page 1 of 2 · 2/26/2020 · hellena admassu 9 10 iii. next meeting: 3/25/2020 wednesday 3-4 pm by...

LBH Hospital PowerPlan Committee Agenda/Minutes

Teleconference Call In 800-501-8979 Access: 6015094# and Online WindStream ONLY

Clinician Quality/Operation Patient Care Services Informatics

✓ Dr. Kenneth Lee (Co-Chair) Christine Sullivan ✓ Mary Zell ✓ Kenny McHugh (Co-Chair)

Dr. Jonathan Thierman ✓ Pat Moloney-Harmon ✓ Min Kwon ✓ Natalya Makarevich

Dr. Oluwasayo Akinyosoye ✓ Amanda Shrout

✓ Dr. Diana Molavi ✓ Janice Marlett

✓ Amelia Dayucos

✓ Brooke Adams

✓ Carole Louis

Dr. Sam Smith Nancy Brown

✓ Ron Mendoza Kristine Feller

Dr. Ian Loper Dr. Kiran Kuna ✓ Kristen Parsons Patricia Kokoski ✓ Steve Goyette

✓ Dr. Jed Rosen ✓ Lisa Urie

✓ Kimberly Bown ✓ Judy Waltz

Action/Plan *

I.

1

2

3

4

Brian Broomell

Approved

Change in dose for DVT/PE prophylaxis (secondary prevention) from 20 mg with dinner to 10

mg QdayKehinde Egbebi

( Cherwell # 455966 / PP # 254 )

Rivaroxaban PP

Anesthesiology PreOp Multi-Phase PowerPlan (Sinai

Only)

Approved

Wednesday February 26, 2019

Invited

LBH/

Sinai

Dr. Charles Albrecht

Pharm/Lab/Rad/Nutrition

Carroll

Guest

NW

marks indicate the presence of the Invited Participants/Guests

Approved( Cherwell # 367399 / PP # 147 )

Agenda Topic Request Details / Meeting Notes

Review New Requests: (PP= PowerPlan)

This would be an order set that would add on to the standard bronchial hygiene consult. This

would add Flutter valve use q4hrs and a check box list for:

Chest xr port, ASAP, ABG, Guaifenesin 600mg BID or 1200 mg BID, Duoneb, nebulized, q 4

hours

( Cherwell # 405641 / PP # 205 )

Cardiac Surgery Bronchial Hygiene PP

Diluted Insulin Pediatric PowerPlan

( Cherwell # 479196 or PP # 266)

Approved with

condition as

stipulated

We need to create a powerplan for diluted insulin for our Pediatric endocrine patients on the

pediatric unit.

Attached please find the above named PowerPlan, created to mitigate the current process of

having nurses "initiate" a PowerPlan and be prompted with alerts that they cannot address.

The attached multi-phase PP allows the Anesthesiologist to select the desired orders in a

"Planned" stage. The nurse can then "Initiate" the first phase only, which orders the IV

Insertion. The provider can then "initiate" phase 2, which includes all the desired medications

and IV Fluids. Final Approval by Periop Governance Committee scheduled for 3/9/2020

required before Go Live

Nicholas Williams

Lindsay Cromwell-Rims/Stephanie Iannucci/Sakinah

Abdullah

of 2

5

6

Jacqueline Hartford

7

Jon Ford

a

b Approved

c Approved

8

Hellena Admassu

9

10

III. Next Meeting: 3/25/2020 Wednesday 3-4 pm by conference call ONLY

* Request Status Update can be followed online by clicking on the hyperlink below and/or from the Physician/Provider Portal

Approved

See Note

Peds Diabetes-Multiphase PowerPlan

SCIP Antibiotics PP Update

Approved

( Cherwell # 472447 / PP # 261 )

Revisions to the Pediatric Diabetes Multiphase powerplan. Final approval required from Ped

Endo. This PP should only be virtualized to Sinai as Carroll will transfer this pt and Ped

service not offered at NW/Levindale. Lab issues need final approval by Pathologist.

ED Stat Antibiotics PP

( Cherwell # 488142 / PP # 279 )

As a part of the SCIP PowerPlan upgrade prompted by reconciliation of abx selection and

dosing differences at Carroll and the other facilities and by the desire to separate out pre-op

and post-op antibiotics instead of locking providers into order post-op prophylaxis doses (no

evidence to support), 8 of the existing SCIP PPs were updated and 2 new ones were created.

Of the 8 existing plans, 7 went through PowerPlan committee in the fall (only one that did not

was ortho). The ortho plan was finalized recently and two other plans, Brain and

Cardiac,Thoracic, Vascular were updated. See attached.

Would like to request for a new PowerPlan build. This Powerplan has been approved by Drs.

Angela Watkins and Neil Roy of the ED. Please see attachment.

New ED RSI and Sedation PowerPlan

( Cherwell # 332003 / PP # 105 )

( Cherwell # 321907 )

Dr. Berkeley

Approved

Approved

Heather M. Wayland-Foelster

Brian Broomell/Pat Moloney-Harmon

I would like to request assistance to create a powerplan/order set for patients with a

diagnosis of status epilepticus.

New EMU/ICU Status Epilepticus PP (Sina Only)

( Cherwell # 349234 / PP # 126 )

Tabled as noted

Ceftriaxone 1 g x 2 for total of 2 g has caused confusion since go-live. Requested per Dr Roy

that order be changed to 1 g. This was reviewed by the ED Pharmacy Service line and the ED

provider groups at Carroll, Northwest, and Sinai.

( Cherwell # 483091 / PP # 275 )

Powerplan Change - Code Status order

When doing reviews of mortalities, codes and rapid responses we are seeing that patients

have default to full code orders. The recommendation to address this concern is to provide a

trigger to Physicians to readdress the Code Status of patients that have this order, similar to

the notification Physicians get with Observation patients. Recommendation from the

Northwest Survival Committee. Additional unresolved issue came up so request is tabled for

future meeting

Brain Surgery (SCIP Antibiotics)

SCIP Antibiotics - Cardiac, Thoracic, Vascular

SCIP Antibiotics - Orthopedics/Musculoskeletal

of 2

https://app.smartsheet.com/b/publish?EQBCT=24d43623093f4f9eabb538af891bf886

2.26.2020 PowerPlan Request Item #1 P 1 of 1

Printed on: 02/04/2020 7:47

Unique Plan Description: Cardiac Surgery Bronchial Hygiene Plan Selection Display: Cardiac Surgery Bronchial Hygiene PlanType: Medical Version: 1 Begin Effective Date: 01/02/2020 01/02/2020 9:49 End Effective Date: Current Available at: SHB Cardiac Surgery Bronchial Hygiene Respiratory Therapy

