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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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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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5.22.2019 PowerPlan Request Item #1 P 2 of 3
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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5.22.2019 PowerPlan Request Item #1 P 3 of 3
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
years old), <18/min (1-2 years old), or Patient is obtunded/unarousable, or POSS>=3
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
years old), <18/min (1-2 years old), or Patient is obtunded/unarousable, or POSS>=3
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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5.22.2019 PowerPlan Request Item #2a P 2 of 2
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
*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 #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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5.22.2019 PowerPlan Request Item #2b P 2 of 6
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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5.22.2019 PowerPlan Request Item #2b P 3 of 6
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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5.22.2019 PowerPlan Request Item #2b P 4 of 6
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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5.22.2019 PowerPlan Request Item #2b P 5 of 6
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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5.22.2019 PowerPlan Request Item #2b P 6 of 6
Other
Patient Teaching T;N, Instruct on: Post-OP, active ankle exercises
Patient Education-Smoking Cessation 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 #3 P 1 of 2
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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5.22.2019 PowerPlan Request Item #3 P 2 of 2
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)*
Notify Provider for VS's of: T;N, Temp > 38.5 or < 36.9, HR> 140, HR< 65, SBP> 125/99, SBP< 90/50, RR> 40, RR< 20,
abdominal pain, rectal bleeding, or vomiting For patients 7 yrs and above(NOTE)*
Notify Provider for VS's of: T;N, Temp > 38.5 or < 36.9, HR> 120, HR< 60, SBP> 130/90, SBP< 90/60, RR> 30, RR< 15,
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
*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 #4 P 1 of 2
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
Vital Signs with Pulse Oximetry T;N, Q4H 20 hr
Vital Signs with Pulse Oximetry T;N, Q4H 20 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
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5.22.2019 PowerPlan Request Item #4 P 2 of 2
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
*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 18 of 110
5.22.2019 PowerPlan Request Item #5 P 1 of 5
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
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5.22.2019 PowerPlan Request Item #5 P 2 of 5
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
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5.22.2019 PowerPlan Request Item #5 P 3 of 5
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
Comments: begin when in active labor or when membranes have ruptured
ampicillin (inj) 1 gm, IV, Q6H, site of infection = Uterus, Suspected Organism = Gram positive cocci, Inj
Comments: until delivery
cefazolin 2 gm, IV, as directed, site of infection = Uterus, Suspected Organism = Gram positive cocci, Inj
Comments: begin when in active labor or when membranes have ruptured
cefazolin 1 gm, IV, Q8H, site of infection = Uterus, Suspected Organism = Gram positive cocci, Inj
Comments: until delivery
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
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5.22.2019 PowerPlan Request Item #5 P 4 of 5
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
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5.22.2019 PowerPlan Request Item #5 P 5 of 5
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
*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 23 of 110
5.22.2019 PowerPlan Request Item #6 P 1 of 9
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 =
Empiric, Inj, Range = 25-100 mg/kg/dose
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)
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5.22.2019 PowerPlan Request Item #6 P 2 of 9
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 =
Empiric, Inj Syringe
cefotaxime (pediatrics) 50 mg/kg, IV, Q8HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =
Empiric, Inj Syringe
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
Comments: Dispose unused drug in black container
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
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5.22.2019 PowerPlan Request Item #6 P 3 of 9
DOBUTamine drip 2000 mcg/ml D5W (NICU) (IVS)* Dextrose 5% in Water
25 ml, IV, concentration = 2000 mcg/ml DOBUTamine
50 mg, mcg/kg/min
DOBUTamine drip 5000 mcg/ml D5W (NICU) (IVS)* Dextrose 5% in Water
25 ml, IV, concentration = 5000 mcg/ml DOBUTamine
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
DOPamine drip 1600mcg/ml D5W (NICU) (IVS)* Dextrose 5% in Water
25 ml, IV, concentration = 1600 mcg/ml DOPamine
40 mg, mcg/kg/min
DOPamine drip 3200mcg/ml D5W (NICU) (IVS)* Dextrose 5% in Water
25 ml, IV, concentration = 3200 mcg/ml DOPamine
80 mg, mcg/kg/min
DOPamine drip 800mcg/ml D10W (NICU) (IVS)* Dextrose 10% in Water
25 ml, IV, concentration = 800 mcg/ml DOPamine
20 mg, mcg/kg/min
DOPamine drip 1600mcg/ml D10W (NICU) (IVS)* Dextrose 10% in Water
25 ml, IV, concentration = 1600 mcg/ml DOPamine
40 mg, mcg/kg/min
DOPamine drip 3200mcg/ml D10W (NICU) (IVS)* Dextrose 10% in Water
25 ml, IV, concentration = 3200 mcg/ml DOPamine
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)*
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5.22.2019 PowerPlan Request Item #6 P 4 of 9
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
ferrous sulfate (pediatrics) 2 mg/kg, PO, Q12HV, Liq
ferrous sulfate (pediatrics) 3 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)
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5.22.2019 PowerPlan Request Item #6 P 5 of 9
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 =
