaluate and Treat-Acute Hosp T;N

Pastoral Care Consult T;N

PT Consult / Evaluate and Treat-Acute Hosp T;N

Inpatient Psyc Consult T;N, If STAT call 25123

Rehab MD Consult / General Rehab

Speech Consult / Evaluate and Treat-Acute Hosp T;N


page 23 of 110


Unique Plan Description: Neonatal (Neofax) Medications Plan Selection Display: Neonatal (Neofax) Medications Plan Synonyms: NICU Medications (Neofax); SCN Medications (Neofax) PlanType: Medical Version: 1 Begin Effective Date: 9/23/2014 9:36 AM End Effective Date: Current Available at: Carroll Hospital SHB Neonatal (Neofax) Medications Medications

acetaminophen (pediatrics) 15 mg/kg, PO, Liq

acyclovir (pediatrics) 20 mg/kg, IV, Q8HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe

adenosine 50 mcg/kg, IV, as directed, PRN, tachycardia (see comments), Inj

Comments: every 2 minutes PRN

alprostadil 10 mcg/ml infusion (NICU) (IVS)* Dextrose 5% in Water

50 ml, IV, concentration = 10 mcg/ml Comments: Dispose unused drug in black container

alprostadil 500 mcg, mcg/kg/min

amphotericin B lipid complex (pediatrics) 5 mg/kg, IV, Q24HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj, Range = 5-7 mg/kg/dose

ampicillin (pediatrics) 100 mg/kg, IV, Q8HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


ampicillin (pediatrics) 100 mg/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism

= Empiric, Inj, Range = 25-100 mg/kg/dose **********(NOTE)*

calcium carbonate 20 mg/kg, PO, Q6HV, Susp

calcium gluconate (pediatrics) 20 mg/kg, PO, Q6HV, Liq

caffeine (pediatrics) 20 mg/kg, PO, ONCE, Liq, Loading dose

caffeine (pediatrics) 6 mg/kg, PO, Q24HV, Start T+1;N, Liq, Range = 5-10 mg/kg/dose

caffeine (pediatrics) 20 mg/kg, IV, ONCE, Inj, Loading dose

caffeine (pediatrics) 6 mg/kg, IV, Q24HV, Start T+1;N, Inj, Range = 5-10 mg/kg/dose

captopril (pediatrics) 0.03 mg/kg, PO, Q8HV, Susp, Range = 0.01-0.05 mg/kg/dose

captopril (pediatrics)

page 24 of 110


0.03 mg/kg, PO, Q12HV, Susp, Range = 0.01-0.05 mg/kg/dose

cefazolin (pediatrics) 25 mg/kg, IV, Q8HV, Inj Syringe

cefazolin (pediatrics) 25 mg/kg, IV, Q12HV, Inj Syringe

> 28 days of age(NOTE)*

cefepime (pediatrics) 50 mg/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe < 28 days of age(NOTE)*

cefepime (pediatrics) 30 mg/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe **********(NOTE)*

cefotaxime (pediatrics) 50 mg/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


cefotaxime (pediatrics) 50 mg/kg, IV, Q8HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


chlorothiazide (pediatrics) 15 mg/kg, PO, Q12HV, Susp, Range = 10-20 mg/kg/dose

clindamycin (pediatrics) 6 mg/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe, Range = 5-7.5 mg/kg/dose

clindamycin (pediatrics) 6 mg/kg, IV, Q8HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe, Range = 5-7.5 mg/kg/dose

Cyclomydril ophthalmic solution 1 gtt, eye(each), as directed, Ophth Sol

Comments: Place eye drops 1 hour before eye exam, give one dose every five minutes times 4

**********(NOTE)*

Dexamethasone IV per DART Protocol(SUB)*

Dexamethasone PO per DART Protocol(SUB)*

diazoxide (pediatrics) 3 mg/kg, PO, Q8HV, Susp, Range = 2-5 mg/kg/dose

digoxin (pediatrics) mcg/kg, IV, Inj

Comments: Dispose unused drug in black container

digoxin (pediatrics) mcg/kg, PO, Liq


Pediarix 0.5 ml, IM, as directed, Inj

**********(NOTE)*

DOBUTamine drip 500 mcg/ml D5W (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 500 mcg/ml DOBUTamine

12.5 mg, mcg/kg/min

page 25 of 110




50 mg, mcg/kg/min



125 mg, mcg/kg/min **********(NOTE)*

DOPamine drip 800mcg/ml D5W (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 800 mcg/ml DOPamine

20 mg, mcg/kg/min



40 mg, mcg/kg/min



80 mg, mcg/kg/min



20 mg, mcg/kg/min



40 mg, mcg/kg/min



80 mg, mcg/kg/min **********(NOTE)*

doxapram 2 mg/ml drip (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 2 mg/ml doxapram

50 mg, mg/kg/hour **********(NOTE)*

Emla 1 appl, TOP, ONCE, Cream, Apply 1 gm to penis 1 hr before circumcision

Comments: Apply 1 gm to penis 1 hr before circumcision

epinephrine drip 25 mcg/ml (NICU) (IVS)*

page 26 of 110


Dextrose 5% in Water 25 ml, IV, concentration = 25 mcg/ml

epinephrine (for wt drip) 0.625 mg, mcg/kg/min

epinephrine drip 200 mcg/ml (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 200 mcg/ml epinephrine (for wt drip)

5 mg, mcg/kg/min

epinephrine drip 400 mcg/ml (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 400 mcg/ml epinephrine (for wt drip)

10 mg, mcg/kg/min

Epogen 300 unit/kg, subQ, MonWedFri, Inj, Range = 200-400 units/kg

erythromycin ophthalmic 0.5% ointment 1 appl, eye(each), ONCE, Ophth Oint

Comments: apply to each conjunctival sac **********(NOTE)*

famotidine (pediatrics) 0.5 mg/kg, PO, Q24HV, Susp

famotidine (pediatrics) 0.5 mg/kg, IV, Q24HV, Inj Syringe

fentanyl (pediatrics) 2 mcg/kg, IV, Q2H, PRN, Inj, Range = 0.5 - 4 mcg/kg/dose

fentanyl (pediatrics) 2 mcg/kg, IV, Q4HV, Inj, Range = 0.5 - 4 mcg/kg/dose

fentanyl drip 5 mcg/ml (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 5 mcg/ml fentanyl (for wt drip)

125 mcg, mcg/kg/hour

fentanyl drip 25 mcg/ml (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 25 mcg/ml fentanyl (for wt drip)

625 mcg, mcg/kg/hour

ferrous sulfate (pediatrics) 1 mg/kg, PO, Q12HV, Liq



fluconazole (pediatrics) 3 mg/kg, Inj Syringe, IV, Q72H, prophylaxis

fluconazole (pediatrics) 12 mg/kg, Inj Syringe, IV, ONCE, loading dose

fluconazole (pediatrics) 6 mg/kg, Inj Syringe, IV, maintenance dose

furosemide (pediatrics)

page 27 of 110


2 mg/kg, PO, Q12HV, Liq

furosemide (pediatrics) 2 mg/kg, PO, Q24HV, Liq

furosemide (pediatrics) 1 mg/kg, IV, Q12HV, Inj

furosemide (pediatrics) 1 mg/kg, IV, Q24HV, Inj

**********(NOTE)*

gentamicin (pediatrics) 5 mg/kg, IV, Q48H, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe Comments: if trough <1 - give dose; if trough >= 1 hold dose and notify physician/NP

gentamicin (pediatrics) 4.5 mg/kg, IV, Q36H, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


gentamicin (pediatrics) 4 mg/kg, IV, Q24HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


**********(NOTE)*

hydrALAzine (pediatrics) 0.3 mg/kg, IV, Q6HV, Inj Syringe, Range = 0.1-0.5 mg/kg/dose

hydrALAzine (pediatrics) 0.5 mg/kg, PO, Q6HV, Susp, Range = 0.25 - 1 mg/kg/dose

hydrocortisone (pediatrics) 15 mg/m2, PO, Q12HV, Susp

hydrocortisone (pediatrics) 15 mg/m2, IV, Q12HV, Inj Added the Power Plan below

NICU Hydrocortisone (Mechanically Ventilated Patients)(SUB)*= Sinai Only Power Plan **********(NOTE)*

ibuprofen IV (pediatrics) 10 mg/kg, IV, ONCE, Inj, day 1

Comments: day 1

ibuprofen IV (pediatrics) 5 mg/kg, IV, Q24HV, Start T+1;N, Inj, Duration = 2 dose(s), day 2 and 3

Comments: day 2 and 3

imipenem (pediatrics) 22 mg/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


IVIG 750 mg/kg, IV, ONCE, Inj, Infuse over 6 hours

Comments: Infuse over 6 hours Prevention of IVH(NOTE)*

indomethacin (pediatrics) 0.1 mg/kg, IV, Q24HV, Inj Syringe, Duration = 3 dose(s)

Indomethacin for PDA Closure(SUB)*

insulin regular 0.1 unit/kg, subQ, Inj

page 28 of 110



insulin drip 0.2 units/ml (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 0.2 units/ml Comments: Dispose unused drug in black container

insulin regular (for wt drip) 5 units, unit/kg/hour

Order Insulin drip 0.2units/mL in 3mL syringe for rate < 0.1 mL/hour(NOTE)*

insulin drip 0.2units/ml (NICU) 3 ml syringe (IVS)* Dextrose 5% in Water

3 ml, IV, ml/hr, concentration = 0.2 units/ml Comments: Dispose unused drug in black container

insulin regular (for wt drip) 0.6 units, unit/kg/hour

***********(NOTE)*

lansoprazole (pediatrics) 1 mg/kg, PO, Q24HV, Susp, Range = 0.73 - 1.66 mg/kg/dose


levothyroxine (pediatrics) 10 mcg/kg, PO, Q24HV, Susp

levothyroxine (pediatrics) 5 mcg/kg, IV, Q24HV, Inj

linezolid (pediatrics) 10 mg/kg, IV, Inj

linezolid (pediatrics) 10 mg/kg, PO, Susp

**********(NOTE)*

MCT Oil 0.5 ml, PO, Q6HV, Liq

metoclopramide (pediatrics) 0.05 mg/kg, PO, Q8HV, Liq, Range = 0.033 - 0.1 mg/kg/dose

Comments: Seal unused drug in ziplock bag, return to pharmacy

midazolam (pediatrics) 0.1 mg/kg, IV, Q2H, PRN, Inj, Range = 0.05 - 0.15 mg/kg/dose

midazolam (pediatrics) 0.1 mg/kg, IV, Q4HV, Inj, Range = 0.05-0.15 mg/kg/dose

midazolam drip 500 mcg/ml (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 500 mcg/ml midazolam (for wt drip)

12.5 mg, mcg/kg/hour

midazolam drip 1000 mcg/ml (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 1000 mcg/ml midazolam (for wt drip)