Bronchial Hygiene Consult T;N

Flutter Valve T;N, q4h

ABG Draw T;N

High Flow Nasal Cannula T;N

BIPAP T;N

Medications

guaifenesin extended release 600 mg, PO, BID, ER Tab (DEF)* 1,200 mg, PO, BID, ER Tab

guaifenesin 200 mg, NG or OGTube, Q4H, Liq (DEF)* 400 mg, NG or OGTube, Q4H, Liq

DuoNeb inhalation solution 3 ml, inhaled, Q4H, Neb (DEF)*

Comments: Max 6 doses in 24 hour period 3 ml, inhaled, Q6H, Neb

Comments: Max 6 doses in 24 hour period Diagnostic Tests

XR-Chest Portable 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 phasetextControl

page 3 of 30


Printed on: 01/23/20 11:28 Domain: P244

Unique Plan Description: Rivaroxaban Plan Selection Display: Rivaroxaban Plan Synonyms: Xarelto PlanType: Medical Version: 2 Begin Effective Date: 07/30/2019 07/30/19 10:04 End Effective Date: Current Available at: Carroll Hospital, lev Spec Hosp, NWH, SHB Rivaroxaban

** Non-valvular Atrial Fibrillation **(NOTE)*

rivaroxaban 20 mg, PO, with dinner, Tab, Indication for Use = Non-valvular Atrial Fibrillation, For CrCl > 50 ml/min

Comments: for CrCl > 50 mL/min

rivaroxaban 15 mg, PO, with dinner, Tab, Indication for Use = Non-valvular Atrial Fibrillation, For CrCl 15-50

ml/min Comments: for CrCl 15-50 mL/min

** Treatment of DVT / PE **(NOTE)* For days 1 - 21(NOTE)*

rivaroxaban 15 mg, PO, BIDPC, Tab, Indication for Use = VTE Treatment, Duration = 42 dose(s), days 1 - 21

ONLY Comments: give on days 1 - 21 ONLY

For days 22 and beyond(NOTE)*

rivaroxaban 20 mg, PO, with dinner, Tab, Indication for Use = VTE Treatment, days 22 and beyond

Comments: give on treatment Days 22 and beyond ** DVT/PE Prophylaxis (Secondary Prevention) **(NOTE)*

rivaroxaban 20 mg, PO, with dinner, Tab, Indication for Use = Secondary Prevention of VTE 10 mg, PO, QDay, Tab, Indication for Use = Secondary Prevention of VTE (to replace

statement above) ** Surgical Prophylaxis **(NOTE)*

rivaroxaban 10 mg, PO, Q24HV, Tab, Indication for Use = Post-Op VTE Prophylaxis (hip or knee), for CrCl > 30

ml/min Comments: for CrCl > 30 ml/min. The initial dose should be taken at least 6 to 10 hours after surgery once hemostasis has been established.

**Reduction of Risk of Major Cardiovascular event in Chronic CAD**(NOTE)* For patients at high risk of VTE (PADUA score >/=4 or IMPROVE VTE risk score >/=3), discontinue rivaroxaban 2.5mg PO BID and start prophylactic heparin or enoxaparin while inpatient.For patients at low risk of VTE (PADUA score <4 or IMPROVE VTE score<3) not needing VTE prophylaxis, rivaroxaban 2.5mg PO BID + ASA 81mg may be continued for prevention of CV events in patients with CAD or PAD while inpatient.For patient with indication for treatment dose anticoagulation already on rivaroxaban 2.5mg PO BID, discontinue 2.5mg BID dose and start patient on recommended dose for treatment indication.(NOTE)*

rivaroxaban 2.5 mg, PO, BID, Tab, Indication for Use = CV prevention in CAD, Chronic CAD for GFR>15 ml/min

aspirin 81 mg, PO, QDay, Chewable Tab, CV prevention in chronic CAD in combination with Rivaroxaban

Comments: CV prevention in chronic CAD in combination with Rivaroxaban **Reduction of Risk of Major Cardiovascular event in Chronic PAD**(NOTE)* For patients at high risk of VTE (PADUA score >/=4 or IMPROVE VTE risk score >/=3), discontinue rivaroxaban 2.5mg PO BID and start prophylactic heparin or enoxaparin while inpatient.For patients at low risk of VTE (PADUA score <4 or IMPROVE VTE score<3) not needing VTE prophylaxis, rivaroxaban 2.5mg PO BID + ASA 81mg may be continued for prevention of CV events in patients with CAD or PAD while inpatient.For patient with indication for treatment dose anticoagulation already on rivaroxaban 2.5mg PO BID, discontinue 2.5mg BID dose and start patient on recommended dose for treatment indication.(NOTE)*

rivaroxaban 2.5 mg, PO, BID, Tab, Indication for Use = CV prevention in PAD, Chronic PAD for GFR >15 ml/min

aspirin 81 mg, PO, QDay, Chewable Tab, CV prevention in chronic PAD in combination with Rivaroxaban

Comments: CV prevention in chronic PAD in combination with Rivaroxaban

remove

Add

page 4 of 30


Printed on: 01/23/20 11:28 Domain: P244

** Consults **(NOTE)*

LAAO/Watchman Education Consult T;N


page 5 of 30


Printed on: 02/24/20 10:13 Domain: B244

Unique Plan Description: Anesthesia PreOp Orders (Sinai Only) Plan Selection Display: Anesthesia PreOp Orders (Sinai Only) PlanType: Medical Version: 1 Begin Effective Date: 02/24/2020 02/24/20 09:52 End Effective Date: Current Available at: SHB Arrival Patient Care Orders

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

Discontinue Anesthesia PreOp plan on discharge from PACU T;N

IV Start / Restart T;N, New start

Laboratory

ABO/Rh Recheck Lab Urgent | Venous Bld, T;N

Blood Glucose Monitoring POC T;N, Stat

BMP ST | Venous Bld, T;N

Hemoglobin ST | Venous Bld, T;N

INR POC CK ST collect, T;N, Blood, INR POC for coumadin patients only

INR / PT ST | Venous Bld, T;N

ISTAT POC T;N, Stat

ISTAT POC T;N, Stat, Hemocue

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

Urine HCG POC T;N, Stat

Type and Screen(SUB)* Diagnostic Tests

EKG. T;N, ASAP

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

Prior to Procedure IV Solutions

Lactated Ringers 1,000 ml, IV, @ 20 ml/hr

Sodium Chloride 0.9% 1,000 ml, IV, @ 20 ml/hr

Lactated Ringers (Bolus) 500 ml, IV, ONCE, Start T;N, STAT, Inj

Comments: infuse over 1 hour Medications Antiemetics

ondansetron 4 mg, IV, ONCE, Start T;N, STAT, Inj

metoclopramide

page 6 of 30



10 mg, IV, ONCE, Start T;N, STAT, Inj

dexameTHASONE 4 mg, IV, ONCE, Start T;N, STAT, Inj (DEF)* 8 mg, IV, ONCE, Start T;N, STAT, Inj