Empiric, Inj Syringe Comments: if trough <1 - give dose; if trough >= 1 hold dose and notify physician/NP
gentamicin (pediatrics) 4 mg/kg, IV, Q24HV, 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
**********(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 =
Empiric, Inj, Range = 20-25 mg/kg/dose
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
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5.22.2019 PowerPlan Request Item #6 P 6 of 9
Comments: Dispose unused drug in black container
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
Comments: Dispose unused drug in black container
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
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5.22.2019 PowerPlan Request Item #6 P 7 of 9
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)*
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5.22.2019 PowerPlan Request Item #6 P 8 of 9
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 =
Empiric, Inj Syringe
tobramycin (pediatrics) 4.5 mg/kg, IV, Q36H, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =
Empiric, Inj Syringe
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 =
Empiric, Inj Syringe, Range = 10-15 mg/kg/dose
vancomycin (pediatrics) 12 mg/kg, IV, Q12HV, site of infection = R/O serious bacterial infection-Peds, Suspected Organism =
Empiric, Inj Syringe, Range = 10-15 mg/kg/dose
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
5.22.2019 PowerPlan Request Item #6 P 9 of 9
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
*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 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)
*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 33 of 110
5.22.2019 PowerPlan Request Item #8 P 1 of 1
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
*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
Changes Marked Below
Add Carroll’s TTE Echo
Virtualize to Carroll
page 34 of 110
5.22.2019 PowerPlan Request Item #9a P 1 of 1
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
*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
Changes Marked Below
Add
page 35 of 110
5.22.2019 PowerPlan Request Item #9b P 1 of 1
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
Saline Lock IV with Routine Flushes per Protocol 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
Changes Marked Below
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
Place in Cardiac Cath Holding T;N
Saline Lock IV with Routine Flushes per Protocol T;N
Sodium Chloride 0.9% 1,000 ml, IV, @ 50 ml/hr, during procedure
*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
Add
Changes Marked Below
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
Place in Cardiac Cath Holding T;N
Saline Lock IV with Routine Flushes per Protocol T;N
Sodium Chloride 0.9% 1,000 ml, IV, @ 50 ml/hr, during procedure
*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
Changes Marked Below
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
Saline Lock IV with Routine Flushes per Protocol 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
*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
Changes Marked Below
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
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
Saline Lock IV with Routine Flushes per Protocol 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
*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
Changes Marked Below
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
NPO T;N, NPO except for medications, Test/Procedure
Patient Care Orders
Cardiovascular Procedure T;N, Reveal Removal
Operative Consent form at bedside T;N
Saline Lock IV with Routine Flushes per Protocol 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
*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
Changes Marked Below
Add
page 41 of 110
5.22.2019 PowerPlan Request Item #10 P 1 of 1
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
5.22.2019 PowerPlan Request Item #11a P 1 of 4
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
Saline Lock IV with Routine Flushes per Protocol T;N
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
PRESSURE BAG (over 30 min)
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
Changes Marked Below
in RED and BLUE
page 43 of 110
5.22.2019 PowerPlan Request Item #11a P 2 of 4
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
morphine 4 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
Changes Marked Below
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
Remove
Remove
Move lactate under ‘Chemistry’
page 44 of 110
5.22.2019 PowerPlan Request Item #11a P 3 of 4
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
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
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
Move to ‘POC Testing’ category
Remove
I missed this – change to N
and TS q3hr x 2
Remove
page 45 of 110
5.22.2019 PowerPlan Request Item #11a P 4 of 4
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
*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 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
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Urinary Catheter Insert T;N
Foley Catheter Maintenance T;N
Saline Lock IV with Routine Flushes per Protocol 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
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
PRESSURE BAG (over 30 min)
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
Changes Marked Below
in RED and BLUE
page 47 of 110
5.22.2019 PowerPlan Request Item #11b P 2 of 3
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
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
BEST PRACTICE: Administration of antibiotics within 1st hour of recognition of symptoms(NOTE)*
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
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT 6
Chemistry
Ethyl Alcohol Level ST | Venous Bld, T;N
Amylase 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
Hematology
CBC ST | Venous Bld, T;N
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
Remove
Remove
Remove
Move lactate under ‘Chemistry’
page 48 of 110
5.22.2019 PowerPlan Request Item #11b P 3 of 3
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
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
Blood Gases
EPOC POC T;N, Stat, EPOC Blood Gases
POC Testing
Blood Glucose Monitoring POC T;N, Stat
Urine Studies
Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)*
Urine Dipstick POC T;N, Stat, Not available at NW ED.