25 mg, mcg/kg/hour

morphine (pediatrics) 0.1 mg/kg, IV, Inj

morphine drip 100 mcg/ml (NICU) (IVS)* Dextrose 5% in Water

25 ml, IV, concentration = 100 mcg/ml

page 29 of 110


morphine (for wt drip) 2.5 mg, mcg/kg/hour

MVI (pediatrics) liquid 0.5 ml, PO, Q12HV, Liq

MVI with iron (pediatrics) liquid 0.5 ml, PO, Q12HV, Liq

**********(NOTE)*

nafcillin (pediatrics) 50 mg/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe, Range = 25-50 mg/kg/dose

nafcillin (pediatrics) 50 mg/kg, IV, Q8HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe, 25-50 mg/kg/dose

naloxone 0.1 mg/kg, IV, Q5 mins, PRN, sedation, Inj

nystatin topical 1 appl, TOP, Q6H, Top Oint, Site of Application = affected area

Comments: apply to affected area

nystatin (pediatrics) 100,000 units, Susp, PO, Q6H

Comments: apply with swab to each side of mouth **********(NOTE)*

palivizumab (pediatrics) 15 mg/kg, IM, ONCE, Inj

pancuronium (pediatrics) 0.1 mg/kg, IV, Q2H, PRN, Other, see comments, Inj, May need to dose q1h

penicillin GK (pediatrics) 50,000 unit/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected

Organism = Empiric, Inj Syringe, Range = 25,000 - 100,000 units/kg/dose

penicillin GK (pediatrics) 50,000 unit/kg, IV, Q8HV, site of infection = R/O serious bacterial infection-Peds, Suspected

Organism = Empiric, Inj Syringe, Range = 25,000 - 100,000 units/kg/dose

PHENobarbital (pediatrics) 20 mg/kg, IV, ONCE, Inj, May need an additional 5-10 mg/kg bolus

PHENobarbital (pediatrics) 3 mg/kg, IV, Q24HV, Start T+1;N, Inj

PHENobarbital (pediatrics) 3 mg/kg, PO, Q24HV, Start T+1;N, Liq

phenytoin (pediatrics) 4 mg/kg, PO, Q24HV, Start T;N+720, Susp, maintenance dose; range 4-8mg/kg/dose

Comments: maintenance dose

poractant alfa (pediatrics) 2.5 ml/kg, ETTube, ONCE, Inh Sol

poractant alfa (pediatrics) 1.25 ml/kg, ETTube, ONCE, Inh Sol

potassium chloride oral (pediatrics) 1 mEq/kg, PO, Q12HV, Liq

propranolol (pediatrics) 0.25 mg/kg, PO, Q6HV, Liq, May need dose up to 3.5 mg/kg/dose

For < 32 weeks, > 1000g newborns only:(NOTE)*

page 30 of 110


phytonadione (pediatrics) 0.5 mg, IM, ONCE, Inj

For < 32 weeks, < 1000g newborns only:(NOTE)*

phytonadione (pediatrics) 0.3 mg/kg, IM, ONCE, Inj

For > 32 weeks newborns only:(NOTE)*

phytonadione (pediatrics) 1 mg, IM, ONCE, Inj

***********(NOTE)*

sodium bicarbonate 4.2% (NICU) 1 mEq/kg, IV, ONCE, Inj

sodium phosphate (pediatrics) 20 mg/kg, PO, Q12HV, Liq

sotalol (pediatrics) 1 mg/kg, PO, Q12HV, Susp

spironolactone (pediatrics) 2 mg/kg, PO, Q24HV, Susp, Range = 1-3 mg/kg/dose

Survanta Intratracheal (pediatrics) ml, inhaled, ONCE, Inh Sol, calculate 4ml/kg and enter final dose

Survanta Intratracheal (pediatrics) ml, inhaled, Q6HV, Inh Sol, Duration = 4 dose(s), calculate 4ml/kg and enter final dose

**********(NOTE)*

tobramycin (pediatrics) 5 mg/kg, IV, Q48H, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


tobramycin (pediatrics) 4.5 mg/kg, IV, Q36H, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


tobramycin (pediatrics) 4 mg/kg, IV, Q24HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe ***********(NOTE)*

ursodiol (pediatrics) 12 mg/kg, PO, Q12HV, Susp, Range = 10-15 mg/kg/dose

************(NOTE)*

vancomycin (pediatrics) 12 mg/kg, IV, Q18H, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


vancomycin (pediatrics) 12 mg/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =


vancomycin (pediatrics) 12 mg/kg, IV, Q8HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =

Empiric, Inj Syringe, Range = 10-15 mg/kg/dose ***********(NOTE)* For > 35 weeks gestation:(NOTE)*

zidovudine (pediatrics) 4 mg/kg, PO, Q12HV, Liq

For 30 weeks to 35 weeks gestation:(NOTE)*

zidovudine (pediatrics)

page 31 of 110


2 mg/kg, PO, Q12HV, Liq, increase to 3mg/kg, Q12HV at 15 days postnatal age For < 30 weeks gestation:(NOTE)*

zidovudine (pediatrics) 2 mg/kg, PO, Q12HV, Liq, Increase to 3mg/kg, Q12HV after 4 weeks postnatal age

For > 35 weeks gestation:(NOTE)*

zidovudine (pediatrics) 3 mg/kg, IV, Q12HV, Inj Syringe

For 30 - 35 weeks gestation:(NOTE)*

zidovudine (pediatrics) 1.5 mg/kg, IV, Q12HV, Inj Syringe, increase to 2.3 mg/kg Q12HV at 15 days postnatal age

For < 30 weeks gestation:(NOTE)*

zidovudine (pediatrics) 1.5 mg/kg, IV, Q12HV, Inj Syringe, increase to 2.3 mg/kg Q12HV after 4 weeks postnatal age


page 32 of 110

5.22.2019 PowerPlan Request Item #7 P 1 of 1 Unique Plan Description: Troponin Q3H Plan Selection Display: Troponin Q3H PlanType: Medical Version: 1 Begin Effective Date: 4/17/2019 9:47 AM End Effective Date: Current Available at: Carroll Hospital Lev Spec Hosp NWH SHB Troponin Q3H

***First instance is scheduled to be collected within 30 minutes or sooner. There is no need to change Priority to STAT***(NOTE)* ***If FIRST Troponin has ALREADY been drawn in the Emergency Department, please order for '2 Doses.’ If not, choose the '3 Doses.'***(NOTE)*

Troponin I, Plasma Timed Study collect Venous Bld, T;N, q3hr, 2 dose(s) (DEF)* Timed Study collect Venous Bld, T;N, q3hr, 3 dose(s)

Troponin T Timed Study collect Venous Bld, T;N, q3hr, 2 dose(s) (DEF)* Timed Study collect Venous Bld, T;N, q3hr, 3 dose(s)


page 33 of 110


Unique Plan Description: Echocardiogram (TTE) PowerPlan Plan Selection Display: Echocardiogram (TTE) PowerPlan PlanType: Medical Version: 1 Begin Effective Date: 8/30/2016 6:57 AM End Effective Date: Current Available at: Carroll Hospital SHB Echocardiogram (TTE) PowerPlan Medications

Definity 1 each, IV, ONCE, PRN, Other, see comments, Inj, for suboptimal apical or ventricular border views

Comments: Definity will be provided by Echo Songrapher if needed. Contraindications are intra-cardiac shunting or allergy to perflutren. Definity is activated, then mixed with NS (8.7 ml) to create a 10 ml IV solution. Starting dose is 2 ml of solution, given in 1 ml increments for optimal echo views.

Diagnostic Tests

Echocardiogram T;N

Echo Complete TTE (CH) T;N


Changes Marked Below

Add Carroll’s TTE Echo

Virtualize to Carroll

page 34 of 110


Unique Plan Description: CV Lab 01 Pre Procedure Pre Cath Orders Plan Selection Display: CV Lab 01 Pre Procedure Pre Cath Orders PlanType: Medical Version: 1 Begin Effective Date: 2/15/2018 1:18 PM End Effective Date: Current Available at: Carroll Hospital CV Lab 01 Pre Procedure Pre Cath Orders

Cardiovascular Procedure T;N

Saline Lock IV with Routine Flushes per Protocol T;N

NPO T;N (DEF)* No exceptions, Test/Procedure



Add

page 35 of 110


Unique Plan Description: CV Lab 04 TEE Plus Cardioversion Pre Procedure Plan Selection Display: CV Lab 04 TEE Plus Cardioversion Pre Procedure PlanType: Medical Version: 1 Begin Effective Date: 2/15/2018 1:35 PM End Effective Date: Current Available at: Carroll Hospital CV Lab 04 TEE Plus Cardioversion Pre Procedure

Echo Transesophageal with Probe TEE T;N

Cardiovascular Procedure T;N, TEE plus cardioversion

EKG. T;N, Stat, ONCE, Pre Procedure

EKG. T;N, Stat, ONCE, Post Procedure

Place in Cardiac Cath Holding T;N




Add

Removed IV Fluid Order

page 36 of 110

5.22.2019 PowerPlan Request Item #9c P 1 of 1

Unique Plan Description: CV Lab 05 Cardioversion without TEE Pre Procedure Plan Selection Display: CV Lab 05 Cardioversion without TEE Pre Procedure PlanType: Medical Version: 1 Begin Effective Date: 2/15/2018 1:36 PM End Effective Date: Current Available at: Carroll Hospital CV Lab 05 Cardioversion without TEE Pre Procedure

Cardiovascular Procedure T;N, cardioversion without TEE

EKG. T;N, Stat, ONCE, Pre Procedure

EKG. T;N, Stat, ONCE, Post Procedure



Sodium Chloride 0.9% 1,000 ml, IV, @ 50 ml/hr, during procedure


Add


page 37 of 110

5.22.2019 PowerPlan Request Item #9d P 1 of 1

Unique Plan Description: CV Lab 07 TEE without Cardioversion Pre Procedure Plan Selection Display: CV Lab 07 TEE without Cardioversion Pre Procedure PlanType: Medical Version: 1 Begin Effective Date: 2/15/2018 1:39 PM End Effective Date: Current Available at: Carroll Hospital CV Lab 07 TEE without Cardioversion Pre Procedure

Echo Transesophageal with Probe TEE T;N

Cardiovascular Procedure T;N, TEE without cardioversion



Sodium Chloride 0.9% 1,000 ml, IV, @ 50 ml/hr, during procedure



Add

page 38 of 110

5.22.2019 PowerPlan Request Item #9e 1 of 1

Unique Plan Description: CV Reveal Insertion - Pre Procedure Orders Plan Selection Display: CV Reveal Insertion - Pre Procedure Orders PlanType: Medical Version: 1 Begin Effective Date: 2/15/2018 1:54 PM End Effective Date: Current Available at: Carroll Hospital CV Reveal Insertion - Pre Procedure Orders Diet

NPO T;N, NPO except for medications, Test/Procedure

Patient Care Orders

Cardiovascular Procedure T;N, Reveal Insertion

Operative Consent form at bedside T;N


Medications

cefazolin 1 gm, IV, ONCE, Routine, site of infection = surgical site (prophylaxis only), Suspected Organism =

Empiric, Inj Comments: 30 - 60 minutes pre procedure

For PCN allergy :(NOTE)*

clindamycin 600 mg, IV, ONCE, Routine, site of infection = surgical site (prophylaxis only), Suspected Organism