scopolamine 1 mg, transdermal, ONCE, Start T;N, STAT, Patch

famotidine 20 mg, IV, ONCE, Start T;N, Inj

Bicitra 15 ml, PO, ONCE, Start T;N, STAT, Liq

Analgesics: Non-Opioids

celecoxib 200 mg, PO, ONCE, Start T;N, STAT, Capsule (DEF)* 400 mg, PO, ONCE, Start T;N, STAT, Capsule

acetaminophen 500 mg, PO, ONCE, Start T;N, STAT, Tab (DEF)* 1,000 mg, PO, ONCE, Start T;N, STAT, Tab

naproxen 500 mg, PO, ONCE, Start T;N, STAT, Tab

gabapentin 300 mg, PO, ONCE, Capsule (DEF)* 400 mg, PO, ONCE, Capsule 600 mg, PO, ONCE, Capsule 800 mg, PO, ONCE, Capsule

pregabalin 75 mg, PO, ONCE, Capsule (DEF)* 150 mg, PO, ONCE, Capsule

Analgesics: Opioids

oxyCODONE immediate release 5 mg, PO, ONCE, Start T;N, STAT, Tab

Comments: May be given in both phase I and II

OxyCONTIN 20 mg, PO, ONCE, Start T;N, STAT, ER Tab (DEF)* 10 mg, PO, ONCE, Start T;N, STAT, ER Tab

fentanyl 12.5 mcg, IV, ONCE, Start T;N, STAT, Inj (DEF)* 25 mcg, IV, ONCE, Start T;N, STAT, Inj 50 mcg, IV, ONCE, Start T;N, STAT, Inj

Sedatives ------------------------------midazolam IV --------------------------------:(NOTE)*

midazolam 1 mg, IV, ONCE, Start T;N, STAT, Inj (DEF)* 2 mg, IV, ONCE, Start T;N, STAT, Inj 1 mg, IV, as directed, PRN, anxiety, Inj, Duration = 2 dose(s)

Comments: 1 mg IV PRN for anxiety may repeat once for a maximum of 2 mg -----------------------------midazolam ORAL------------------------------- :(NOTE)*

midazolam 0.5 mg/kg, PO, ON CALL, Start T;N, Liq, Max Dose = 20mg

Comments: Max dose = 20mg

lorazepam 1 mg, PO, ONCE, Start T;N, STAT, Tab

Inhaled Beta-2 Agonists, Short-Acting

albuterol neb 2.5mg 1 neb, inhaled, ONCE, Start T;N, STAT, Neb

albuterol MDI 2 puff(s), inhaled, ONCE, Start T;N, STAT, Oral Inhaler

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

DuoNeb inhalation solution 3 ml, inhaled, ONCE, Start T;N, STAT, Neb

Comments: Max 6 doses in 24 hour period Miscellaneous

page 7 of 30



Solu-Cortef 100 mg, IV, ONCE, Inj

diphenhydrAMINE 12.5 mg, IV, ONCE, Start T;N, STAT, Inj (DEF)* 25 mg, IV, ONCE, Start T;N, STAT, Inj 50 mg, IV, ONCE, Start T;N, STAT, Inj

Beta Blockers

metoprolol 25 mg, PO, ONCE, Start T;N, STAT, Tab (DEF)* 50 mg, PO, ONCE, Start T;N, STAT, Tab 1 mg, IV, ONCE, Start T;N, STAT, Inj 2 mg, IV, ONCE, Start T;N, STAT, Inj 0.5 mg, IV, ONCE, PRN, Other, see comments, Inj, prn if pt is on a beta blocker and has NOT taken

their dose and sbp>100 and HR>60 Comments: prn if pt is on a beta blocker and has NOT taken their dose and sbp>100 and HR>60


page 8 of 30



Unique Plan Description: Diluted Insulin Pediatric PowerPlan Plan Selection Display: Diluted Insulin Pediatric PowerPlan PlanType: Medical Version: 1 Begin Effective Date: 02/06/2020 02/06/20 11:18 End Effective Date: Current Available at: SHB Diluted Insulin Pediatric PowerPlan Medications

Diluted insulin aspart is available at a concentration of 10 units/mL Provider to update order comments with the insulin to carbohydrate (I:C) ratio, correction scale, and ketone coverage.(NOTE)*

NovoLOG, (diluted 10 units/ml) insulin to carbohydrate ratio, correction scale, and ketone coverage sliding scale, subQ, as directed, PRN, Other, see comments, Inj

Comments: Give insulin based on insulin to carbohydrate ratio, correction scale, and ketone correction as specified: Nurse administration instructions: Diluted insulin aspart is 10 units/ml. Measure dose with a 30 unit (0.3ml) insulin syringe. 1 unit marking on the syringe= 0.1 units of insulin. Ex. 2 unit mark=0.2 units of insulin. After each blood glucose level is obtained, refer to physician to reevaluate the scale prior to administering the next dose. Dispose unused drug in black container

For complex regimens using diluted insulin aspart 10 units/mL, use separate order sentences to specify the doses and time.(NOTE)*

NovoLOG, (diluted 10 units/ml) units, subQ, Inj

Comments: Nurse administration instructions:Diluted insulin aspart is 10 units/ml. Measure dose with a 30 unit (0.3ml) insulin syringe. 1 unit marking on the syringe= 0.1 units of insulin. Ex. 2 unit mark=0.2 units of insulin. Dispose unused drug in black container





Hypoglycemia Treatment * If Blood Glucose is less than 70 mg/dL and patient is alert, administer 15 grams of fast-acting carbohydrate orally.(NOTE)* * Re-test Blood Glucose in 15 min, NHO if Blood Glucose is not > 90.(NOTE)* ** If patient is seizing or unconscious or unable to drink:(NOTE)*

Dextrose 10% in Water 1,000 ml, IV, ml/hr

Comments: PRN patient is seizing or unconscious or unable to drink Glucagon DoseWeight < 20kg= Dose 0.5mgWeight >/= 20 kg= Dose 1 mg:(NOTE)*

glucagon 0.5 mg, IM, as directed, PRN, Other, see comments, Inj [Less Than 20 kg] (DEF)*

Comments: PRN patient is seizing or unconscious or unable to drink 1 mg, IM, as directed, Other, see comments, Inj [Greater Than or Equal To 20 kg]

Comments: PRN patient is seizing or unconscious or unable to drink Laboratory POC Testing

Fingersticks POC T;N, AC and bedtime and 0300

Urine Dipstick POC T;N, Stat

*Report Legend:

page 9 of 30


Unique Plan Description: Peds Diabetes-Multiphase PowerPlan Plan Selection Display: Peds Diabetes-Multiphase PowerPlan PlanType: Medical Version: 1 Begin Effective Date: 11/1/2016 7:16 AM End Effective Date: Current Available at all facilities Emergency Department Vital Signs