Toxicology Screen Urine (Send Out) T;N, Urine, ST collect
Drug Abuse Screen (DAS) T;N, Urine, ST collect
Microbiology BEST PRACTICE: Obtain blood cultures prior to antibiotic administration(NOTE)*
Blood Culture T;N, Blood, RT, Peripheral
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:
Changes Marked Below
Remove
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
Is this Tox Send Out at CHC and Drug Abuse Screen
at Sinai/NW? No, THE OPPOSITE
page 49 of 110
5.22.2019 PowerPlan Request Item #11c P 1 of 4
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
Vital Signs per Acuity
Cardiac Monitor T;N, Document and interpret rhythm; WHEN IN CARE CENTER
NON-INPATIENT UNIT Cardiac Monitor T;N, When in patient care area
Activity
Bedrest T;N, Times 3 hours then advance if pain free
Diet
NPO T;N, NPO except for medications
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
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)
Changes Marked Below
in RED and BLUE
page 50 of 110
5.22.2019 PowerPlan Request Item #11c P 2 of 4
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
Changes Marked Below
page 51 of 110
5.22.2019 PowerPlan Request Item #11c P 3 of 4
20 mg, IV, ONCE, Inj
furosemide 40 mg, IV, ONCE, Inj
furosemide 80 mg, IV, ONCE, Inj
H2 Antagonists
famotidine 20 mg, IV, ONCE, Inj
famotidine 20 mg, PO, ONCE, Tab
Miscellaneous
nesiritide (bolus) 2 mcg/kg, IV, ONCE, Inj
morphine 2 mg, IV, ONCE, Inj
Maalox 30 ml, PO, ONCE, Susp
Laboratory
ED Addon Lab T;N, Stat
Chemistry Panels
CMP ST | Venous Bld, T;N
BMP ST | Venous Bld, T;N
Cardiac Enzymes
Troponin I, Plasma ST | Venous Bld, T;N
Troponin I, Plasma Timed Study collect Venous Bld, T;N+180
Troponin T ST collect Venous Bld, T;N
Troponin T Timed Study collect Venous Bld, T;N+180
Chemistry
Lactate (Single - NOT for Suspected Sepsis) ST | Venous Bld, T;N
Magnesium level ST | Venous Bld, T;N
Phosphorus level ST | Venous Bld, T;N
ProBNP ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
PT ST | Venous Bld, T;N
APTT ST | Venous Bld, T;N
D-Dimer ST | Venous Bld, T;N
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
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
5.22.2019 PowerPlan Request Item #11c P 4 of 4
D-Dimer ELISA ST | Venous Bld, T;N
Fibrinogen Activity 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
Changes Marked Below
Remove
Move to ‘POC Testing’ category
page 53 of 110
5.22.2019 PowerPlan Request Item #11d P 1 of 3
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
Vital Signs per Acuity
Cardiac Monitor
NON-INPATIENT UNIT Cardiac Monitor T;N, When in patient care area
Activity
Bedrest T;N, X3 hours then advance if pain free
Bedrest T;N, Bathroom Privileges
Up Ad Lib T;N, ad lib
Diet
NPO T;N, NPO except for medications
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, 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, 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
Changes Marked Below
in RED and BLUE
page 54 of 110
5.22.2019 PowerPlan Request Item #11d P 2 of 3
metoprolol 25 mg, PO, BID, Tab
metoprolol 50 mg, PO, BID, Tab
Miscellaneous
Maalox 30 ml, PO, ONCE, Susp
Laboratory
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
N-Terminal Brain Natriuretic Peptide ST | Venous Bld, T;N
Cardiac Enzymes
Troponin I, Plasma ST collect Venous Bld, T;N
Troponin T 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
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
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 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
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Changes Marked Below
Remove
Move to ‘POC Testing’ category
Move cardiac enzymes under ‘Chemistry’
Add magnesium and Phos under ‘Chemistry’
page 55 of 110
5.22.2019 PowerPlan Request Item #11d P 3 of 3
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
*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
Changes Marked Below
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
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, Continuous
ABG Draw T;N
IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
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
Changes Marked Below
in RED and BLUE
page 57 of 110
5.22.2019 PowerPlan Request Item #11e P 2 of 5
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)*
azithromycin 500 mg, PO, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =
Empiric, Tab
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 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)*
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 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)*
Changes Marked Below
page 58 of 110
5.22.2019 PowerPlan Request Item #11e P 3 of 5
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