= Empiric, Inj Comments: 30-60 minutes pre procedure

---OR---(NOTE)*

vancomycin 1 gm, IV, ONCE, Routine, site of infection = surgical site (prophylaxis only), Suspected Organism =

Empiric Comments: 30-60 minutes pre-procedure



Add

page 39 of 110

5.22.2019 PowerPlan Request Item #9f P 1 of 1

Unique Plan Description: CV Reveal Insertion - Pre Procedure Orders Plan Selection Display: CV Reveal Insertion - Pre Procedure Orders PlanType: Medical Version: 1 Begin Effective Date: 2/15/2018 1:54 PM End Effective Date: Current Available at: Carroll Hospital CV Reveal Insertion - Pre Procedure Orders Diet


Patient Care Orders

Cardiovascular Procedure T;N, Reveal Insertion



Medications






---OR---(NOTE)*





Add

page 40 of 110

5.22.2019 PowerPlan Request Item #9g P 1 of 1

Unique Plan Description: CV Reveal Removal - Pre Procedure Orders Plan Selection Display: CV Reveal Removal - Pre Procedure Orders PlanType: Medical Version: 1 Begin Effective Date: 2/15/2018 1:57 PM End Effective Date: Current Available at: Carroll Hospital CV Reveal Removal - Pre Procedure Orders Diet


Patient Care Orders

Cardiovascular Procedure T;N, Reveal Removal



Medications






---OR---(NOTE)*





Add

page 41 of 110


Unique Plan Description: AMI Admission (Example Only) Plan Selection Display: AMI Admission PlanType: Medical Version: 1 Begin Effective Date: 2/18/2014 9:07 AM End Effective Date: Current Available at: Carroll Hospital Lev Spec Hosp NWH SHB AMI Admission Admit/Diagnosis Code Status Patient Alerts Vital Signs Activity Diet Patient Care Orders

Intake and Output T;N

Weight T;N, QDay, Standing as tolerated

Straight Catheterize T;N, If no void in next 8 hours

Straight Catheterize T;N, Urinary obstruction/retention

Foley Catheter Insert T;N

Foley Catheter Maintenance T;N

Do Not Vaccinate T;N, Pneumococcal, Indicate follow-up needed on discharge instructions

Do Not Vaccinate T;N, Influenza, Indicate follow-up needed on discharge instructions

Saline Lock IV with Routine Flushes per Protocol VTE Prophylaxis Respiratory Therapy IV Solutions Medications Laboratory Diagnostic Tests Consults Special Other *Report Legend:

Future State

Current Order Sentence

page 42 of 110


Unique Plan Description: ED Adult: Abdominal Pain Plan Selection Display: ED Adult: Abdominal Pain PlanType: Medical Version: 3 Begin Effective Date: 11/20/2018 8:46 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Abdominal Pain Vital Signs

BEST PRACTICE: Maintain MAP > 65 mmHg +/- SBP > 90 mmHg, urine output >/= 0.5 ml/kg/hr(NOTE)*

Vital Signs per Acuity Diet

NPO T;N

NPO T;N, NPO except for medications

Patient Care Orders


Respiratory Therapy

Oxygen Therapy Protocol T;N

Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula, Wean to Room Air

IV Solutions BEST PRACTICE: Immediately bolus 30ml/kg for all septic patients with hypotension or lactate greater than or equal to 4, choose option below based on patient weight(NOTE)* BEST PRACTICE: Notify attending for SBP<90 or MAP<65 after initial fluid bolus completed.(NOTE)* BEST PRACTICE: Notify attending if lactate > or equal to 4(NOTE)*

sodium chloride 0.9% (Bolus) 30 ml/kg, IV, ONCE, STAT, Inj, WIDE OPEN, infuse over 1 hr

Comments: WIDE OPEN

NS (Bolus) 30 ml/kg, IV, ONCE, STAT, Inj, WIDE OPEN, infuse over 30 min(s), 30 ML/KG BOLUS VIA

PRESSURE BAG (over 30 min)

LR (Bolus) 30 ml/kg, IV, ONCE, STAT, Inj, WIDE OPEN, infuse over 30 min(s), 30 ML/KG BOLUS VIA


Sodium Chloride 0.9% 1,000 ml, IV, Duration = 2 dose(s), @ 1,000 ml/hr, for patients < 65kg, WIDE OPEN

Sodium Chloride 0.9% 1,000 ml, IV, Duration = 3 dose(s), @ 1,000 ml/hr, for patients > 65kg, WIDE OPEN

Lactated Ringers 1,000 ml, IV, Duration = 2 dose(s), @ 1,000 ml/hr, for patients < 65kg, WIDE OPEN

Lactated Ringers 1,000 ml, IV, Duration = 3 dose(s), @ 1,000 ml/hr, for patients > 65kg, WIDE OPEN

Sodium Chloride 0.9% 1,000 ml, IV, @ 150 ml/hr, maintenance fluids

Lactated Ringers 1,000 ml, IV, @ 150 ml/hr, maintenance fluids

Dextrose 5% with LR 1,000 ml, IV, ml/hr

Medications


in RED and BLUE

page 43 of 110


BEST PRACTICE: Administration of antibiotics within 1st hour of recognition of symptoms(NOTE)*

ED: Sepsis Antibiotics(SUB)* Antiemetics

ondansetron 4 mg, IV, ONCE, Inj

H2 Antagonists

famotidine 20 mg, PO, ONCE, Tab

famotidine 20 mg, IV, ONCE, Inj

Proton Pump Inhibitors

pantoprazole 40 mg, PO, ONCE, EC Tab

pantoprazole 40 mg, IV, ONCE, Inj

Analgesics: Non-Opioids

acetaminophen 650 mg, PO, ONCE, Tab

acetaminophen 1,000 mg, PO, ONCE, Tab

ibuprofen 400 mg, PO, ONCE, Tab

ketorolac 30 mg, IV, ONCE, Inj

Analgesics: Opioids

oxycodone immediate release 10 mg, PO, ONCE, Tab

morphine 2 mg, IV, ONCE, Inj


hydromorphone 1 mg, IV, ONCE, Inj

Antacids

Maalox 30 ml, PO, ONCE, Susp

simethicone 80 mg, PO, ONCE, Chewable Tab

Laboratory BEST PRACTICE: Repeat lactate within 6 hours of initial lactate(NOTE)*

Lactate (Initial Sepsis) Reflex ST collect Venous Bld, T;N

ED Addon Lab T;N, Stat

Chemistry Panels

CMP ST | Venous Bld, T;N

BMP ST | Venous Bld, T;N

Hepatic Function Panel ST | Venous Bld, T;N

ISTAT POC T;N, Stat, ISTAT 6

Chemistry

Amylase level



Move all ‘Chemistry Panel’ labs under ‘Chemistry’

Change to ‘Direct Bilirubin’

Remove

Remove

Move lactate under ‘Chemistry’

page 44 of 110


ST | Venous Bld, T;N

Albumin level ST | Venous Bld, T;N

Ionized Calcium ST | Venous Bld, T;N

Lipase level ST | Venous Bld, T;N

Magnesium level ST | Venous Bld, T;N

Phosphorus level ST | Venous Bld, T;N

Lactate (Single - NOT for Suspected Sepsis) ST | Venous Bld, T;N

Cardiac Enzymes

Myoglobin, Plasma ST | Venous Bld, T;N, and q4h x 2

Troponin T ST collect Venous Bld, T;N

Troponin I, Plasma ST | Venous Bld, T;N, and q4h x 2

Troponin T Timed Study collect Venous Bld, T;N, q3hr, 9 hr

Hematology

CBC ST | Venous Bld, T;N


PT ST | Venous Bld, T;N

APTT ST | Venous Bld, T;N

D-Dimer ST | Venous Bld, T;N

Fibrinogen Activity ST | Venous Bld, T;N

Urine Studies

Urine Dipstick POC T;N, Stat, Not available at NW ED.

Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)*

Urine HCG POC T;N, Stat, Not available at NW ED.

Urine HCG Qualitative T;N, Urine

Microbiology BEST PRACTICE: Obtain blood cultures prior to antibiotic administration(NOTE)*

Blood Culture T;N, Blood, ST, Peripheral, #1

Blood Culture T;N+1, Blood, ST, Peripheral, #2

Diagnostic Tests

EKG T;N, Stat

EKG. T;N, Stat

Remove

Remove

Move to ‘POC Testing’ category


Remove

I missed this – change to N

and TS q3hr x 2

Remove

page 45 of 110


EKG POC T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain

XR-Abdomen Series(F/E) w PA Chest T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Abd/Pel W IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain

CT-Abd/Pel W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain

CT-Abd/Pel W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain

CT-Abd/Pel WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain

CT-Abd/Pel WOW IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain

CT-Abd/Pel WOW IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain

CT-Abdomen W IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Abdomen W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Abdomen W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Abdomen WO IV WO Oral Contrast

CT-Abdomen WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Pelvis W IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain

CT-Pelvis W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain

CT-Pelvis WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Pelvis W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Pelvis WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

US-Abdomen Complete T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Abdominal Pain


page 46 of 110

5.22.2019 PowerPlan Request Item #11b P 1 of 3 Unique Plan Description: ED Adult: Altered Mental Status Plan Selection Display: ED Adult: Altered Mental Status PlanType: Medical Version: 3 Begin Effective Date: 11/20/2018 8:48 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Altered Mental Status Vital Signs

BEST PRACTICE: Maintain MAP > 65 mmHg +/- SBP > 90 mmHg, urine output >/= 0.5 ml/kg/hr(NOTE)*

Vital Signs per Acuity

Neuro Checks T;N, Perform checks with vital signs

Diet

NPO T;N


Regular Diet T;N

Patient Care Orders

Urinary Catheter Insert T;N

Foley Catheter Maintenance T;N


Respiratory Therapy

Oxygen Therapy T;N, Wean to Room Air

Oxygen (NW)(LSH)(CH) T;N, Routine, Wean to Room Air

ABG Draw T;N, ST



Comments: WIDE OPEN









in RED and BLUE

page 47 of 110





Medications

naloxone 0.4 mg, IV, ONCE, Inj, for opiate reversal

Comments: for opiate reversal

naloxone 2 mg, IV, ONCE, Inj, for opiate reversal

Comments: for opiate reversal

Dextrose 50% 50 ml, IV, ONCE, Inj

lorazepam 1 mg, IV, ONCE, Inj

flumazenil 1 mg, IV, ONCE, Inj, for benzodiazepine reversal

Comments: for benzodiazepine reversal

midazolam 1 mg, IV, ONCE, Inj


ED: Sepsis Antibiotics(SUB)* Laboratory

BEST PRACTICE: Repeat lactate within 6 hours of initial lactate(NOTE)*

Lactate (Initial Sepsis) Reflex ST | Venous Bld, T;N


Chemistry Panels





Chemistry

Ethyl Alcohol Level ST | Venous Bld, T;N

Amylase level ST | Venous Bld, T;N





Hematology





Remove

Remove

Remove


page 48 of 110







Blood Gases

EPOC POC T;N, Stat, EPOC Blood Gases

POC Testing

Blood Glucose Monitoring POC T;N, Stat

Urine Studies



Toxicology Screen Urine (Send Out) T;N, Urine, ST collect

Drug Abuse Screen (DAS) T;N, Urine, ST collect


Blood Culture T;N, Blood, RT, Peripheral


Comments: #2

Sputum Culture w/ gram stain T;N, Sputum Expectorated, RT

Diagnostic Tests

EKG T;N, Stat

EKG POC T;N, Stat

EKG. T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Altered Mental State

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Altered Mental State

CT-Head/Brain W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Altered Mental State