Vital Signs per Acuity T;N, q1h

Diet

NPO T;N, Test/Procedure

NPO T;N, NPO except for medications

Patient Care Orders Assessment

Neuro Checks T;N, Q1H

IV Solutions Initial fluids(NOTE)* Bolus with 10 - 20 mL/kg over 1 hour(NOTE)*

sodium chloride 0.9% (Bolus) ml, IV, ONCE, Inj, infuse over 1 hr(s)

After 1st fluid bolus: Start 1.5 x maintenance fluid after bolus(NOTE)* Select NS order below if glucose > 250 mg/dL(NOTE)*

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

If glucose < 250 mg/dL, select D5NS or D10NS order below(NOTE)*

Dextrose 5% with 0.9% NaCl 1,000 ml, IV, ml/hr

Dextrose 10% & 0.9% NS 1000ml & KAcet 20meq &KPhos 13.6 mmol (IVS)* Dextrose 5% with 0.9% NaCl

1,000 ml, IV, ml/hr Comments: D10NS & K Acetate 20 mEq & K Phosphate 13.63 mmol (13.63mmol Phos = 20mEq K)

Dextrose 50% 50 gm, Every Bag

potassium acetate 20 mEq, Every Bag

potassium phosphate 13.63 mmol, Every Bag

If serum potassium is greater than 4 mEq/dL, DO NOT give potassium but check level every hour(NOTE)* Medications

insulin (regular) drip (Peds DKA) (IVS)* (Change) {This Needs to be unchecked} Sodium Chloride 0.9%

100 ml, IV Comments: Do not give insulin bolus, dispose unused drug in black container

insulin regular (for wt drip) 100 units, 0.1, unit/kg/hour

Laboratory Peds New-Onset Diabetes Labs

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 10.00.9200.17609"></HEAD><BODY><FONT style="BACKGROUND-COLOR: #ffff00">*** For New Onset Diabetes Only

page 10 of 30


***</FONT></BODY></HTML>(NOTE)*

Peds New-Onset Diabetes Labs(SUB)* Panels

BMP ST | Venous Bld, T;N

CMP ST | Venous Bld, T;N

Chemistry

Magnesium level ST | Venous Bld, T;N

Phosphorus level ST | Venous Bld, T;N

Vitamin D 25 - Hydroxy level ST | Venous Bld, T;N

POC Testing

Fingersticks POC T;N, Stat, Q1H

EPOC POC T;N, Stat, EPOC All Tests

Urine Dipstick POC T;N, Stat

Hematology

CBC ST | Venous Bld, T;N

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

HgB A1c ST | Venous Bld, T;N

IGA, Serum ST | Venous Bld, T;N

Tissue Transglutaminase (tTG), IgA ST | Venous Bld, T;N

Urine Studies

Urine HCG POC T;N, Stat

Microbiology

Blood Culture T;N, Blood, ST

Urine Culture T;N, ST

Diagnostic Tests

EKG POC T;N, Stat, If serum K>6.0

EKG. T;N, Stat, If serum K>6.0

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

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

PICU DKA Admission Admit/Diagnosis

Admit T;N, Inpatient, PICU

page 11 of 30


Start Observation (CHANGE) {Uncheck; let docs choose} T;N, Pediatrics

Diagnosis T;N, DKA

Admitting Physician. T;N

Attending Physician. T;N

Transfer to: T;N, PICU

Code Status

Code Status T;N, Full Resuscitation

Vital Signs

Vital Signs T;N, per PICU monitoring

Neuro Checks T;N, Q1H

Notify Provider for VS's of: (CHANGE) T;N

Cardio-Respiratory Monitoring T;N

Pulse Oximetry Continuous T;N, pulse ox, Continuous

Activity

Bedrest T;N (DEF)* T;N, Bathroom Privileges

Elevate T;N, Head of Bed (DEF)* T;N, Head of Bed 30 degrees

Activity as Tolerated T;N

OOB T;N, to chair (DEF)* T;N, ambulate in room, with assistance T;N, as tolerated

Diet

Dietitian to Manage Medical Nutrition Therapy (Change) T;N

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

Restricted Diet T;N, Room Service, Pediatric, Clear Liquid

Patient Care Orders

IV Start / Restart T;N

Intake and Output Strict T;N

Provide Educational Material (Change: Pt Care Order) {New Order} T;N

IV Solutions

page 12 of 30


Sodium Chloride 0.9% 1000 ml & KAcet 20meq & KPhos 13.6 mmol (IVS)* Sodium Chloride 0.9%

1,000 ml, IV, ml/hr Comments: NS & K Acetate 20 mEq & K Phosphate 13.63 mmol (13.63mmol Phos = 20mEq K)



Dextrose 10% & 0.9% NS 1000ml & KAcet 20meq &KPhos 13.6 mmol (IVS)* Dextrose 5% with 0.9% NaCl

1,000 ml, IV, ml/hr Comments: D10NS & K Acetate 20 mEq & K Phosphate 13.63 mmol (13.63mmol Phos = 20mEq K)

Dextrose 50% 50 gm, Every Bag



Medications

insulin drip 1 unit/ml (PICU) 250ml (IVS)* Sodium Chloride 0.9%

250 ml, IV Comments: Dispose unused drug in black container

insulin regular (for wt drip) 250 units, 0.1, unit/kg/hour

insulin glargine units, subQ, Qbedtime, Inj

Comments: Dispose unused drug in black container

heparin flush pf 10 units/ml 1 ml, IV, BID, Inj

famotidine (pediatrics) 0.4 mg/kg, IV, Q12H, Inj Syringe

Comments: mix in NS Laboratory

HgB A1c RT collect Venous Bld, T;N

Peds New-Onset Diabetes Labs

Peds New-Onset Diabetes Labs(SUB)* Hematology

CBC RT | Venous Bld, T;N

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

Chemistry Panels

BMP RT | Venous Bld, T;N, q2hr, 4 hr (Change – Do not remove) {Uncheck}

epoch bmp RT | Venous Bld, T;N, q2h (Change)

Fingersticks POC (Change) Please do not add this here T;+1, RT, Q2H

BMP RT | Venous Bld, T;+6, Q4H (DO NOT Remove) {Uncheck}

CMP

page 13 of 30


RT | Venous Bld, T;N Chemistry

Amylase level RT | Venous Bld, T;N

Lipase level RT | Venous Bld, T;N

Hcg Qualitative Test RT | Venous Bld, T;N

Magnesium level RT | Venous Bld, T;N, q4hr

Phosphorus level RT | Venous Bld, T;N, q4hr

POC Testing

EPOC POC {Change Parameters for order & Precheck } RT | Venous Bld, T;N, q2h (Change)