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 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
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 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
moxifloxacin 400 mg, IV, ONCE, Site of Infection = Pneumonia, Community acquired, Suspected Organism =
Empiric, Inj
Changes Marked Below
page 59 of 110
5.22.2019 PowerPlan Request Item #11e P 4 of 5
levofloxacin 750 mg, IV, ONCE, site of infection = Pneumonia, Community acquired, Suspected Organism =
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
acetaminophen 650 mg, PO, ONCE, Tab
Comments: do NOT exceed TOTAL acetaminophen daily dose of 4 grams/24 hours
acetaminophen 1,000 mg, PO, ONCE, Tab
Comments: do NOT exceed TOTAL acetaminophen daily dose of 4 grams/24 hours
ibuprofen 400 mg, PO, ONCE, Tab
guaifenesin 200 mg, PO, ONCE, Liq
pseudoephedrine 30 mg, PO, ONCE, Tab
loratadine 10 mg, PO, ONCE, Tab
Laboratory
ED Addon Lab T;N, Stat
Chemistry Panels
CMP ST | Venous Bld, T;N
BMP ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT 6
Chemistry
Lactate (Single - NOT for Suspected Sepsis) ST | Venous Bld, T;N
Magnesium level ST | Venous Bld, T;N
Phosphorus level ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
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
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Remove
Move to ‘POC Testing’ category
Change to Lactate (initial sepsis) reflex
Add Urine Studies section with Urinalysis w micro
reflex AND Toxicology screen DRAB
page 60 of 110
5.22.2019 PowerPlan Request Item #11e P 5 of 5
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
*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
Changes Marked Below
page 61 of 110
5.22.2019 PowerPlan Request Item #11f P 1 of 3
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
Vital Signs per Acuity T;N
Diet
NPO T;N
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
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
Comments: do NOT exceed TOTAL acetaminophen daily dose of 4 grams/24 hours
ondansetron ODT 4 mg, PO, ONCE, STAT, ODT Tab
ondansetron
Changes Marked Below
in RED and BLUE
page 62 of 110
5.22.2019 PowerPlan Request Item #11f P 2 of 3
4 mg, IV, ONCE, STAT, Inj Laboratory Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
Chemistry
Amylase 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
Hcg Quantitative Test ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
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
Blood Bank
Type, Crossmatch & Transfuse(SUB)*
Antibody Screen-Gel ST | Venous Bld, T;N, *must also order ABO/Rh
ED Addon Lab T;N, Stat
ABO/Rh ST | Venous Bld, T;N, *must also order Antibody Screen-Gel
Blood Gases
EPOC POC T;N, Stat, EPOC Blood Gases
Urine Studies
Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)*
Urine Dipstick POC T;N, Stat, Not available at NW ED.
Urine HCG POC T;N, Stat, Not available at NW ED.
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
Remove
Remove
Remove
Remove
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
Remove or file under top Laboratory header
page 63 of 110
5.22.2019 PowerPlan Request Item #11f P 3 of 3
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
*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
Changes
Marked Below
Uncheck
page 64 of 110
5.22.2019 PowerPlan Request Item #11g P 1 of 4
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
Vital Signs per Acuity Diet
NPO T;N
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders OBTAIN URINE FOR POSSIBLE CULTURE PRIOR TO STARTING ANTIBIOTIC THERAPY(NOTE)*
Saline Lock IV with Routine Flushes per Protocol T;N
IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
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
Changes Marked Below
in RED and BLUE
page 65 of 110
5.22.2019 PowerPlan Request Item #11g P 2 of 4
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
acetaminophen 650 mg, PO, ONCE, Tab
Comments: do NOT exceed TOTAL acetaminophen daily dose of 4 grams/24 hours
acetaminophen 1,000 mg, PO, ONCE, Tab
Comments: do NOT exceed TOTAL acetaminophen daily dose of 4 grams/24 hours
ibuprofen 400 mg, PO, ONCE, Tab
Laboratory
ED Addon Lab T;N, Stat
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
Changes Marked Below
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
5.22.2019 PowerPlan Request Item #11g P 3 of 4
Vaginitis, DNA Probe ST collect, T;N
Sed Rate ST | Venous Bld, T;N
C Reactive Protein ST | Venous Bld, T;N
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
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
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
Coagulation
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, If positive, save for C&S; Not available at NW ED.
Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)*
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;
Vaginal Bleeding (non-pregnancy)
CT-Abd/Pel W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
and add lactate reflex
Remove
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
Remove
Remove
Remove
page 67 of 110
5.22.2019 PowerPlan Request Item #11g P 4 of 4
CT-Abd/Pel W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
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;
Vaginal Bleeding (non-pregnancy)
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;
Vaginal Bleeding (non-pregnancy)
CT-Abd/Pel WOW IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Abdomen W IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Abdomen W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Abdomen W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Abdomen WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Abdomen WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Pelvis W IV and Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Pelvis W IV Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Pelvis WO IV WO Oral Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Pelvis W Oral Contrast Only T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
CT-Pelvis WOW IV Contrast T;N Stat, Transport Mode: STRETCHER, No-Pt <350 lb./159 kg, Reason: Female UTI; PID; STD;
Vaginal Bleeding (non-pregnancy)
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
NPO T;N, NPO except for medications
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
Saline Lock IV with Routine Flushes per Protocol T;N
Transfuse Red Cells Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula
IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
Medications
famotidine 20 mg, PO, ONCE, Tab
famotidine 20 mg, IV, ONCE, Inj
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
morphine 2 mg, IV, ONCE, Inj
Changes Marked Below
in RED and BLUE
page 69 of 110
5.22.2019 PowerPlan Request Item #11h P 2 of 2
morphine 4 mg, IV, ONCE, Inj
Laboratory
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
Chemistry
Magnesium level ST | Venous Bld, T;N
Phosphorus level ST | Venous Bld, T;N
Lipase level ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
PT ST | Venous Bld, T;N
APTT ST | Venous Bld, T;N
Guaiac Stools POC T;N, Stat, Guiac first stool
Blood Bank
Antibody Screen-Gel ST | Venous Bld, T;N, *must also order ABO/Rh
ABO/Rh ST | Venous Bld, T;N, *must also order Antibody Screen-Gel
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:
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
Remove
Move to ‘POC Testing’ category
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
Vital Signs per Acuity Diet
NPO T;N
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
ABG Draw T;N, ST
IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
Medications
acetaminophen 650 mg, PO, ONCE, Tab
acetaminophen 1,000 mg, PO, ONCE, Tab
ibuprofen 400 mg, PO, ONCE, Tab
ibuprofen 600 mg, PO, ONCE, Tab
ketorolac 30 mg, IV, ONCE, Inj
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
Changes Marked Below
in RED and BLUE
page 71 of 110
5.22.2019 PowerPlan Request Item #11i P 2 of 3
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
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
Chemistry
Amylase 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
Carboxyhemoglobin ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
PT ST | Venous Bld, T;N
APTT ST | Venous Bld, T;N
Blood Gases
EPOC POC T;N, Stat, EPOC Blood Gases
Urine Studies
Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)*
Urine Dipstick POC T;N, Stat, Not available at NW ED.
Diagnostic Tests
EKG T;N, Stat
EKG POC T;N, Stat
EKG.
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
Remove
Remove
Remove
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
page 72 of 110
5.22.2019 PowerPlan Request Item #11i P 3 of 3
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
*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 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
NPO T;N, NPO except for medications
Restricted Diet T;N
Patient Care Orders
Intake and Output T;N
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
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)*
Changes Marked Below
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
CMP ST | Venous Bld, T;N
BNP(ProBNP) ST | Venous Bld, T;N, only if HF diagnosis is uncertain
Chemistry
Magnesium level ST | Venous Bld, T;N
Digoxin level ST | Venous Bld, T;N
Cardiac Enzymes
Troponin I, Plasma ST | Venous Bld, T;N
Troponin T ST collect Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N
APTT ST | Venous Bld, T;N
PT/ INR ST | Venous Bld, T;N
D-Dimer 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
*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
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
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
ED Addon Lab T;N, Stat
Drug Abuse Screen (DAS) T;N, Urine, ST collect
Drugs of Abuse Panel T;N, Urine, ST collect
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
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
ISTAT POC T;N, Stat, ISTAT 6
Cardiac Enzymes
Troponin I, Plasma ST | Venous Bld, T;N
Troponin T ST collect Venous Bld, T;N
Chemistry
Amylase level ST | Venous Bld, T;N
Lipase level ST | Venous Bld, T;N
Ionized Calcium ST | Venous Bld, T;N
Magnesium level ST | Venous Bld, T;N
Phosphorus level ST | Venous Bld, T;N
Acetaminophen Level ST | Venous Bld, T;N
Carbamazepine Level ST | Venous Bld, T;N
Depakene Level ST | Venous Bld, T;N
Changes Marked Below
in RED and BLUE
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
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
Digoxin level ST | Venous Bld, T;N
Dilantin Level ST | Venous Bld, T;N
Ethyl Alcohol 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
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N
Coagulation
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
Blood Gases
EPOC POC T;N, Stat, EPOC Blood Gases
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
Blood Culture T;N, Blood, RT, Peripheral
Blood Culture T;N, Blood, RT, Peripheral
Sputum Culture w/ gram stain T;N, Sputum Expectorated, RT
*Report Legend:
Changes Marked Below
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
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
Vital Signs per Acuity Diet
NPO T;N
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula, Wean to Room Air
IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
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
Changes Marked Below
in RED and BLUE
Changes Marked Below
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5.22.2019 PowerPlan Request Item #11l P 2 of 3
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
ED Addon Lab T;N, Stat
ISTAT POC T;N, Stat, ISTAT-6
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Chemistry
Amylase level ST | Venous Bld, T;N
Ionized Calcium ST | Venous Bld, T;N
Lactate (Single - NOT for Suspected Sepsis) 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
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
PT ST | Venous Bld, T;N
APTT ST | Venous Bld, T;N
Urine Studies
Urine HCG POC T;N, Stat, Not available at NW ED.
Urine HCG Qualitative T;N, Urine
Urine Dipstick POC T;N, Stat, Not available at NW ED.