CT-Head/Brain WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Altered Mental State

CT-Head/Brain WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Altered Mental State

*Report Legend:


Remove



Is this Tox Send Out at CHC and Drug Abuse Screen

at Sinai/NW? No, THE OPPOSITE

page 49 of 110


Unique Plan Description: ED Adult: Chest Pain-High Risk (track 1&2) Plan Selection Display: ED Adult: Chest Pain-High Risk (track 1&2) PlanType: Medical Version: 2 Begin Effective Date: 6/19/2018 7:17 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Chest Pain-High Risk (track 1&2) Vital Signs


Cardiac Monitor T;N, Document and interpret rhythm; WHEN IN CARE CENTER


Activity

Bedrest T;N, Times 3 hours then advance if pain free

Diet


Patient Care Orders


Respiratory Therapy


Oxygen (NW)(LSH)(CH) T;N, via Nasal Cannula, Wean to Room Air, Continuous

IV Solutions

sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj

Sodium Chloride 0.9% 1,000 ml, IV

Dextrose 5% in Water 1,000 ml, IV

eptifibatide standard drip (IVS)* premix diluent eptifibatide infusion 75mg/100ml

diltiazem drip standard (Non Critical Care Only) (IVS)* premix diluent diltiazem infusion 125 mg/125 ml

Diltiazem Continuous Infusion - Critical Care Only(NOTE)*

diltiazem drip standard (Critical Care Only) (IVS)* premix diluent (titrate) diltiazem infusion 125 mg/125 ml

Intravenous nitrates(NOTE)* Nitroglycerin Continuous Infusion - Non Critical Care Only(NOTE)*

nitroglycerin drip standard (Non Critical Care Only) (IVS)* premix diluent nitroglycerin infusion 50 mg/250mL

Nitroglycerin Continuous Infusion - Critical Care Only(NOTE)*

nitroglycerin drip standard (Critical Care Only) (IVS)* premix diluent (titrate)


in RED and BLUE

page 50 of 110


nitroglycerin infusion 50 mg/250mL DOPamine Continuous Infusion - Non Critical Care Only(NOTE)*

DOPamine drip standard (Non Critical Care Only) (IVS)* premix diluent DOPamine infusion 400 mg/ 250 mL

DOPamine Continuous Infusion - Critical Care Only(NOTE)*

DOPamine drip standard (Critical Care Only) (IVS)* premix diluent (titrate) DOPamine infusion 400 mg/ 250 mL

nesiritide drip standard (IVS)* Dextrose 5% in Water nesiritide (for wt drip) Medications Salicylates

aspirin 162 mg, PO, ONCE, STAT, Chewable Tab

aspirin 325 mg, PO, ONCE, STAT, Tab

Glycoprotein IIb/IIIa Inhibitors

eptifibatide (bolus) 180 mcg/kg, IV, ONCE, STAT, Inj, maximum bolus = 22.6mg

Anticoagulants

enoxaparin 1 mg/kg, subQ, ONCE, Inj

Heparin Drip for ACS (UA/NSTEMI or STEMI) Weight-Based Dosing Protocol(SUB)* Beta Blockers

metoprolol 5 mg, IV, Q15 mins, Inj, Duration = 3 dose(s)

metoprolol 50 mg, PO, ONCE, Tab

atenolol 50 mg, PO, ONCE, Tab

carvedilol 3.125 mg, PO, ONCE, Tab

carvedilol 6.25 mg, PO, ONCE, Tab

Calcium Channel Blockers

diltiazem 5 mg, IV, ONCE, Inj

diltiazem 10 mg, IV, ONCE, Inj

diltiazem 0.25 mg/kg, IV, ONCE, Inj

Comments: bolus dose Nitrates

nitroglycerin 0.4 mg, SL, Q5 mins, PRN, chest pain, SL Tab, Duration = 3 dose(s)

Comments: X 3 doses prn Angiotensin-Converting Enzyme Inhibitors

captopril 6.25 mg, PO, ONCE, Tab

lisinopril 2.5 mg, PO, ONCE, Tab

Loop Diuretics

furosemide


page 51 of 110


20 mg, IV, ONCE, Inj

furosemide 40 mg, IV, ONCE, Inj

furosemide 80 mg, IV, ONCE, Inj

H2 Antagonists



Miscellaneous

nesiritide (bolus) 2 mcg/kg, IV, ONCE, Inj



Laboratory


Chemistry Panels



Cardiac Enzymes

Troponin I, Plasma ST | Venous Bld, T;N

Troponin I, Plasma Timed Study collect Venous Bld, T;N+180


Troponin T Timed Study collect Venous Bld, T;N+180

Chemistry




ProBNP ST | Venous Bld, T;N

Hematology








Change to ‘Lactate (initial sepsis) Reflex’

Move cardiac enzymes under ‘Chemistry’

Is this the CHC d-dimer? Should it always appear as an

alternative to the SH d-dimer, for CHC viewing? NOT VIEWABLE

AT CARROLL

page 52 of 110


D-Dimer ELISA ST | Venous Bld, T;N


Urine Studies

Urine HCG POC T;N, Stat, for women of child-bearing age; Not available at NW ED.

Urine HCG Qualitative T;N, Urine, for women of child-bearing age

Diagnostic Tests

EKG T;N, Stat, within 10 minutes of arrival, chest pain

EKG POC T;N, Stat, within 10 minutes of arrival

EKG. T;N, Stat, within 10 minutes of arrival

Dobutamine Stress Test, Nuclear(SUB)*

CT-Aortic Dissection T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain

CT-Thorax PE T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain

CT-Thorax W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Thorax WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Thorax WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

NM-Myocard SPECT Multi T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain-High Risk (track

1&2)

NM-Nuclear Stress Test (NW) T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain-Jigh Risk (track

1&2)

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Chest Pain-High Risk (Track

1&2)

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain-High Risk (track

1&2) *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


Remove


page 53 of 110


Unique Plan Description: ED Adult: Chest Pain-Low Risk (track 3) Plan Selection Display: ED Adult: Chest Pain-Low Risk (track 3) PlanType: Medical Version: 2 Begin Effective Date: 6/19/2018 7:15 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Chest Pain-Low Risk (track 3) Vital Signs


Cardiac Monitor


Activity

Bedrest T;N, X3 hours then advance if pain free

Bedrest T;N, Bathroom Privileges

Up Ad Lib T;N, ad lib

Diet


Patient Care Orders


Respiratory Therapy


Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula, Wean to Room Air, Continuous

IV Solutions


Sodium Chloride 0.9% 1,000 ml, IV, ml/hr

Dextrose 5% in Water 1,000 ml, IV

Medications Provider should continue patient's home medication regimen(NOTE)*

Salicylates

aspirin 162 mg, PO, ONCE, STAT, Chewable Tab

Comments: chew tablets

aspirin 325 mg, PO, ONCE, STAT, Tab

Nitrates

nitroglycerin 0.4 mg, SL, Q5 mins, PRN, chest pain, SL Tab, x 3 doses

Comments: X 3 doses prn Beta Blockers


in RED and BLUE

page 54 of 110


metoprolol 25 mg, PO, BID, Tab

metoprolol 50 mg, PO, BID, Tab

Miscellaneous


Laboratory


Chemistry Panels



N-Terminal Brain Natriuretic Peptide ST | Venous Bld, T;N

Cardiac Enzymes

Troponin I, Plasma ST collect Venous Bld, T;N


Troponin I, Plasma Timed Study collect Venous Bld, T;N+180

Troponin T Timed Study collect Venous Bld, T;N+180

Hematology







Urine Studies

Urine HCG POC T;N, Stat, For women of childbearing age; Not available at NW ED.

Urine HCG Qualitative T;N, Urine, For women of childbearing age

Diagnostic Tests

CT-Aortic Dissection T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain

CT-Thorax PE T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain

CT-Thorax W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Thorax WO IV Contrast



Remove


Move cardiac enzymes under ‘Chemistry’

Add magnesium and Phos under ‘Chemistry’

page 55 of 110


T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

CT-Thorax WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg

NM-Myocard SPECT Multi T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain-Low Risk (track

3)

NM-Myocard SPECT Multi (NW) T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain-Low Risk (track

3)

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Chest Pain-Low Risk (Track 3)

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Chest Pain-Low Risk (track

3) Cardiac

EKG. T;N, Stat, within 10 minutes of arrival

EKG. T;N, Stat, w/Chest Pain

EKG POC T;N, Stat, within 10 minutes of arrival

EKG POC T;N, Stat, w/Chest Pain

EKG T;N, Stat, within 10 minutes of arrival, chest pain

EKG T;N, Stat, w/Chest Pain, chest pain

Other

ED Referral for Low Risk Chest Pain Referral (CH) T;N



page 56 of 110

5.22.2019 PowerPlan Request Item #11e P 1 of 5

Unique Plan Description: ED Adult: Community Acquired Pneumonia Plan Selection Display: ED Adult: Community Acquired Pneumonia PlanType: Medical Version: 1 Begin Effective Date: 10/31/2017 9:34 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Community Acquired Pneumonia Patient Alerts

Isolation T;N, Airborne (negative air flow), If TB/SARS is being considered

Vital Signs

Pulse Ox (Pt Care) T;N, On room air or baseline O2.