Fingersticks POC (Change) {New Order in this section & Prechecked} T;+1, RT, Q2H

EPOC POC T+1;0400, Routine (Change)

EPOC POC T+1;0400, Routine, PRN (Change)

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

Microbiology

MRSA Amplified RT | Nasal, T;N

Diagnostic Tests

EKG POC T;N, Stat

EKG. T;N, Stat

Consults

Care Mgmt Peds Inpt Consult (CHANG) {Should be prechecked} T;N (DEF)* T;N, Referral reason: Requirement (Change)

Child Life Specialist Consult {Precheck} T;N, Routine

Nutrition Consult {This is for New onset diabetics} T;N, New Onset Diabetes Diet Education

Pastoral Care Consult T;N

Care Mgmt Peds Inpt Consult (Change) T;N

Ped Endocrine Consult: Call Ped Endo x2-8331 T;N

Peds Hyperglycemia Admit/Diagnosis

Admit T;N, Inpatient, 3CHS-Peds

Start Observation T;N, Pediatrics

Diagnosis (Change) {Remove diagnosis and require it to be entered}

page 14 of 30


T;N, (Def*)

Admitting Physician. T;N

Attending Physician. T;N

Consulting Physician T;N

Transfer to: T;N, Pediatrics

Code Status

Code Status T;N, Full Resuscitation

Vital Signs

Vital Signs T;N, q4H (Change) {Remove special Instructions}

Neuro Checks T;N, Q4H (Change)

Notify Provider for VS's of: {Precheck}

T;N; {Import VS Orders with Ranges from Peds ASTHMA; currently exist} ***For Ages 1-3 select the following***(NOTE)*

Notify Provider for VS's of: T;N, Temp > 38.0 C, HR> 160, HR< 80, RR> 40, RR< 14, 02 Sat< 92, For Ages 1 - 3

***For Ages 4-5 select the following***(NOTE)*

Notify Provider for VS's of: T;N, Temp > 38.0 C, HR> 140, HR< 50, RR> 36, RR< 12, 02 Sat< 92, For Ages 4-5





***For Ages 12+ select the following***(NOTE)*

Notify Provider for VS's of: T;N, Temp > 38.0 C, HR> 120, HR< 50, RR> 28, RR< 8, 02 Sat< 92, For Ages 12+

Cardio-Respiratory Monitoring (Change) {Uncheck} T;N

Pulse Oximetry Continuous {Uncheck} T;N, pulse ox, Continuous (Change)

Activity

Bedrest T;N (DEF)* T;N, Bathroom Privileges

Elevate T;N, Head of Bed (DEF)* T;N, Head of Bed 30 degrees

Activity as Tolerated T;N

OOB T;N, to chair (DEF)* T;N, ambulate in room, with assistance T;N, as tolerated

Diet

Dietitian to Manage Medical Nutrition Therapy (Change) T;N

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Diet order: (Change) {Add new order} Pediatric Regular diet (age), sugar free syrup and sugar free beverages only; Nursing to deliver tray

NPO (CHANGE) {Uncheck} T;N, No exceptions (DEF)* T;N, NPO except for medications T;N, NPO except for ice chips

PO Supplements (SHB) T;N, BID, 2 Low Carbohydrate Snacks per Day

Snacks 15 g CHO BID, use unit floorstock (Change) {Add new order}

Restricted Diet T;N, Pediatric

Provide Educational Material (Change: Pt Care Order) {Add new order} T;N

Patient Care Orders

IV Start / Restart T;N

Intake and Output Strict T;N

IV Solutions

Sodium Chloride 0.45% 1000 ml & K Acetate 20 meq (IVS)* Sodium Chloride 0.45%

1,000 ml, IV, ml/hr potassium acetate

20 mEq, Every Bag

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

sodium chloride 0.9% (Bolus) 10 ml/kg, IV, ONCE, Inj

Medications ** For complex regimens, use separate order sentences to specify the doses and time **(NOTE)*

Aspart (NovoLOG) carbohydrate to insulin ratio (PEDS) (Change) {New order Carb to Insulin ratio} sliding scale, subQ, units, AC and bedtime and 0300, Inj


Aspart (NovoLOG), sliding scale (PEDS) (Change) {Name change} units, subQ, AC and bedtime and 0300, Inj


NovoLOG (Change) units, subQ, Inj






Aspart (NovoLOG), Carb Ctrl, sliding scale (PEDS) Diluted (Change) {Add diluted insulin} units, subQ, AC and bedtime and 0300, Inj


Aspart (NovoLOG), sliding scale (PEDS) Diluted (Change) {Add diluted insulin} units, subQ, AC and bedtime and 0300, Inj


NPH (Change) units, subQ, Inj


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Insulin Glargine (Lantus) (Change) units, subQ, Qbedtime, Inj


Lantus (Change) units, subQ, QDay, Inj


insulin regular (Change) units, subQ, Inj

Comments: Dispose unused drug in black container Hypoglycemia Treatment

* If Blood Glucose is less than 70 mg/dL and patient is alert, administer 15 grams of fast-acting carbohydrate orally.(NOTE)* * Re-test Blood Glucose in 15 min, NHO if Blood Glucose is not > 90.(NOTE)* ** If patient is seizing or unconscious or unable to drink:(NOTE)*

Dextrose 10% in Water (New Change) PLEASE Check This 1,000 ml, IV, ml/hr

Weight < 20kg:(NOTE)*

glucagon (New Change) PLEASE Check This 0.5 mg, IM, ONCE, Inj

Weight > 20kg:(NOTE)*

glucagon (New Change) PLEASE Check This 1 mg, IM, ONCE, Inj

Type II Diabetes Mellitus for children 10 years old and older:(NOTE)*

metformin 500 mg, PO, QD, Tab (Change)

Miscellaneous PRN Medications

metformin {Moved to Misc medications, not a Hypoglycemia Med} 500 mg, PO, QD, Tab (Change)

acetaminophen (pediatrics) 15 mg/kg, Q4H, PRN, Liq

acetaminophen 650 mg, PO, Q4H, PRN, Tab

acetaminophen (pediatrics) 20 mg/kg, rectal, Q6H, PRN, Supp

acetaminophen 650 mg, rectal, Q6H, PRN, Supp

ibuprofen 10 mg/kg, PO, Q6H, PRN, Susp

ibuprofen (pediatrics) 400 mg, PO, Q6H, PRN, Tab

Laboratory

HgB A1c RT | Whole Blood, T;N

Peds New-Onset Diabetes Labs (below) include HgB A1c. Please do not order the above if ordering the below PowerPlan.(NOTE)*