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
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Remove
Remove
Remove
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
Change to Lactate Reflex
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5.22.2019 PowerPlan Request Item #11l P 3 of 3
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
*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
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
Vital Signs per Acuity
Neuro Checks T;N, perform with vital signs
Diet
NPO T;N
NPO T;N, NPO except for medications
Regular Diet T;N
Regular Diet T;N
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula
ABG Draw T;N, ST
IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Laboratory
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
Chemistry
Amylase level
Changes Marked Below
in RED and BLUE
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
Remove
Remove
page 81 of 110
5.22.2019 PowerPlan Request Item #11m P 2 of 3
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
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
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
Blood Gases
EPOC POC T;N, Stat, EPOC Blood Gases
Urine Studies
Toxicology Screen Urine (Send Out) T;N, Urine, ST collect
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
Move to ‘POC Testing’ category
Remove
Remove, unless this is a CHC test only
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5.22.2019 PowerPlan Request Item #11m P 3 of 3
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
*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 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
Vital Signs per Acuity Diet
NPO T;N
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Nasogastric/Orogastric Tube Insert T;N
Nasogastric/Orogastric Tube Maintenance T;N
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula, Wean to Room Air
ABG Draw T;N, ST
IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
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
Changes Marked Below
in RED and BLUE
Changes Marked Below
page 84 of 110
5.22.2019 PowerPlan Request Item #11n P 2 of 4
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
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP
Changes Marked Below Move all ‘Chemistry Panel’
labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
page 85 of 110
5.22.2019 PowerPlan Request Item #11n P 3 of 4
ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
Chemistry
Amylase 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
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
Ethyl Alcohol Level ST | Venous Bld, T;N
Carbamazepine Level ST | Venous Bld, T;N
Depakene Level ST | Venous Bld, T;N
Digoxin 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
Phenobarbital Level ST | Venous Bld, T;N
Theophylline Level ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
PT ST | Venous Bld, T;N
APTT ST | Venous Bld, T;N
D-Dimer ST | Venous Bld, T;N
Fibrinogen Activity
Remove
Remove
Add Comment, ‘Must transport on Ice.’
Remove
Remove
Remove
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5.22.2019 PowerPlan Request Item #11n P 4 of 4
ST | Venous Bld, T;N Blood Gases
EPOC POC T;N, Stat, EPOC Blood Gases
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
Drug Abuse Screen (DAS) T;N, Urine, ST collect
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)*
*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
Changes Marked Below
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
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
Vital Signs per Acuity Diet
NPO T;N
NPO T;N, NPO except for medications
Patient Care Orders
Strain Urine T;N
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula, Wean to Room Air
IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
Medications Analgesics: Non-Opioids
acetaminophen 650 mg, PO, ONCE, Tab
ketorolac 30 mg, IV, ONCE, Inj
Analgesics: Opioids
oxycodone immediate release 5 mg, PO, ONCE, Tab
morphine 2 mg, IV, ONCE, Inj
morphine 4 mg, IV, ONCE, Inj
hydromorphone 1 mg, IV, ONCE, Inj
hydromorphone 2 mg, IV, ONCE, Inj
Antiemetics
Changes Marked Below
in RED
page 88 of 110
5.22.2019 PowerPlan Request Item #11o P 2 of 3
ondansetron 4 mg, IV, ONCE, Inj
Laboratory
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
Chemistry
Amylase 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
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
PT ST | Venous Bld, T;N
APTT 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, 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
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Remove
Remove
Remove
Move to ‘POC Testing’ category
Move to ‘POC Testing’
category
page 89 of 110
5.22.2019 PowerPlan Request Item #11o P 3 of 3
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
*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 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)*
Vital Signs per Acuity
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
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Urinary Catheter Insert T;N
Urinary Catheter Maintenance T;N, Discontinue orders: Remove per nursing protocol
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
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)
Changes Marked Below
in RED and BLUE
Changes Marked Below
page 91 of 110
5.22.2019 PowerPlan Request Item #11p P 2 of 3
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
PRESSURE BAG (over 30 min)
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
methylPREDNISolone 125 mg, IV, ONCE, Inj
morphine 2 mg, IV, ONCE, Inj
lorazepam 1 mg, IV, ONCE, Inj
lorazepam 2 mg, IV, ONCE, Inj
midazolam 1 mg, IV, ONCE, Inj
midazolam 2 mg, IV, ONCE, Inj
BEST PRACTICE: Administration of antibiotics within 1st hour of recognition of symptoms(NOTE)*
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
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
Chemistry
Magnesium level ST | Venous Bld, T;N
Phosphorus level ST | Venous Bld, T;N
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Remove
Move under ‘Chemistry’
page 92 of 110
5.22.2019 PowerPlan Request Item #11p P 3 of 3
ProBNP ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
D-Dimer ST | Venous Bld, T;N
Blood Gases
EPOC POC T;N, Stat, EPOC Blood Gases
EPOC POC T;N, Stat, EPOC Blood Gases, after oxygen delivery device change or mechanical ventilation
Microbiology BEST PRACTICE: Obtain blood cultures prior to antibiotic administration(NOTE)*
Blood Culture T;N, Blood, RT, Peripheral, #1 pre-antibiotics
Blood Culture T;N, Blood, RT, Peripheral, #2 pre-antibiotics
Sputum Culture w/ gram stain T;N, Sputum Expectorated, RT
AFB Culture T;N, RT
Urine Studies
Urine Dipstick POC T;N, Stat, Not available at NW ED.