Vital Signs per Acuity T;N

Pulse Ox (Pt Care) T;N, check before and after aerosol treatment; WHEN IN CARE CENTER

Diet

NPO T;N


Regular Diet T;N

Patient Care Orders


Respiratory Therapy


Oxygen (NW)(LSH)(CH) T;N, Routine, Continuous

ABG Draw T;N

IV Solutions





Medications Oral Antibiotics(NOTE)* Recommendations based on ISDA 2003 CAP guidelines.(NOTE)* Previously healthy outpatients with NO recent antibiotic therapy (Select ONE):(NOTE)*

azithromycin 500 mg, Tab, PO, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric


in RED and BLUE

page 57 of 110


doxycycline 100 mg, Tab, PO, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric Previously healthy outpatients with recent antibiotic therapy:(NOTE)* Recommended- fluoroquinolone alone OR azithromycin PLUS amoxicillin OR Augmentin.(NOTE)*

moxifloxacin 400 mg, PO, ONCE, Site of Infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Tab

levofloxacin 750 mg, PO, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Tab, for CrCl >= 10 ml/min

azithromycin 500 mg, PO, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Tab

amoxicillin 1,000 mg, PO, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Capsule

Augmentin 2,000 mg, PO, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Tab Outpatients with comorbidities (COPD, diabetes, renal or congestive heart failure) and NO recent antibiotic therapy (Select ONE):(NOTE)*


Empiric, Tab


Empiric, Tab


Empiric, Tab, for CrCl >= 10 ml/min Outpatients with comorbidities (COPD, diabetes, renal or congestive heart failure) AND recent antibiotic therapy:(NOTE)* Recommended- fluoroquinolone alone OR azithromycin PLUS amoxicillin OR Augmentin)(NOTE)*


Empiric, Tab




Empiric, Tab


Empiric, Capsule


Empiric, Tab Suspected aspiration with infection:(NOTE)*

Augmentin 875 mg, PO, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Tab Influenza with bacterial superinfection:(NOTE)*


page 58 of 110



Empiric, Tab




Empiric, Capsule


Empiric, Tab IV Antibiotics(NOTE)* Recommended- fluoroquinolone alone OR azithromycin PLUS ceftriaxone OR Unasyn(NOTE)*

moxifloxacin 400 mg, IV, ONCE, Site of Infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Inj

levofloxacin 750 mg, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Inj, for CrCl >= 10 ml/min

azithromycin 500 mg, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Inj

ceftriaxone 1 gm, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism = Empiric,

Inj

Unasyn 1.5 gm, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Inj Suspected Pseudomonas Infection:(NOTE)* Recommended- Zosyn + Azithromycin +/- Gent OR Zosyn + fluoroquinolone +/- Gent(NOTE)*

Zosyn 3.375 gm, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Inj

Zosyn 3.375 gm, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Inj


Empiric, Inj


Empiric, Inj, for CrCl >= 10 ml/min

azithromycin 500 mg, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Inj Suspected Pseudomonas infection (with a Beta lactam allergy):(NOTE)* Recommended- aztreonam PLUS fluoroquinolone(NOTE)*

aztreonam 1 gm, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism = Empiric,

Inj


Empiric, Inj


page 59 of 110



Empiric, Inj, for CrCl >= 10 ml/min ADD to regimen if aspiration suspected:(NOTE)*

clindamycin 600 mg, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =

Empiric, Inj


Comments: do NOT exceed TOTAL acetaminophen daily dose of 4 grams/24 hours




guaifenesin 200 mg, PO, ONCE, Liq

pseudoephedrine 30 mg, PO, ONCE, Tab

loratadine 10 mg, PO, ONCE, Tab

Laboratory


Chemistry Panels




Chemistry




Hematology



Blood Gases

EPOC POC T;N, Stat, EPOC Blood Gases, Blood Gas : If SpO2 on room air is less than 96%

Microbiology

Culture / Blood T;N, Blood, RT, Peripheral, #1 pre-antibiotics

Culture / Blood T;N, Blood, RT, Peripheral, #2 pre-antibiotics

Sputum Culture w/ gram stain T;N, Sputum Expectorated, RT, pre-antibiotics



Remove


Change to Lactate (initial sepsis) reflex

Add Urine Studies section with Urinalysis w micro

reflex AND Toxicology screen DRAB

page 60 of 110


AFB Culture T;N, RT

Throat Culture / Beta Strep T;N, Throat, RT

Rapid Strep Test-POC (Sinai ED Only) T;N, Stat

Legionella Antigen (Urine) T;N, Urine, ST

Influenza PCR ST collect Nasopharyngeal Swab, T;N

Urine Pneumococcal Antigen T;N, Urine, ST

Diagnostic Tests

EKG T;N, Stat

EKG. T;N, Stat

EKG POC T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Suspected CAP

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Suspected CAP



page 61 of 110


Unique Plan Description: ED Adult: Ectopic Pregnancy-Rule Out Plan Selection Display: ED Adult: Ectopic Pregnancy-Rule Out PlanType: Medical Version: 1 Begin Effective Date: 4/4/2017 8:54 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Ectopic Pregnancy-Rule Out Vital Signs


Diet

NPO T;N


Regular Diet T;N

Patient Care Orders


Transfuse Red Cells T;N, Stat

Respiratory Therapy

Oxygen Therapy T;N, Stat, Wean to Room Air

Oxygen (NW)(LSH)(CH) T;N, Stat, via Nasal Cannula

ABG Draw T;N, ST

IV Solutions

sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Start T;N, STAT, Inj

Sodium Chloride 0.9% 1,000 ml, IV, STAT, ml/hr, Start T;N

Lactated Ringers 1,000 ml, IV, STAT, ml/hr, Start T;N

Medications

hydromorphone 1 mg, IV, ONCE, STAT, Inj

hydromorphone 2 mg, IV, ONCE, STAT, Inj

morphine 2 mg, IV, ONCE, STAT, Inj

morphine 4 mg, IV, ONCE, STAT, Inj

acetaminophen 650 mg, PO, ONCE, STAT, Tab


ondansetron ODT 4 mg, PO, ONCE, STAT, ODT Tab

ondansetron


in RED and BLUE

page 62 of 110


4 mg, IV, ONCE, STAT, Inj Laboratory Chemistry Panels




ISTAT POC T;N, Stat, ISTAT-6

Chemistry






Hcg Quantitative Test ST | Venous Bld, T;N

Hematology







Blood Bank

Type, Crossmatch & Transfuse(SUB)*




Blood Gases


Urine Studies







Remove

Remove

Remove

Remove




Remove or file under top Laboratory header

page 63 of 110


Urine HCG Qualitative T;N, Urine, ST collect

Diagnostic Tests

EKG T;N, Stat

EKG POC T;N, Stat

EKG. T;N, Stat

US-Limited OB T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: r/o Ectopic Pregnancy

US-Ectopic Pregnancy <14 weeks T;N Stat

US-Transvaginal OB US T;N Stat


Changes

Marked Below

Uncheck

page 64 of 110


Unique Plan Description: ED Adult: Female Genitourinary: UTI;PID;STD; or Vaginal Bleeding (non-pregnancy) Plan Selection Display: ED Adult: Female Genitourinary: UTI;PID;STD; or Vaginal Bleeding (non-pregnancy) PlanType: Medical Version: 1 Begin Effective Date: 10/31/2017 9:50 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Female Genitourinary: UTI;PID;STD; or Vaginal Bleeding (non-pregnancy) Vital Signs


NPO T;N


Regular Diet T;N

Patient Care Orders OBTAIN URINE FOR POSSIBLE CULTURE PRIOR TO STARTING ANTIBIOTIC THERAPY(NOTE)*


IV Solutions





Medications Acute uncomplicated cystitis/ pyelonephritis(NOTE)*

Bactrim DS tablet 1 tab(s), PO, ONCE, Site of Infection = UTI, Suspected Organism = Empiric, Tab

cephalexin 500 mg, PO, ONCE, site of infection = UTI, Suspected Organism = Empiric, Capsule

For patients allergic to Sulfa:(NOTE)*

cefazolin 1 gm, IV, ONCE, site of infection = UTI, Suspected Organism = Empiric, Inj

Acute cystitis, pregnant patient:(NOTE)*

amoxicillin 250 mg, PO, ONCE, site of infection = UTI, Suspected Organism = Empiric, Capsule

Macrobid 100 mg, PO, ONCE, site of infection = UTI, Suspected Organism = Empiric, Capsule

cephalexin 500 mg, PO, ONCE, site of infection = UTI, Suspected Organism = Empiric, Capsule

Acute pyelonephritis, pregnant patient (select BOTH):(NOTE)*

ampicillin (inj)

gentamicin 3 mg/kg, IV, ONCE, site of infection = UTI, Suspected Organism = Empiric, Inj

Acute complicated cystitis/ foley:(NOTE)*

gentamicin 3 mg/kg, IV, ONCE, site of infection = UTI, Suspected Organism = Empiric, Inj


in RED and BLUE

page 65 of 110


For chlamydia:(NOTE)*

azithromycin 1 gm, PO, ONCE, site of infection = Sexually Transmitted Diseases, Suspected Organism = Empiric,

Oral Powder Uncomplicated urethritis, cervicitis (gonorrhea)- treat also for Chlamydia:(NOTE)*

ceftriaxone 125 mg, IM, ONCE, site of infection = Sexually Transmitted Diseases, Suspected Organism = Empiric,

Inj Pelvic Inflammatory Disease (PID):(NOTE)* Recommended: Ceftriaxone + Doxycycline OR Cefoxitin + Doxycycline :(NOTE)*

ceftriaxone 250 mg, IM, ONCE, site of infection = Sexually Transmitted Diseases, Suspected Organism = Empiric,

Inj

doxycycline 100 mg, PO, ONCE, site of infection = Sexually Transmitted Diseases, Suspected Organism = Empiric,

Tab

metronidazole 500 mg, PO, ONCE, site of infection = Sexually Transmitted Diseases, Suspected Organism = Empiric,

Tab

cefoxitin 2 gm, IV, ONCE, site of infection = Sexually Transmitted Diseases, Suspected Organism = Empiric, Inj

doxycycline 100 mg, IV, ONCE, site of infection = Sexually Transmitted Diseases, Suspected Organism = Empiric,

Inj Comments: Seal unused drug in ziplock bag, return to pharmacy

Vaginal Candidiasis:(NOTE)*

fluconazole 150 mg, PO, ONCE, Tab

Comments: Suspected Organism = Candida sp. Trichomoniasis:(NOTE)*

metronidazole 2,000 mg, PO, ONCE, site of infection = Sexually Transmitted Diseases, Suspected Organism =

Empiric, Tab Bacterial vaginosis:(NOTE)*

metronidazole 500 mg, PO, ONCE, site of infection = Other, Suspected Organism = Empiric, Tab






Laboratory


RPR ST | Venous Bld, T;N

Syphilis EIA w/ Reflex RPR ST collect Venous Bld, T;N

Gonorrhoeae_Amplified ST collect, T;N

Chlamydia_Amplified ST collect, T;N


Move all micro tests under microbiology: gonorh,

chlam, vaginitis; move RPR, Syphilis to chemistry;

RPR is Carroll only and Syph EIA is SH/NW

page 66 of 110


Vaginitis, DNA Probe ST collect, T;N

Sed Rate ST | Venous Bld, T;N

C Reactive Protein ST | Venous Bld, T;N

Chemistry Panels




Blood Bank



Hematology



Coagulation





Urine Studies

Urine Dipstick POC T;N, Stat, If positive, save for C&S; Not available at NW ED.


Urine HCG POC T;N, Stat, If capable of childbearing; Not available at NW ED.