Peds New-Onset Diabetes Labs(SUB)* Hematology

CBC RT | Venous Bld, T;N

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

Chemistry Panels

BMP RT | Venous Bld, T;N, q2hr, 4 hr

+6 Hours BMP

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RT | Venous Bld, T;N, Q4H

CMP RT | Venous Bld, T;N

Chemistry

Amylase level RT | Venous Bld, T;N

Lipase level RT | Venous Bld, T;N

Magnesium level RT | Venous Bld, T;N, Q4H

Phosphorus level RT | Venous Bld, T;N, Q4H

Hcg Qualitative Test RT | Venous Bld, T;N

POC Testing

Fingersticks POC (Change) {Add New order to POC Testing} T;N, AC and bedtime and 0300,

EPOC POC (Change) T+1;0400, Routine

EPOC POC (Change) T+1;0400, Routine, PRN

Urine Dipstick POC (Change) {Precheck} T;N, Routine, QVoid (DEF)* T;N, Routine, q4h T;N, Routine, q8h

Microbiology

MRSA Amplified (Change) {UnCheck} RT | Nasal, T;N

Diagnostic Tests

EKG POC T;N, Stat

EKG. T;N, Stat

Consults

Care Mgmt Peds Inpt Consult (Change) [There should be prechecked only be one choice in this consult request and the reason should be “Required.”

T;N, Referral reason: Required

Child Life Specialist Consult (Change) {This should be prechecked} T;N, Routine

Nutrition Consult (Change) {No Check reason for consult} T;N, New Onset Diabetes Diet Education

Nutrition Consult (Change) {Duplicative} T;N

Pastoral Care Consult T;N

Care Mgmt Peds Inpt Consult (Change) {Duplicative Order} T;N

Ped Endocrine Consult: Call Ped Endo x2-8331 T;N

*Report Legend:

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Unique Plan Description: ED Stat IV Antibiotics Plan Selection Display: ED Stat IV Antibiotics Plan Synonyms: ED Stat ( Sepsis ) IV Antibiotics PlanType: Medical Version: 2 Begin Effective Date: 02/14/2020 02/14/20 13:00 End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Stat IV Antibiotics Medications

cefepime 2 gm, IV, ONCE, STAT, Indication = Other, Suspected Organism = Empiric, Inj

Select order below for Ceftriaxone 2 gm dose=1 gm x 2 doses

cefTRIAxone 1 gm, IV, ONCE, STAT, Indication = Other, Suspected Organism = Empiric, duration = 2 dose(s), Inj

(DEF)* Comments: 2 gm = 1gm q10min x 2 doses

1 gm, IV, ONCE, STAT, Indication = Other, Inj

levoFLOXacin 750 mg, IV, ONCE, STAT, Indication = Other, Suspected Organism = Empiric, Inj

piperacillin-tazobactam 3.375 gm, IV, ONCE, STAT, Indication = Other, Suspected Organism = Empiric, Inj

Zosyn CH (ED ONLY) 4.5 gm, IV, ONCE, STAT, Indication = Other, duration = 1 dose(s), Inj, infuse over 30 min(s)

For current or previous infection with resistant gram-negative bacteria(NOTE)*

meropenem 1 gm, IV, ONCE, STAT, Indication = Other, Suspected Organism = Empiric, duration = 2 dose(s), Inj

Comments: For current or previous infection with resistant gram-negative bacteria Not for use as monotherapy in sepsis (Vanomycin and Ciprofloxacin)(NOTE)*

vancomycin 1.5 gm, IV, ONCE, STAT, Indication = Other, Suspected Organism = Empiric, Inj, for patients < 69 kg

vancomycin 2 gm, IV, ONCE, STAT, Indication = Other, Suspected Organism = Empiric, Inj, for patients > 70 kg

For patients with life-threatening reaction to penicillins AND cephalosporins; Not for use as monotherapy in sepsis (Vanomycin and Ciprofloxacin)(NOTE)*

ciprofloxacin 400 mg, IV, ONCE, STAT, Indication = Other, Suspected Organism = Empiric, Inj

Comments: For patients with life-threatening reaction to penicillins AND cephalosporins See separate powerplan for aminoglycosides(NOTE)*


remove

add

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2.26.2020 PowerPlan Request Item #7a P 1 of 2

Unique Plan Description: Brain Surgery (SCIP Antibiotics) Plan Selection Display: Brain Surgery (SCIP Antibiotics) PlanType: Sub Phase - No Visibility Version: 2 Begin Effective Date: 9/18/2019 9:03 AM End Effective Date: Current Available at: NWH SHB Brain Surgery (SCIP Antibiotics) Medications NOTE: Please select a PRE-Operative AND POST-Operative antibiotic order sentence IF both are desired PRE-Operative Antibiotic

Weight >= 120 kg(NOTE)*

ceFAZolin 3 gm, IV, ONCE, Routine, Indication = Surgical site infection prophylaxis, Inj

Weight < 120 kg(NOTE)*


For patients with an anaphylactic reaction to penicillins or cephalosporins, use vancomycin alone (NOTE)* For patients with confirmed MRSA colonization, consider addition of vancomycin to cefazolin (NOTE)*

Weight > 80 kg(NOTE)*

vancomycin 2 gm, IV, ONCE, Routine, site of infection = surgical site (prophylaxis only), Suspected Organism =

Empiric, duration = 24 hr, Inj Comments: Begin initial infusion 2 hours prior to procedure

Weight <= 80 kg(NOTE)*




vancomycin 2 gm, IV, ONCE, Routine, Indication = Surgical site infection prophylaxis, Inj

Comments: Vancomycin should be used in combination with cefazolin unless patient has an anaphylactic reaction to penicillins or cephalosporins. Infuse the ENTIRE DOSE prior to procedure.

Weight 91-120 kg(NOTE)*

vancomycin 1.5 gm, IV, ONCE, Routine, Indication = Surgical site infection prophylaxis, Inj



vancomycin

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2.26.2020 PowerPlan Request Item #7a P 2 of 2

1.25 gm, IV, ONCE, Routine, Indication = Surgical site infection prophylaxis, Inj Comments: Vancomycin should be used in combination with cefazolin unless patient has an anaphylactic reaction to penicillins or cephalosporins. Infuse the ENTIRE DOSE prior to procedure.




POST-Operative Antibiotic (optional)

Schedule to begin 8 hours after scheduled time of pre-operative dose. If CrCl <= 10 ml/min, do not select a post-operative cefazolin dose.(NOTE)* Weight>=120 kg(NOTE)*

ceFAZolin 3 gm, IV, Q8HV, Routine, Indication = Surgical site infection prophylaxis, duration = 2 dose(s), Inj

Comments: Post-operative surgical site infection prophylaxis. Schedule to begin 8 hours after pre-operative dose.

