1 © 2011  Zynx Health Incorporated  |  The information contained herein is confidential and proprietary to Zynx Health Incorporated and is intended for its authorized recipient. Unauthorized review, use, disclosure or distribution is strictly prohibited. All rights reserved.

Handling Complex Orderables

2 © 2011  Zynx Health Incorporated  |  The information contained herein is confidential and proprietary to Zynx Health Incorporated and is intended for its authorized recipient. Unauthorized review, use, disclosure or distribution is strictly prohibited. All rights reserved.

Insulin Sliding Scale - DEPRECATED

• Children Orderables– < 250 mg/dl Blood Glucose Level

–2 units INSULIN HUMAN-R SUBCUTANEOUSLY PRN– > 251 mg/dl Blood Glucose Level

–6 units INSULIN HUMAN-R SUBCUTANEOUSLY PRN

• Complex Orderable Attributes– Frequency* (e.g. PRN)– Route* (e.g. Subcutaneously)– Instructions

3 © 2011  Zynx Health Incorporated  |  The information contained herein is confidential and proprietary to Zynx Health Incorporated and is intended for its authorized recipient. Unauthorized review, use, disclosure or distribution is strictly prohibited. All rights reserved.

Insulin Sliding Scale (section with Boolean AND; ie, all or none)

• Insulin Sliding Scale (section with Boolean AND; ie, all or none)– Fingerstick blood glucose qac and qhs– Hypoglycemia protocol PRN fingerstick blood glucose < 70

milligram/deciliter and patient is symptomatic– Insulin Regular 2 unit subcutaneously qac and qhs PRN fingerstick blood

glucose 150-199 milligram/deciliter– Insulin Regular 4 unit subcutaneously qac and qhs PRN fingerstick blood

glucose 200-249 milligram/deciliter– Insulin Regular 6 unit subcutaneously qac and qhs PRN fingerstick blood

glucose 250-299 milligram/deciliter– Insulin Regular 8 unit subcutaneously qac and qhs PRN fingerstick blood

glucose 300-349 milligram/deciliter– Insulin Regular 10 unit subcutaneously qac and qhs PRN fingerstick

blood glucose 350-399 milligram/deciliter– Insulin Regular 12 unit subcutaneously qac and qhs PRN fingerstick

blood glucose > 400 milligram/deciliter– Call provider if fingerstick blood glucose > 400 milligram/deciliter

4 © 2011  Zynx Health Incorporated  |  The information contained herein is confidential and proprietary to Zynx Health Incorporated and is intended for its authorized recipient. Unauthorized review, use, disclosure or distribution is strictly prohibited. All rights reserved.

Total Parenteral Nutrition (TPN)• Children Orderables

– AMINO ACIDS 10% IV BAG 10% 500 ML– DEXTROSE 10% IN WATER (D10W) IV BAG 1 ML– FAT EMULSION 10% IV BTL 500 ML– KCL INU VIAL 40MEQ/20 ML 20 ML– MULTIVITAMIN INJ VIAL 10 ML– TRACE ELEMENT INU VIAL 5 ML– SOD PHOSPHATE INU VIAL 4MEQ/ML 15 ML

• Complex Orderable Attributes– Central Line vs Peripheral Line (Route?)– Infuse Over (Units of time)– Initial rate of infusion (ML/HR)– Order Frequency (ACHSPRN)– Instruction (Free Text)– Total Volume (2021 ML)– Patient Ages (Adult, Pediatric, Neonatal)

5 © 2011  Zynx Health Incorporated  |  The information contained herein is confidential and proprietary to Zynx Health Incorporated and is intended for its authorized recipient. Unauthorized review, use, disclosure or distribution is strictly prohibited. All rights reserved.

PCA

• Patient-controlled analgesia (PCA) is any method of allowing a person in pain to administer their own pain relief.The infusion is programmable by the prescriber. If it is programmed and functioning as intended, the machine is unlikely to deliver an overdose of medication.