Urine HCG Qualitative T;N, Urine, If capable of childbearing

Microbiology

Gram Stain T;N, Other, ST, Urine

Gram Stain T;N, Other, ST, Vaginal Discharge

Diagnostic Tests

US-Abdomen Limited T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;

Vaginal Bleeding (non-pregnancy)

CT-Abd/Pel W IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Abd/Pel W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;




and add lactate reflex

Remove



Remove

Remove

Remove

page 67 of 110


CT-Abd/Pel W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Abd/Pel WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Abd/Pel WOW IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Abd/Pel WOW IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Abdomen W IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Abdomen W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Abdomen W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Abdomen WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Abdomen WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Pelvis W IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Pelvis W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Pelvis WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Pelvis W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


CT-Pelvis WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;


XR-Abdomen KUB T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;

Vaginal Bleeding (non-pregnancy) *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

page 68 of 110

5.22.2019 PowerPlan Request Item #11h P 1 of 2 Unique Plan Description: ED Adult: GI Bleed Plan Selection Display: ED Adult: GI Bleed PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:14 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: GI Bleed Vital Signs

Vital Signs

Orthostatic Vital Signs T;N, BP and Pulse Only, Sitting and lying with vital signs

Diet

NPO T;N


Patient Care Orders

Nasogastric/Orogastric Tube Insert T;N

Nasogastric/Orogastric Tube Maintenance T;N, to Low Intermittent Suction, Lavage nasogastric tube with Normal Saline until clear


Transfuse Red Cells Respiratory Therapy


Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula

IV Solutions





Medications



pantoprazole 40 mg, PO, ONCE, EC Tab

pantoprazole 40 mg, IV, ONCE, Inj, if patient is NPO

phytonadione 1 mg, IV, ONCE, Inj, consider for warfarin reversal



in RED and BLUE

page 69 of 110

5.22.2019 PowerPlan Request Item #11h P 2 of 2


Laboratory


Chemistry Panels





Chemistry




Hematology





Guaiac Stools POC T;N, Stat, Guiac first stool

Blood Bank



Type, Crossmatch & Transfuse(SUB)* Diagnostic Tests

EKG T;N, Stat

EKG. T;N, Stat

EKG POC T;N, Stat

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: NG tube placement. Order if

NG tube to be used for medication *Report Legend:




Remove


uncheck

page 70 of 110

5.22.2019 PowerPlan Request Item #11i P 1 of 3

Unique Plan Description: ED Adult: Headache Plan Selection Display: ED Adult: Headache PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:15 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Headache Vital Signs


NPO T;N


Regular Diet T;N

Patient Care Orders


Respiratory Therapy

ABG Draw T;N, ST

IV Solutions





Medications






Fioricet 1 tab(s), PO, ONCE, Tab

sumatriptan 6 mg, subQ, ONCE, Inj

dihydroergotamine 1 mg, IV, ONCE, Inj

metoclopramide 10 mg, IV, ONCE, Inj

indomethacin


in RED and BLUE

page 71 of 110


75 mg, PO, ONCE, ER Capsule

prochlorperazine 5 mg, IV, ONCE, Inj

prochlorperazine 10 mg, PO, ONCE, Tab

promethazine 25 mg, PO, ONCE, Tab

Laboratory


Chemistry Panels





Chemistry






Carboxyhemoglobin ST | Venous Bld, T;N

Hematology





Blood Gases


Urine Studies



Diagnostic Tests

EKG T;N, Stat

EKG POC T;N, Stat

EKG.




Remove

Remove

Remove



page 72 of 110


T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Headache

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Headache

CT-Head/Brain W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Headache

CT-Head/Brain WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Headache

CT-Head/Brain WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Headache


page 73 of 110

5.22.2019 PowerPlan Request Item #11j P 1 of 2

Unique Plan Description: ED Adult: Heart Failure Plan Selection Display: ED Adult: Heart Failure Plan Synonyms: CHF PlanType: Medical Version: 1 Begin Effective Date: 2/28/2017 9:18 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Heart Failure Patient Alerts

Notify MD if Notify MD for urinary output <1000mL in 2 hours (or <500mL if cre >2.5) after IV diuretics

Vital Signs

Vital Signs with Pulse Oximetry T;N

Cardiac Monitor T;N, when in patient care area

NON-INPATIENT UNIT Cardiac Monitor T;N, when in patient care area

Activity

Bedrest T;N, when in patient care area

Diet


Restricted Diet T;N

Patient Care Orders



Respiratory Therapy


Oxygen (NW)(LSH)(CH) T;N, via Nasal Cannula

BIPAP T;N

IV Solutions

nitroglycerin drip standard (Critical Care Only) (IVS)* premix diluent (titrate) nitroglycerin infusion 50 mg/250mL Medications

furosemide 40 mg, IV, ONCE, STAT, Inj (DEF)* 80 mg, IV, ONCE, STAT, Inj

nitroglycerin 0.4 mg, SL, ONCE, STAT

nitroglycerin 2% topical ointment 1 in, TOP, ONCE, Top Oint

morphine 1 mg, IV, ONCE, STAT, Inj (DEF)*


page 74 of 110

5.22.2019 PowerPlan Request Item #11j P 2 of 2

2 mg, IV, ONCE, STAT, Inj 4 mg, IV, ONCE, STAT, Inj

Laboratory Chemistry Panels


BNP(ProBNP) ST | Venous Bld, T;N, only if HF diagnosis is uncertain

Chemistry


Digoxin level ST | Venous Bld, T;N

Cardiac Enzymes



Hematology


Auto Differential ST | Venous Bld, T;N


PT/ INR ST | Venous Bld, T;N


Urine Studies

Urinalysis w/Reflex to Urine Culture ST | Urine, T;N

Diagnostic Tests

EKG T;N

EKG POC T;N

EKG. T;N

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER

XR-Chest 1V T;N Stat, Transport Mode: PORTABLE




add phosphorous

Move all ‘cardiac enzyme’ labs under ‘Chemistry’

page 75 of 110

5.22.2019 PowerPlan Request Item #11k P 1 of 2 Unique Plan Description: ED Adult: Lab Plan Selection Display: ED Adult: Lab PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:15 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Lab Respiratory Therapy

ABG Draw T;N, ST

Laboratory



Drugs of Abuse Panel T;N, Urine, ST collect

Chemistry Panels




Note: Lipid Panel includes Total Cholesterol, HDL, Triglycerides, and Calculated LDL. LDL Direct will be added by reflex when triglycerides are > 400.(NOTE)*

Lipid Panel RT | Venous Bld, T;N


Cardiac Enzymes



Chemistry






Acetaminophen Level ST | Venous Bld, T;N

Carbamazepine Level ST | Venous Bld, T;N

Depakene Level ST | Venous Bld, T;N


in RED and BLUE



Remove

Remove

Add comment, ‘Must Transport on Ice.’

Move all ‘cardiac enzymes’ labs under ‘Chemistry’

Move to urine studies; why are there 2 here? CHC

vs SH/NW? YES

Remove

Add lactate

reflex

page 76 of 110

5.22.2019 PowerPlan Request Item #11k P 2 of 2


Dilantin Level ST | Venous Bld, T;N


Lithium Level ST | Venous Bld, T;N

Methotrexate Level ST | Serum, T;N

Phenobarbital Level ST | Venous Bld, T;N

Salicylate Level ST | Venous Bld, T;N

Theophylline Level ST | Venous Bld, T;N

Hematology


Auto Differential ST | Venous Bld, T;N

Coagulation





Blood Gases


Urine Studies





Microbiology




*Report Legend:





page 77 of 110

5.22.2019 PowerPlan Request Item #11l P 1 of 3

Unique Plan Description: ED Adult: Nausea / Vomiting / Diarrhea Plan Selection Display: ED Adult: Nausea / Vomiting / Diarrhea PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:16 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Nausea / Vomiting / Diarrhea Vital Signs


NPO T;N


Regular Diet T;N

Patient Care Orders


Respiratory Therapy



IV Solutions





Medications Antidiarrheal Agents

Avoid if bloody diarrhea or febrile(NOTE)*

loperamide 4 mg, PO, ONCE, NOW, Capsule

loperamide 2 mg, PO, as directed, Other, see comments, Capsule

Comments: after each loose stool: Do not exceed 16 mg/24 hours. Antibiotics

Consider empiric therapy while awaiting culture results in the following patients: with fever or bloody diarrhea, greater than 8 stools per day, immunocompromised or dehydrated.(NOTE)*

Bactrim DS tablet 1 tab(s), PO, ONCE, Site of Infection = GI infection, Suspected Organism = Empiric, Tab

metronidazole 500 mg, PO, ONCE, site of infection = GI infection, Suspected Organism = C. difficile, Tab

metronidazole 500 mg, IV, ONCE, site of infection = GI infection, Suspected Organism = C. difficile, Inj

Antiemetics

ondansetron


in RED and BLUE


page 78 of 110


4 mg, IV, ONCE, Inj

metoclopramide 10 mg, IV, ONCE, Inj

prochlorperazine 10 mg, PO, ONCE, Tab

prochlorperazine 25 mg, rectal, ONCE, Supp

promethazine 25 mg, rectal, ONCE, Supp

Laboratory



Chemistry Panels



Chemistry







Hematology





Urine Studies




Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)* Microbiology

Blood Culture T;N, Blood, RT, Peripheral, consider if febrile

Blood Culture T;N, Blood, RT, Peripheral, consider if febrile



Remove

Remove

Remove



Change to Lactate Reflex

page 79 of 110


Culture / Stool T;N, Stool, RT

Ova/Parasites Examination Feces, RT collect

Guaiac Stools POC T;N, Stat

Diagnostic Tests

EKG T;N, Stat

EKG POC T;N, Stat

EKG. T;N, Stat

XR-Abdomen Flat & Erect T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Nausea / Vomiting / Diarrhea


Remove

Move to POC category

page 80 of 110

5.22.2019 PowerPlan Request Item #11m P 1 of 3

Unique Plan Description: ED Adult: Neuro Symptoms Deficit Plan Selection Display: ED Adult: Neuro Symptoms Deficit PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:16 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Neuro Symptoms Deficit Vital Signs


Neuro Checks T;N, perform with vital signs

Diet

NPO T;N


Regular Diet T;N

Regular Diet T;N

Patient Care Orders


Respiratory Therapy



ABG Draw T;N, ST

IV Solutions




Laboratory


Chemistry Panels





Chemistry

Amylase level


in RED and BLUE




Remove

Remove

page 81 of 110







Hematology







Blood Gases


Urine Studies


Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)* Diagnostic Tests

EKG T;N, Stat

EKG. T;N, Stat

EKG POC T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-Head/Brain W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-Head/Brain WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-Head/Brain WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-C Spine W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-C Spine WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-C Spine WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-L Spine W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

Remove

Remove


Remove

Remove, unless this is a CHC test only

page 82 of 110


CT-L Spine WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-L Spine WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-T Spine W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-T Spine WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit

CT-T Spine WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Neuro Symptoms Deficit


page 83 of 110

5.22.2019 PowerPlan Request Item #11n P 1 of 4

Unique Plan Description: ED Adult: Psych Disorder-Suicide Attempt/Overdose Plan Selection Display: ED Adult: Psych Disorder-Suicide Attempt/Overdose PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:17 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Psych Disorder-Suicide Attempt/Overdose Vital Signs


NPO T;N


Regular Diet T;N

Patient Care Orders

Nasogastric/Orogastric Tube Insert T;N

Nasogastric/Orogastric Tube Maintenance T;N


Respiratory Therapy



ABG Draw T;N, ST

IV Solutions





Sodium Chloride 0.45% 1000ml & sodium bicarbonate 100 meq (IVS)* Sodium Chloride 0.45%

1,000 ml, IV, ml/hr sodium bicarbonate

100 mEq, Every Bag

Dextrose 5% 1000ml & sodium bicarbonate 100 meq (IVS)* Dextrose 5% in Water

1,000 ml, IV, ml/hr sodium bicarbonate

100 mEq, Every Bag DOPamine Continuous Infusion - Non Critical Care Only(NOTE)*

DOPamine drip standard (Non Critical Care Only) (IVS)* premix diluent


in RED and BLUE


page 84 of 110


250 ml, IV DOPamine infusion 400 mg/ 250 mL

400 mg, mcg/kg/min DOPamine Continuous Infusion - Critical Care Only(NOTE)*

DOPamine drip standard (Critical Care Only) (IVS)* premix diluent (titrate)