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
*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
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
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
Vital Signs per Acuity
NON-INPATIENT UNIT Cardiac Monitor T;N, When in patient care area
Cardiac Monitor T;N
Diet
NPO T;N
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula, Wean to Room Air
ABG Draw IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
Medications
lorazepam 2 mg, IV, ONCE, Inj
Comments: for seizure
lorazepam 4 mg, IV, ONCE, Inj, max dose = 4 mg
Comments: for seizure
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
Changes Marked Below
in RED and BLUE
page 94 of 110
5.22.2019 PowerPlan Request Item #11q P 2 of 3
100 mg, IV, ONCE, Inj Comments: give over 5 minutes
Dextrose 50% 50 ml, IV, ONCE, Inj
Comments: for hypoglycemia Laboratory
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT- 6
Chemistry
Magnesium level ST | Venous Bld, T;N
Phosphorus level ST | Venous Bld, T;N
Amylase level ST | Venous Bld, T;N
Ionized Calcium ST | Venous Bld, T;N
Lipase level ST | Venous Bld, T;N
Ethyl Alcohol Level ST | Venous Bld, T;N
Drug Levels
Phenytoin Level ST | Venous Bld, T;N
Carbamazepine Level ST | Venous Bld, T;N
Phenobarbital Level ST | Venous Bld, T;N
Valproic Acid Level ST | Venous Bld, T;N
Primidone Level ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
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
Blood Gases
Changes Marked Below
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
Remove
Remove
Add Comment, ‘Must Transport on Ice.’
Remove
Remove
Remove
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5.22.2019 PowerPlan Request Item #11q P 3 of 3
EPOC POC T;N, Stat, EPOC Blood Gases
Urine Studies
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
Toxicology Screen Urine (Send Out) T;N, Urine, ST collect
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
*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
Move to ‘POC Testing’ category
Move to ‘POC Testing’ category
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
NPO T;N, NPO except for medications
Regular Diet T;N
Encourage PO Intake T;N, Push oral fluids
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula
ABG Draw IV Solutions
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% (Bolus) 1,000 ml, IV, ONCE, Inj
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
Changes Marked Below
in RED and BLUE
page 97 of 110
5.22.2019 PowerPlan Request Item #11r P 2 of 3
hydromorphone mg, IV, ONCE, Inj, Therapeutic rationale= Pain, While in room
Comments: On reassessment may repeat x 2 Analgesics: Non-Opioids
ketorolac 30 mg, IV, ONCE, Inj
ketorolac 15 mg, IV, ONCE, Inj, for age>65, weight <50 kg or reduced renal function
acetaminophen 650 mg, PO, ONCE, Tab
acetaminophen 1,000 mg, PO, ONCE, Tab
ibuprofen 600 mg, PO, ONCE, Tab
Antiemetics No IV promethazine(NOTE)*
ondansetron 4 mg, IV, ONCE, Inj
Miscellaneous No IV Push diphenhydramine unless anaphylactic reaction(NOTE)*
diphenhydrAMINE 50 mg, PO, ONCE, Capsule (DEF)* 50 mg, IM, ONCE, Inj
Laboratory
Lipase level ST | Venous Bld, T;N
Ionized Calcium ST | Venous Bld, T;N
Phosphorus level ST | Venous Bld, T;N
Chemistry Panels
ED Addon Lab T;N, Stat
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
Chemistry
Amylase level ST | Venous Bld, T;N
Magnesium level ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Retic Count ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
Sed Rate ST | Venous Bld, T;N
Changes Marked Below
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
Remove
Remove
Remove
Move under ‘Chemistry’
Remove
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5.22.2019 PowerPlan Request Item #11r P 3 of 3
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
Hemoglobin Electrophoresis ST | Venous Bld, T;N
Blood Gases
EPOC POC T;N, Stat, EPOC Blood Gases
Urine Studies
Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)*
Urine Dipstick POC T;N, Stat, Not available at NW ED.