6 © 2011  Zynx Health Incorporated  |  The information contained herein is confidential and proprietary to Zynx Health Incorporated and is intended for its authorized recipient. Unauthorized review, use, disclosure or distribution is strictly prohibited. All rights reserved.

Patient Controlled Analgesia

• Children Orderables– Morphine PCA (PF) INJ PKG 1MG/ML

• Complex Orderable Attribute– Concentration: 1 MG/ML– Loading Dose: 10 MG– Basal Rate: 1 MG/HR– Demand Dose: 3 MG– Demand Interval: 10 MIN– Lockout Amount: 10 MG– Lockout Interval: 15 MIN– Rescue Dose: 0.5 MG– Rescue Dose Interval: 5 MIN– Rescue Dose Duration: 8 Doses– Route: IV– Frequency: ACHSPRN

7 © 2011  Zynx Health Incorporated  |  The information contained herein is confidential and proprietary to Zynx Health Incorporated and is intended for its authorized recipient. Unauthorized review, use, disclosure or distribution is strictly prohibited. All rights reserved.

IV with Additives - Deprecated

• Children Orderables– Fluids:

–½ NS IV BAG 1000 ML 1000 ML–D5 1/2NS IV BAG 1000 ML–…

– Additives:–HYDROCORTISONE INJ VIAL 1000MG/2ML 2 EA (Dose 100,

UOM mg)–MAGNESIUM SULF 50% INJ VIAL 8MEQ/2ML 2ML (Dose 8,

UOM meq)–…

• Complex Orderable Metadata– Route: IV– Rate:– Order Frequency: ACHSPRN– Instructions

8 © 2011  Zynx Health Incorporated  |  The information contained herein is confidential and proprietary to Zynx Health Incorporated and is intended for its authorized recipient. Unauthorized review, use, disclosure or distribution is strictly prohibited. All rights reserved.

Complex IV Set

• DOPamine drip 800mg/500mL D5W– Diluent: D5W Titratable Base– Additive: DOPamine (for infusion) 800 mg– IV Attributes:

–500 mL, IV, –Starting Dose: 2 mcg/kg/min, –Titrate Increment: 0.5 mcg/kg/min every 5 minutes, –Keep MAP Greater Than: 60, –Hold if HR Greater than: 120, –Priority: Routine, –Start time offset: Now, –Special Inst: maximum dose of 20mcg/kg/min, titrate. –Comments: Ordered as: DOPamine DRIP 800mg/500mL

D5W

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Oral Steroid Tapering

• Children Orders– PREDNIZONE 10MG TAB (Dose 10MG, Freq: BID, Route Oral, Duration: 2

Days)– PREDNIZONE 5MG TAB (Dose 5MG, Freq: BID, Route Oral, Duration: 3 Days)– PREDNIZONE 1MG TAB (Dose 1MG, Freq: BID, Route Oral, Duration: 3 Days)– PREDNIZONE 1MG TAB (Dose 1MG, Freq: Daily, Route Oral, Duration: 2 Days)– PREDNIZONE 1MG TAB (Dose 1MG, Freq: TID, Route Oral, Duration: 1 Days)– PREDNIZONE 0.5MG TAB (Dose 0.5MG, Freq: QID, Route Oral, Duration: 5

Days)

• Complex Orderable Metadata– Instructions

10 © 2011  Zynx Health Incorporated  |  The information contained herein is confidential and proprietary to Zynx Health Incorporated and is intended for its authorized recipient. Unauthorized review, use, disclosure or distribution is strictly prohibited. All rights reserved.

Respiratory Protocol – Currently unstructured

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Respiratory Protocol - Structured• XOR

– AND–Ventilator settings–OR

–Pulse Oximetry–Blood gas, arterial

– AND–XOR

–Oxygen via nasal canula–Oxygen via nonrebreather face mask–Oxygen via simple face mask–Oxygen via venturi mask

–XOR–Pulse Oximetry–OR

– Pulse Oximetry– Blood gas, arterial