250 ml, IV, Start T;N, Titrate By = 2.5 mcg/kg/min, Titrate Frequency (min)= 5, Maximum Dose = 50 mcg/kg/min

Comments: Adjust titration dose according to patient response DOPamine infusion 400 mg/ 250 mL

400 mg, mcg/kg/min

norepinephrine drip standard (IVS)* Dextrose 5% in Water (titrate)

500 ml, IV, Start T;N, standard concentration, Titrate By = 2 mcg/min, Titrate Frequency (min)= 5, Maximum Dose = 50 mcg/min

Comments: Adjust titration dose according to patient response norepinephrine

4 mg, mcg/min Medications

charcoal sorbitol base 50 gm, PO, ONCE, Liq

acetylcysteine 140 mg/kg, NGTube, ONCE, STAT, Liq

Comments: Loading dose: dilute with soda or fruit juice to a five percent solution before administration.

acetylcysteine 70 mg/kg, NGTube, Q4H, Start T;N+4, Liq, Duration = 17 dose(s), Total dose = 1330 mg /kg

acetylcysteine 150 mg/kg, IV, ONCE, STAT, Inj

Comments: Loading dose: in 200 ml D5W to infuse over 1 hour

acetylcysteine 50 mg/kg, IV, ONCE, STAT, Inj

Comments: in 500 ml D5W: infuse over 4 hours

acetylcysteine 100 mg/kg, IV, ONCE, Start T;N+4, Inj

Comments: in 1000 ml D5W, infuse over 16 hours

naloxone 0.4 mg, IV, ONCE, STAT, Inj

naloxone 1 mg, IV, ONCE, STAT, Inj

lorazepam 2 mg, IV, ONCE, STAT, Inj

Comments: for seizure

glucagon 5 mg, IV, ONCE, STAT, Inj

calcium gluconate 1 gm, IV, ONCE, STAT, Inj

Dextrose 50% 50 ml, IV, ONCE, STAT, Inj

Laboratory


Chemistry Panels


CMP

Changes Marked Below Move all ‘Chemistry Panel’

labs under ‘Chemistry’


page 85 of 110





Chemistry






Osmolality, Serum ST | Venous Bld, T;N

Toxicology Screen Blood (Send Out) Drug Levels

Acetaminophen Level ST | Venous Bld, T;N, 4 hours after ingestion

Salicylate Level ST | Venous Bld, T;N



Depakene Level ST | Venous Bld, T;N


Dilantin Level ST | Venous Bld, T;N

Lithium Level ST | Venous Bld, T;N

Methotrexate Level ST | Serum, T;N


Theophylline Level ST | Venous Bld, T;N

Hematology






Fibrinogen Activity

Remove

Remove

Add Comment, ‘Must transport on Ice.’

Remove

Remove

Remove

page 86 of 110


ST | Venous Bld, T;N Blood Gases


Urine Studies






Diagnostic Tests

EKG T;N, Stat

EKG POC T;N, Stat

EKG. T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Psychiatric Disorder-Suicide

Attempt/Overdose

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Psychiatric Disorder-Suicide

Attempt/Overdose NOTE: If intubation necessary ensure high minute ventilation to maintain alkalemia with serum pH 7-50 - 7.59.(NOTE)*






page 87 of 110

5.22.2019 PowerPlan Request Item #11o P 1 of 3

Unique Plan Description: ED Adult: Renal Colic/Flank Pain Plan Selection Display: ED Adult: Renal Colic/Flank Pain PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:17 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Renal Colic/Flank Pain Vital Signs


NPO T;N


Patient Care Orders

Strain Urine T;N


Respiratory Therapy



IV Solutions





Medications Analgesics: Non-Opioids



Analgesics: Opioids

oxycodone immediate release 5 mg, PO, ONCE, Tab





Antiemetics


in RED

page 88 of 110



Laboratory


Chemistry Panels




Chemistry






Hematology





Urine Studies



Urine HCG POC T;N, Stat, for women of childbearing age, Not available at NW ED.

Urine HCG Qualitative T;N, Urine, for women of childbearing age

Diagnostic Tests

EKG T;N, Stat

EKG. T;N, Stat

EKG POC T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Renal Colic/ Flank Pain

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Renal Colic/ Flank Pain

XR-Abdomen KUB T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Renal Colic/ Flank Pain

CT-Abd/Pel W Oral Contrast Only



Remove

Remove

Remove


Move to ‘POC Testing’

category

page 89 of 110


T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Renal Colic/ Flank Pain

CT-Abd/Pel WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Renal Colic/ Flank Pain

CT-Abdomen WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Renal Colic/ Flank Pain

CT-Abdomen W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Renal Colic/ Flank Pain

CT-Pelvis WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Renal Colic/ Flank Pain

CT-Pelvis W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Renal Colic/ Flank Pain


page 90 of 110

5.22.2019 PowerPlan Request Item #11p P 1 of 3

Unique Plan Description: ED Adult: Respiratory Distress/Failure Plan Selection Display: ED Adult: Respiratory Distress/Failure PlanType: Medical Version: 3 Begin Effective Date: 11/20/2018 8:47 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Respiratory Distress/Failure Patient Alerts

Isolation T;N, If AFB ordered

Vital Signs BEST PRACTICE: Maintain MAP > 65 mmHg +/- SBP > 90 mmHg, urine output >/= 0.5 ml/kg/hr(NOTE)*


Pulse Ox (Pt Care) T;N, Checks before and after aerosol treatment

Activity

Elevate T;N, Head of Bed greater than 30 degrees

Diet

NPO T;N


Regular Diet T;N

Patient Care Orders

Urinary Catheter Insert T;N

Urinary Catheter Maintenance T;N, Discontinue orders: Remove per nursing protocol


Respiratory Therapy


Oxygen (NW)(LSH)(CH) T;N, Stat, Continuous

Ventilator Settings T;N, Mechanical Ventilation; Initiation and adjustment per Respiratory Therapy

Oxygen Therapy T;N, Non-Invasive Ventilation; Initiation and adjustment per Respiratory therapy.

CPAP T;N, Initiate and adjust per Respiratory Therapy

BIPAP T;N, Initiate and adjust per Respiratory Therapy

ABG Draw IV Solutions

BEST PRACTICE: Immediately bolus 30ml/kg for all septic patients with hypotension or lactate greater than or equal to 4, choose option below based on patient weight(NOTE)* BEST PRACTICE: Notify attending for SBP<90 or MAP<65 after initial fluid bolus completed.(NOTE)* BEST PRACTICE: Notify attending if lactate > or equal to 4(NOTE)*

sodium chloride 0.9% (Bolus)


in RED and BLUE


page 91 of 110


30 ml/kg, IV, ONCE, STAT, Inj, WIDE OPEN, infuse over 1 hr Comments: WIDE OPEN












Medications

methylPREDNISolone 125 mg, IV, ONCE, Inj











Chemistry Panels




Chemistry





Remove

Move under ‘Chemistry’

page 92 of 110


ProBNP ST | Venous Bld, T;N

Hematology




Blood Gases


EPOC POC T;N, Stat, EPOC Blood Gases, after oxygen delivery device change or mechanical ventilation


Blood Culture T;N, Blood, RT, Peripheral, #1 pre-antibiotics



AFB Culture T;N, RT

Urine Studies


Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)* Diagnostic Tests

EKG T;N, Stat

EKG. T;N, Stat

EKG POC T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Respiratory Distress/ Failure

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Respiratory Distress/ Failure

CT-Thorax W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Respiratory Distress/ Failure

CT-Thorax WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Respiratory Distress/ Failure

CT-Thorax WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Respiratory Distress/ Failure





page 93 of 110

5.22.2019 PowerPlan Request Item #11q P 1 of 3

Unique Plan Description: ED Adult: Seizures Plan Selection Display: ED Adult: Seizures PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:18 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Seizures Vital Signs



Cardiac Monitor T;N

Diet

NPO T;N


Regular Diet T;N

Patient Care Orders


Respiratory Therapy








Medications



lorazepam 4 mg, IV, ONCE, Inj, max dose = 4 mg


fosphenytoin 15 mg/kg, IV, ONCE, STAT, Inj, mg = mg PE, max dose = 1500 mg PE

PHENobarbital 10 mg/kg, IV, ONCE, Inj

Comments: for seizure, max rate = 50 mg/min

thiamine


in RED and BLUE

page 94 of 110


100 mg, IV, ONCE, Inj Comments: give over 5 minutes

Dextrose 50% 50 ml, IV, ONCE, Inj

Comments: for hypoglycemia Laboratory


Chemistry Panels




ISTAT POC T;N, Stat, ISTAT- 6

Chemistry







Drug Levels

Phenytoin Level ST | Venous Bld, T;N



Valproic Acid Level ST | Venous Bld, T;N

Primidone Level ST | Venous Bld, T;N

Hematology







Blood Gases





Remove

Remove

Add Comment, ‘Must Transport on Ice.’

Remove

Remove

Remove

page 95 of 110



Urine Studies





Diagnostic Tests

EKG T;N, Stat

EKG POC T;N, Stat

EKG. T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Seizures

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Seizures

CT-Head/Brain W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Seizures

CT-Head/Brain WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Seizures

CT-Head/Brain WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Seizures




Replace with in-house drugs of abuse

screen (DRAB)

page 96 of 110

5.22.2019 PowerPlan Request Item #11r P 1 of 3

Unique Plan Description: ED Adult: Sickle Cell Crisis Plan Selection Display: ED Adult: Sickle Cell Crisis PlanType: Medical Version: 2 Begin Effective Date: 7/10/2018 9:40 AM End Effective Date: Current Available at: NWH SHB ED Adult: Sickle Cell Crisis Vital Signs

Vital Signs per Acuity q4h 24 hr

+24 Hours Vital Signs per Acuity q8h

Diet

NPO T;N


Regular Diet T;N

Encourage PO Intake T;N, Push oral fluids

Patient Care Orders


Respiratory Therapy




Dextrose 5% with 0.45% NaCl 1,000 ml, IV, @ 80 ml/hr

Sodium Chloride 0.45% 1,000 ml, IV, @ 80 ml/hr


Sodium Chloride 0.9% 1,000 ml, IV, Duration = 1 dose(s), @ 250 ml/hr

Lactated Ringers 1,000 ml, IV, Duration = 1 dose(s), @ 250 ml/hr

Dextrose 5% with LR 1,000 ml, IV, Duration = 1 dose(s), @ 250 ml/hr

Medications Reassess per unit guidelines and until pain score is reached(NOTE)*

Analgesics: Opioids

morphine mg, IV, ONCE, Inj, Therapeutic rationale= pain

hydromorphone mg, IM, ONCE, Inj, Therapeutic rationale= Pain, While in triage

hydromorphone mg, PO, ONCE, Tab, Therapeutic rationale= While in triage


in RED and BLUE

page 97 of 110


hydromorphone mg, IV, ONCE, Inj, Therapeutic rationale= Pain, While in room

Comments: On reassessment may repeat x 2 Analgesics: Non-Opioids


ketorolac 15 mg, IV, ONCE, Inj, for age>65, weight <50 kg or reduced renal function