Weight <120 kg(NOTE)*



For patients with an anaphylactic reaction to penicillins or cephalosporins or confirmed MRSA colonization (NOTE)* A single pre-operative dose of vancomycin is sufficient for surgical site prophylaxis (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

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2.26.2020 PowerPlan Request Item #7b P 1 of 2

Unique Plan Description: SCIP Antibiotics - Cardiac, Thoracic, Vascular Plan Selection Display: SCIP Antibiotics - Cardiac, Thoracic, Vascular PlanType: Medical Version: 1 Begin Effective Date: 2/24/2014 1:21 PM End Effective Date: Current Available at: Carroll Hospital NWH SHB SCIP Antibiotics - Cardiac, Thoracic, Vascular Medications

NOTE: Please select a PRE-Operative AND POST-Operative antibiotic order sentence IF both are desired PRE-Operative Antibiotic

Weight >= 120 kg(NOTE)*



For patients with penicillin allergy(NOTE)* Weight > 80 kg(NOTE)*



Weight <= 80 kg(NOTE)*



For patients with an anaphylactic reaction to penicillins or cephalosporins, use vancomycin alone. (NOTE)* For patients with confirmed MRSA colonization, consider addition of vancomycin to cefazolin. (NOTE)*








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2.26.2020 PowerPlan Request Item #7b P 2 of 2







Schedule to begin 8 hours after scheduled time of pre-operative dose. If CrCl <= 10 ml/min, do not select a post-operative cefazolin dose.(NOTE)*



Weight <120 kg(NOTE)*



For patients with an anaphylactic reaction to penicillins or cephalosporins or confirmed MRSA colonization (NOTE)* A single pre-operative dose of vancomycin is sufficient for surgical site prophylaxis (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

page 23 of 30

2.26.2020 PowerPlan Request Item #7c P 1 of 2 Unique Plan Description: SCIP Antibiotics - Orthopedics/Musculoskeletal Plan Selection Display: SCIP Antibiotics - Orthopedics/Musculoskeletal PlanType: Medical Version: 1 Begin Effective Date: March 2020 End Effective Date: Current Available at: Carroll Hospital NWH SHB SCIP Antibiotics - Orthopedics/Musculoskeletal Medications NOTE: Please select a PRE-Operative AND POST-Operative antibiotic order sentence IF both are desired

Includes spine surgery(NOTE)*

PRE-Operative Antibiotic Weight >= 120 kg(NOTE)*

cefazolin 3 gm, IV, ONCE, Routine, Indication = surgical site infection prophylaxis, Inj


cefazolin 2 gm, IV, ONCE, Routine, Indication = surgical site infection prophylaxis, Inj

For patients with confirmed MRSA colonization, consider addition of vancomycin to cefazolin (NOTE)* For patients with an anaphylactic reaction to penicillins or cephalosporins, either vancomycin or clindamycin are recommended (NOTE)*


vancomycin 2 gm, IV, ONCE, Routine, Indication = surgical site infection prophylaxis, Inj



vancomycin 1.5 gm, IV, ONCE, Routine, Indication = surgical site infection prophylaxis



vancomycin 1.25 gm, IV, ONCE, Routine, Indication = surgical site infection prophylaxis

Comments: Vancomycin should be used in combination with cefazolin unless patient has an anaphylactic reaction to penicillins or cephalosporins. Infuse the ENTIRE DOSE prior to procedure. Weight <70 kg(NOTE)*

vancomycin 1 gm, IV, ONCE, Routine, Indication = surgical site infection prophylaxis Comments: Vancomycin should be used in combination with cefazolin unless patient has an

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2.26.2020 PowerPlan Request Item #7c P 2 of 2

anaphylactic reaction to penicillins or cephalosporins. Infuse the ENTIRE DOSE prior to procedure. Clindamycin is an alternative to vancomycin for patients with an anaphylactic reaction to penicillins or cephalosporins who are not colonized with MRSA (NOTE)*

clindamycin 900 mg, IV, ONCE, Routine, Indication = surgical site infection prophylaxis, Inj


Comments: Schedule to begin 8 hours after scheduled time of pre-operative dose. If CrCl ≤ 10 ml/min, do not select a post-operative cefazolin dose Weight >= 120 kg(NOTE)*

cefazolin 3 gm, IV, Q8H, Routine, Indication = surgical site infection prophylaxis, duration = 2 doses, Inj



cefazolin 2 gm, IV, Q8H, Routine, Indication = surgical site infection prophylaxis, duration = 2 doses, Inj


For patients with an anaphylactic reaction to penicillins or cephalosporins or confirmed MRSA colonization (NOTE)* A single pre-operative dose of vancomycin is sufficient for surgical site prophylaxis. If infection suspected, order maintenance therapy separately. (NOTE)* For patients with an anaphylactic reaction to penicillins or cephalosporins who received clindamycin pre-operatively (NOTE)*

clindamycin 900 mg, IV, Q8H, Routine, Indication = surgical site infection prophylaxis, duration = 2 doses, Inj


*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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Unique Plan Description: ED Adult: RSI and Sedation Management Plan Selection Display: ED Adult: RSI and Sedation Management PlanType: Medical Version: 1 Begin Effective Date: 02/05/2020 02/05/20 13:34 End Effective Date: Current Available at: Carroll Hospital NWH SHB ED Adult: RSI and Sedation Management

INDUCTION(NOTE)* Etomidate: recommended dose 0.3 mg/kg(NOTE)* Avoid repeat dosing following intubation(NOTE)*

etomidate mg, IV, ONCE, STAT, Inj

Comments: Avoid repeat dosing following intubation Ketamine: recommended dose 1-2 mg/kg(NOTE)* May increase HR and BP; may provide bronchodilation(NOTE)*

ketamine mg, IV, ONCE, STAT, Inj

Comments: May increase HR and BP; may provide bronchodilation Midazolam: recommended dose 0.1-0.3mg/kg(NOTE)*

midazolam mg, IV, ONCE, STAT, Inj

PARALYSIS(NOTE)* Rocuronium: recommended dose based on ideal body weight 0.6-1.2 mg/kg(NOTE)*

rocuronium mg, IV, ONCE, STAT, Inj

Succinylcholine: recommended dose 1- 1.5 mg/kg(NOTE)* Avoid use in hyperkalemia, history of malignant hyperthermia, spinal, crush or burn injuries and other denervating injuries and diseases(NOTE)*

succinylcholine mg, IV, ONCE, STAT, Inj

ANALGESIA(NOTE)* Prioritize analgesia over sedation(NOTE)*

fentanyl 50 mcg, IV, Q15 mins, STAT, PRN, sedation, Inj, Duration = 3 dose(s)

fentanyl mcg, IV, ONCE, STAT, Inj

fentanyl drip (CH) (IVS)* premix diluent

250 ml, IV, STAT, @ 25 mcg/hour fentaNYL (for drip) (CH)

2,500 mcg, Every Bag

fentanyl drip (max conc) (IVS)* premix diluent (titrate)