Toxicology Screen Urine (In House / DRAB) T;N, Urine, ST collect
Microbiology
Blood Culture
Blood Culture 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
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
*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
Move to ‘POC Testing’ category
Remove
Move to ‘POC Testing’ category
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
Vital Signs per Acuity
Orthostatic BP's T;N, obtain orthostatic BP
Cardiac Monitor T;N, Document and interpret rhythm; WHILE IN CARE CENTER
NON-INPATIENT UNIT Cardiac Monitor T;N, When in patient care area
Diet
NPO T;N
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy T;N
Oxygen (NW)(LSH)(CH) T;N, Routine, via Nasal Cannula
ABG Draw IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Dextrose 5% with LR 1,000 ml, IV, ml/hr
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Laboratory
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
Hepatic Function Panel ST | Venous Bld, T;N
ISTAT POC
Changes Marked Below
in RED and BLUE
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Change to ‘Direct Bilirubin’
Remove
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5.22.2019 PowerPlan Request Item #11s P 2 of 3
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
Amylase level ST | Venous Bld, T;N
Ionized Calcium ST | Venous Bld, T;N
Lactate (Single - NOT for Suspected Sepsis) 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
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
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
Blood Gases
EPOC POC T;N, Stat, EPOC 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
Changes Marked Below
Remove
Remove
Remove
Change to ‘Lactate (Initial Sepsis) Reflex’
Remove
Move to ‘POC Testing’ category
Move all ‘cardiac labs under ‘Chemistry’
Remove
Remove
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5.22.2019 PowerPlan Request Item #11s P 3 of 3
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
*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 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
Vital Signs per Acuity
Pulse Ox (Pt Care) T;N, Before and after aerosol treatment
Diet
NPO T;N
NPO T;N, NPO except for medications
Regular Diet T;N
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
Oxygen (NW)(LSH)(CH) T;N, Stat, 2 Liters, via Nasal Cannula
ABG Draw IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
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
Changes Marked Below
in RED
page 103 of 110
5.22.2019 PowerPlan Request Item #11t P 2 of 3
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
acetaminophen 650 mg, PO, ONCE, Tab
acetaminophen 1,000 mg, PO, ONCE, Tab
ibuprofen 400 mg, PO, ONCE, Tab
guaifenesin 200 mg, PO, ONCE, Liq
pseudoephedrine 30 mg, PO, ONCE, Tab
Laboratory
ED Addon Lab T;N, Stat
Chemistry Panels
BMP ST | Venous Bld, T;N
CMP ST | Venous Bld, T;N
ISTAT POC T;N, Stat, ISTAT-6
Chemistry
Magnesium level ST | Venous Bld, T;N
Phosphorus level ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
Microbiology
Blood Culture T;N, Blood, RT, Peripheral, #1 pre-antibiotics
Blood Culture T;N, Blood, RT, Peripheral, #2 pre-antibiotics
Sputum Culture w/ gram stain T;N, Sputum Expectorated, RT
Comments: pre-antibiotics
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Remove
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5.22.2019 PowerPlan Request Item #11t P 3 of 3
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
*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
Changes Marked Below
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
Vital Signs per Acuity T;N
Patient Care Orders
Saline Lock IV with Routine Flushes per Protocol T;N
Respiratory Therapy
Oxygen Therapy Protocol T;N
IV Solutions
sodium chloride 0.9% (Bolus) 1,000 ml, IV, ONCE, Inj
Sodium Chloride 0.9% 1,000 ml, IV, ml/hr
Lactated Ringers 1,000 ml, IV, ml/hr
Dextrose 5% with LR 1,000 ml, IV, ml/hr
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
CMP ST | Venous Bld, T;N
BMP
Changes Marked Below
in RED and BLUE
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
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
CBC ST | Venous Bld, T;N
Auto Differential ST | Venous Bld, T;N, MUST ORDER CBC WITH THIS
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
Changes Marked Below
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
Intake and Output T;N
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 Therapy Protocol T;N
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
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
Changes Marked Below
in RED and BLUE
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5.22.2019 PowerPlan Request Item #11v P 2 of 3
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
PRESSURE BAG (over 30 min)
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
Medications BEST PRACTICE: Administration of antibiotics within 1st hour of recognition of symptoms(NOTE)*
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
Straight Catheter Patient if no void in 30 minutes(NOTE)* Chemistry Panels
CMP ST | Venous Bld, T;N
ISTAT POC T;N, Stat, IStat 6
Chemistry
Lipase level ST | Venous Bld, T;N
Hematology
CBC ST | Venous Bld, T;N
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
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
Sputum Culture w/ gram stain T;N, ST
Urine Studies
Urinalysis (non-catheter) w/ Micro, w/ Reflex Culture PowerPlan(SUB)*
HCG Urine POC
Changes Marked Below
Changes Marked Below
Move all ‘Chemistry Panel’ labs under ‘Chemistry’
Remove
Move to ‘POC Testing’ category
Move lactate under ‘Chemistry’
uncheck
page 109 of 110
5.22.2019 PowerPlan Request Item #11v P 3 of 3
T;N, Stat, Not available at NW ED.
Urine HCG Qualitative T;N, Urine
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
*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 110 of 110