Antiemetics No IV promethazine(NOTE)*


Miscellaneous No IV Push diphenhydramine unless anaphylactic reaction(NOTE)*

diphenhydrAMINE 50 mg, PO, ONCE, Capsule (DEF)* 50 mg, IM, ONCE, Inj

Laboratory




Chemistry Panels






Chemistry



Hematology


Retic Count ST | Venous Bld, T;N


Sed Rate ST | Venous Bld, T;N





Remove

Remove

Remove

Move under ‘Chemistry’

Remove

page 98 of 110






Hemoglobin Electrophoresis ST | Venous Bld, T;N

Blood Gases


Urine Studies



Toxicology Screen Urine (In House / DRAB) T;N, Urine, ST collect

Microbiology

Blood Culture

Blood Culture Blood Bank



Type, Crossmatch & Transfuse(SUB)* Diagnostic Tests

EKG POC T;N, Stat

EKG. T;N, Stat

EKG T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Sickle Cell Crisis

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Sickle Cell Crisis


Remove


Remove


page 99 of 110

5.22.2019 PowerPlan Request Item #11s P 1 of 3

Unique Plan Description: ED Adult: Syncope and Near Syncope Plan Selection Display: ED Adult: Syncope and Near Syncope PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:19 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Syncope and Near Syncope Vital Signs


Orthostatic BP's T;N, obtain orthostatic BP

Cardiac Monitor T;N, Document and interpret rhythm; WHILE IN CARE CENTER


Diet

NPO T;N


Regular Diet T;N

Patient Care Orders


Respiratory Therapy

Oxygen Therapy T;N







Laboratory


Chemistry Panels




ISTAT POC


in RED and BLUE



Remove

page 100 of 110


T;N, Stat, ISTAT-6 Cardiac Enzymes

Troponin I, Plasma ST | Venous Bld, T;N, then every 4 hours X 2

Troponin T Timed Study collect Venous Bld, T;N, q3hr, 9 hr

Myoglobin, Plasma ST | Venous Bld, T;N, then every 4 hours X 2

Chemistry

Albumin level ST | Venous Bld, T;N







Hematology







Blood Gases


Diagnostic Tests

EKG T;N, Stat

EKG POC T;N, Stat

EKG. T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Head/Brain W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Head/Brain WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope


Remove

Remove

Remove

Change to ‘Lactate (Initial Sepsis) Reflex’

Remove


Move all ‘cardiac labs under ‘Chemistry’

Remove

Remove

page 101 of 110


CT-Head/Brain WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Thorax W IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Thorax WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Thorax WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Abdomen W IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Abdomen W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Abdomen W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Abdomen WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope

CT-Abdomen WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Syncope and Near Syncope


page 102 of 110

5.22.2019 PowerPlan Request Item #11t P 1 of 3

Unique Plan Description: ED Adult: Upper Respiratory Symptoms with Fever Plan Selection Display: ED Adult: Upper Respiratory Symptoms with Fever PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:19 AM End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: Upper Respiratory Symptoms with Fever Patient Alerts

Isolation T;N, If AFB ordered

Vital Signs


Pulse Ox (Pt Care) T;N, Before and after aerosol treatment

Diet

NPO T;N


Regular Diet T;N

Patient Care Orders


Respiratory Therapy


Oxygen (NW)(LSH)(CH) T;N, Stat, 2 Liters, via Nasal Cannula






Medications Antibiotics

Pharyngitis: Reserve antbiotic treatment until after culture results.(NOTE)* Sinusitis: Reserve antibiotic use for patients given decongestants/ analgesics for 7 days prior and who have maxillary/ facial pain and purulent nasal discharge. If severe illness, treat sooner.(NOTE)* If NO antibiotic use in prior month:(NOTE)*

amoxicillin 500 mg, PO, ONCE, site of infection = Sinusitis, Suspected Organism = Empiric, Tab

If antibiotic use in prior month:(NOTE)*

Augmentin 875 mg, PO, ONCE, site of infection = Sinusitis, Suspected Organism = Empiric, Tab

Penicillin allergic patients:(NOTE)*

moxifloxacin


in RED

page 103 of 110


400 mg, PO, ONCE, site of infection = Sinusitis, Suspected Organism = Empiric, Tab

levofloxacin 750 mg, PO, ONCE, site of infection = Sinusitis, Suspected Organism = Empiric, Tab, for CrCl >= 10

ml/min

azithromycin 500 mg, PO, ONCE, site of infection = Sinusitis, Suspected Organism = Empiric, Tab

Acute bronchitis: antibiotic therapy not recommended.(NOTE)* SEVERE Acute exacerbation of chronic bronchitis (increased dyspnea, increased sputum viscosity/purulence, increased sputum volume):(NOTE)*

Augmentin 875 mg, PO, ONCE, site of infection = Bronchitis, Suspected Organism = Empiric, Tab

azithromycin 500 mg, PO, ONCE, site of infection = Bronchitis, Suspected Organism = Empiric, Tab

Antihistamines

loratadine 10 mg, PO, ONCE, Tab

Miscellaneous




guaifenesin 200 mg, PO, ONCE, Liq

pseudoephedrine 30 mg, PO, ONCE, Tab

Laboratory


Chemistry Panels




Chemistry



Hematology



Microbiology




Comments: pre-antibiotics



Remove

page 104 of 110


AFB Culture T;N, RT

Comments: pre-antibiotics

Throat Culture / Beta Strep T;N, Throat, RT

Rapid Strep Test-POC (Sinai ED Only) T;N, Stat

Diagnostic Tests

EKG T;N, Stat

EKG POC T;N, Stat

EKG. T;N, Stat

XR-Chest 2V T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Upper Respiratory

Symptoms

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg, Reason: Upper Respiratory Symptoms



page 105 of 110

5.22.2019 PowerPlan Request Item #11u P 1 of 2

Unique Plan Description: ED: Non-Surgical Spine Service Plan Selection Display: ED: Non-Surgical Spine Service PlanType: Medical Version: 1 Begin Effective Date: 2/7/2017 8:19 AM End Effective Date: Current Available at: Carroll Hospital SHB ED: Non-Surgical Spine Service Vital Signs


Patient Care Orders


Respiratory Therapy


IV Solutions





Medications

acetaminophen 650 mg, PO, Q4H, Tab

Comments: for adjunctive pain therapy, do NOT exceed TOTAL acetaminophen daily dose of 4 grams/24 hours

ibuprofen 600 mg, PO, Q6H, PRN, pain moderate (pain score 4-6), Tab

Comments: for adjunctive pain therapy

oxycodone immediate release 5 mg, PO, Q4H, PRN, pain moderate (pain score 4-6), Tab

oxycodone immediate release 10 mg, PO, Q4H, PRN, pain severe (pain score 7-10), Tab

ketorolac 30 mg, IV, ONCE, Inj, for radicular pain

Comments: for radicular pain *** Methylprednisolone is not to be administered to diabetic patients ***(NOTE)*

methylPREDNISolone 1 gm, IV, ONCE, Inj, infuse over 1.5 hr

Comments: dilute in 250ml NS, not to be administered to diabetic patients

hydromorphone 1 mg, IV, Q2H, PRN, pain severe (pain score 7-10), Inj, for breakthrough pain

Comments: for breakthrough pain Laboratory Chemistry Panels


BMP


in RED and BLUE


page 106 of 110

5.22.2019 PowerPlan Request Item #11u P 2 of 2

ST | Venous Bld, T;N Chemistry

CRP ST | Venous Bld, T;N

Hematology



ESR Urine Studies

Urine Toxicology Screen (In House / DRAB) T;N, Urine, ST collect

Drugs of Abuse Panel T;N, Urine, ST collect

Diagnostic Tests

XR-T Spine T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Back Pain

XR-L Spine 2 or 3 Views T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Back Pain

CT-L Spine WO IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Back Pain

CT-Pelvis W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Back Pain

CT-Pelvis WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Back Pain

CT-Pelvis WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Back Pain

Consults

zzzPain Management - LifeBridge Physical Medicine and Rehabilitation - Referral T;N, T;N | If Patients being admitted to Observation Status, 8am-5pm, call 410-601-6597After hours,

page SH Rehab resident on call

PT Consult / Evaluate and Treat-Acute Hosp *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


Remove

Remove – Unless this is a CHC thing. There is only

one urine tox screen avail at Sinai, the first one

listed. KEEP FOR CARROLL

page 107 of 110

5.22.2019 PowerPlan Request Item #11v P 1 of 3

Unique Plan Description: ED: Suspected Sepsis Plan Selection Display: ED: Suspected Sepsis PlanType: Medical Version: 3 Begin Effective Date: 11/20/2018 8:44 AM End Effective Date: Current Available at: NWH SHB ED: Suspected Sepsis Patient Alerts

Stop Sepsis Alert T;N

Vital Signs BEST PRACTICE: Maintain MAP > 65 mmHg +/- SBP > 90 mmHg, urine output >/= 0.5 ml/kg/hr(NOTE)*

Vital Signs per Acuity T;N, Best Practice: Maintain MAP > 65 mmHg +/- SBP > 90 mmHg, urine output >/= 0.5 ml/kg/hr

Cardiac Monitor T;N

Pulse Oximetry Continuous T;N, pulse ox, Continuous

Diet

NPO T;N

Patient Care Orders


Urinary Catheter Insert T;N, Indwelling

Urinary Catheter Maintenance T;N, To straight drainage, Discontinue orders: Remove per nursing protocol

Straight Catheterize T;N

Respiratory Therapy


Oxygen (NW)(LSH)(CH) T;N, Routine

ABG Draw T;N, RT

Suction T;N, PRN

Intubate T;N

Ventilator Settings T;N

Endotracheal Tube Maintenance T;N



Comments: WIDE OPEN


in RED and BLUE

page 108 of 110












Medications BEST PRACTICE: Administration of antibiotics within 1st hour of recognition of symptoms(NOTE)*




Straight Catheter Patient if no void in 30 minutes(NOTE)* Chemistry Panels


ISTAT POC T;N, Stat, IStat 6

Chemistry


Hematology


Auto Differential ST | Venous Bld, T;N, Must Be Ordered with CBC

Coagulation

PT/ INR ST | Venous Bld, T;N

PTT ST | Venous Bld, T;N


Blood Culture T;N, Blood, ST, Peripheral, #1

Blood Culture T;N+1, Blood, ST, Peripheral, #2

Sputum Culture w/ gram stain T;N, ST

Urine Studies


HCG Urine POC




Remove



uncheck

page 109 of 110


T;N, Stat, Not available at NW ED.


Diagnostic Tests

EKG T;N, Stat

Electrocardiogram POC T;N, Stat

EKG. T;N, Stat

XR-Chest Portable T;N Stat, Transport Mode: PORTABLE

XR-Chest 2V T;N Stat, Transport Mode: PORTABLE, No-Pt <350 lb./159 kg


page 110 of 110

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