50 ml, IV, @ 25 mcg/hour fentanyl infusion 50mcg/ml

2,500 mcg, Every Bag SEDATION(NOTE)* Aim for light sedation unless clinically contraindicated(NOTE)* Benzodiazepines are NOT recommended as first line for sedation(NOTE)* Dexmedetomidine (Precedex) may not be effective for deep sedation(NOTE)*

dexmedeTOMidine standard drip (CH) (IVS)* sodium chloride 0.9% (titrate)

100 ml, IV, Goal = Titrate to RASS goal, Titrate By = 0.1 mcg/kg/hour, Titrate Frequency (min)= 30, Maximum Dose = 1.5 mcg/kg/hour

dexmedeTOMidine (for wt drip) 400 mcg, 0.2, mcg/kg/hour

dexmedeTOMidine drip (MAX volume) (IVS)* sodium chloride 0.9% (titrate)

page 26 of 30



150 ml, IV, Goal = Titrate to RASS goal, Titrate By = 0.1 mcg/kg/hour, Titrate Frequency (min)= 15, Maximum Dose = 1.5 mcg/kg/hour

dexmedeTOMidine (for wt drip) 600 mcg, 0.2, mcg/kg/hour

Dexmedetomidine (Precedex) may bolus if hemodynamically stable(NOTE)*

dexmedeTOMidine 1 mcg/kg, IV, ONCE, STAT, Inj

Comments: infuse over 10 minutes

midazolam 2 mg, IV, ONCE, STAT, Inj

midazolam 4 mg, IV, ONCE, STAT, Inj

propofol drip standard 100ml (IVS)* premix diluent (titrate)

100 ml, IV, Titrate By = 10 mcg/kg/min, Titrate Frequency (min)= 5, Maximum Dose = 88 mcg/kg/min

Comments: Adjust the drip as needed based on patient condition propofol infusion 1000 mg/100 mL

1,000 mcg, 5, mcg/kg/min *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 phasetextControl

page 27 of 30



Unique Plan Description: EMU/ICU Status Epilepticus Plan Selection Display: EMU/ICU Status Epilepticus PlanType: Medical Version: 1 Begin Effective Date: 02/04/2020 02/04/20 15:46 End Effective Date: Current Available at: SHB EMU/ICU Status Epilepticus

0 to 5 minutes Stabilization(NOTE)*

Miscellaneous Nursing Order (NON-Medication) T;N, Stabilize patient - airway, breathing, circulation, exam

Miscellaneous Nursing Order (NON-Medication) T;N, Record times and seizure assessment in IVIEW

Peripheral Line Flush Nursing Protocol(SUB)* Early SE 5 - 15 min Initial treatment(NOTE)*

lorazepam 2 mg, IV, ONCE, STAT, Inj (DEF)* 4 mg, IV, ONCE, STAT, Inj

midazolam 2 mg, IV, ONCE, STAT, Inj (DEF)* 5 mg, IV, ONCE, STAT, Inj 5 mg, IM, ONCE, STAT, Inj 10 mg, IM, ONCE, STAT, Inj

diazepam 5 mg, IV, ONCE, STAT, Inj

Established SE 15 - 30min and Refractory SE 15 - 30min(NOTE)*

fosphenytoin 20 mg/kg, IV, ONCE, STAT, Inj, mg = mg PE

valproic acid 20 mg/kg, IV, ONCE, STAT, Inj (DEF)* 30 mg/kg, IV, ONCE, STAT, Inj

PHENobarbital 10 mg/kg, IV, ONCE, Inj, for seizure, max rate = 5mg/min

levETIRAcetam 3,000 mg, IV, ONCE, STAT, Inj

lacosamide 400 mg, IV, ONCE, STAT, Inj, Loading Dose (DEF)*

Comments: Administer each loading dose vial IVP over 3 minutes (max rate of 80 mg/min). Monitor the patient's blood pressure and heart rate every 15 minutes for 1 hour after total dose has been administered

600 mg, IV, ONCE, STAT, Inj, Loading Dose Comments: Administer each loading dose vial IVP over 3 minutes (max rate of 80 mg/min). Monitor the patient's blood pressure and heart every 15 minutes for 1 hour after total dose has been administered

brivaracetam 200 mg, IV, ONCE, STAT, Inj

Super Refractory SE 40 - 60min (Critical Care ONLY) (Not for use in EMU)(NOTE)*

propofol drip standard 100ml (non titratable) (IVS)* premix diluent

100 ml, IV propofol

1,000 mg, 40, mcg/kg/min

midazolam drip standard (non titratable) (IVS)* Dextrose 5% in Water

100 ml, IV midazolam

100 mg, 5, mg/hour

PENTobarbital (bolus) 5 mg/kg, IV, Q1H, STAT, Inj, Duration = 2 dose(s) (DEF)*

Comments: Loading dose; Infuse over 1 hour mg/kg, IV, ONCE, Inj

page 28 of 30



PENTobarbital drip standard (IVS)* Sodium Chloride 0.9%

500 ml, IV PENTobarbital (for wt drip)

2,500 mg, 2, mg/kg/hour

ketamine (bolus) 2 mg/kg, IV, ONCE, STAT, Inj

ketamine drip standard (refractory status epilepticus) (IVS)* Sodium Chloride 0.9%

250 ml, IV ketamine (for wt drip)

2,000 mg, 3, mg/kg/hour Maintenance Dosing(NOTE)*

phenytoin 100 mg, PO, TID, ER Capsule (DEF)* 300 mg, PO, QDay, ER Capsule 100 mg, NGTube, TID, Susp

fosphenytoin 100 mg, IV, Q8H, Inj, mg = mg PE

valproic acid 250 mg, IV, TID, Inj (DEF)* 500 mg, IV, BID, Inj 250 mg, PO, TID, Capsule 500 mg, PO, BID, Capsule 500 mg, NGTube, BID, Liq

PHENobarbital 32.4 mg, PO, TID, Tab (DEF)* 60 mg, PO, BID, Tab

levETIRAcetam 500 mg, IV, BID, Inj (DEF)* 1,000 mg, IV, BID, Inj 1,500 mg, IV, BID, Inj 500 mg, PO, BID, Tab 1000 mg, PO, BID, Tab 1500 mg, PO, BID, Tab

lacosamide 100 mg, IV, Q12H, Inj (DEF)* 200 mg, IV, Q12H, Inj 50 mg, PO, BID, Tab 100 mg, PO, BID, Tab 200 mg, PO, BID, Tab

brivaracetam 50 mg, IV, BID, Inj (DEF)* 100 mg, IV, BID, Tab, starting dose

Comments: Starting Dose 50 mg, PO, BID, Tab 100 mg, PO, BID, Tab


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page 1 of 2 · 2/26/2020 · hellena admassu 9 10 iii. next meeting: 3/25/2020 wednesday 3-4 pm by...

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