Download Telephone order from:

The licensed independent practitioner must check () the desired boxes. All order sheets must be signed with date/time by the licensed independent practitioner
with ID #. A generic or therapeutically equivalent drug as approved by the P&T Committee may be dispensed unless other wise specifically stated.
Diagnosis:
Allergies:
Attending:
Consultants:
Consult:  PT
 OT
Precautions:  Seizure
 Speech  Pastoral Care  Social Work  Nutrition  Diabetic Educator
 Aspiration
ACTIVITY:
 Bed rest
 Head of Bed FLAT
 Head of Bed
degrees
 Out of Bed with assistance
MONITORING/TREATMENTS:
 Vital Signs and Neuro checks every one hour
 Vital Signs and Neuro checks every two hours
 Vital Signs and Neuro checks every four hours
 Strict Intake & Output measurements and record every one hour
 Foley Catheter to gravity
 Sequential Compression Devices  Foot compression booties to bilateral lower extremities
 Gastric intubation (if Endotracheally Intubated, Oral Gastric Tube is preferred route) and confirm placement with STAT portable x-ray
 Low continuous suction
 Clamped, check residuals every four hours
 Transduce Arterial Line
 Transduce Central Venous Pressure Line and record CVP with vital signs as ordered above
RESPIRATORY:
 Critical Care Medicine will write ventilator management orders.
 Maintain SpO2 (Oxygen Saturation) greater than 94%
 Nasal cannula
l/minute
 Face mask
%
 Incentive spirometry, 10 breaths per hour while awake
AUTOMATIC STOP ORDERS INCLUDE: Narcotics – 7 days (Demerol 48 hrs) Antibiotics – 7 days
DRAINS
 Jackson-Pratt number 1: record output every 4 hours and prn
 Drain to Gravity DO NOT COMPRESS BULB
 Thumb suction
 Jackson-Pratt number 2: record output every 4 hours and prn
 Drain to Gravity DO NOT COMPRESS BULB
 Thumb suction
DIAGNOSTICS:


LABS:
 CBC
 BMP, Magnesium and Phosphorus
 PT/INR/aPTT
 Phenytoin (Dilantin) level
 Vancomycin Peak and Trough levels after 3rd dose given
 Type and Screen
 Telephone order from: ____________________________________MD / NP / PA _____________________________ Date________ Time_______  RB&C
(circle one)
Provider Signature______________________________________________________________ ID #______________________ Date_______ Time _______
RN Signature___________________________________ Date_________ Time_______
USC Signature_______________________ Date________ Time________
Patient Identification
PILOT
NEUROSURGERY ICU ORDERS
WAH ###-### (3/09)
page 1of 3
The licensed independent practitioner must check () the desired boxes. All order sheets must be signed with date/time by the licensed independent practitioner
with ID #. A generic or therapeutically equivalent drug as approved by the P&T Committee may be dispensed unless other wise specifically stated.
STEROIDS
 dexamethasone (Decadron)
mg intravenously every _________ hours
 methylprednisolone (Solu-Medrol) 7500 mg / 250 mL
 30 mg/kg bolus over 15 minutes, then initiate continuous infusion
 Continuous infusion 5.4 mg/kg/hour intravenous X ________ hours
DVT PROPHYLAXIS
 enoxaparin (Lovenox) 40 mg SQ daily
 enoxaparin (Lovenox) 30 mg SQ daily (Cr Cl < 30 mL/min)
GI PROPHYLAXIS
 famotidine (Pepcid) 20 mg IV daily
 famotidine (Pepcid) 20 mg po daily at hs
 pantoprazole (Protonix) 40 mg IV daily
 pantoprazole (Protonix) 40 mg po daily before breakfast
ANTIEMETIC
 ondansterone (Zofran) 4 mg intravenously every 6 hours as needed for nausea/vomiting
AUTOMATIC STOP ORDERS INCLUDE: Narcotics – 7 days (Demerol 48 hrs) Antibiotics – 7 days
ANTIEPILEPTIC DRUGS
 levetiracetam (Keppra)
Route
Bolus Dose: (choose one)
Maintenance doses: (choose one)
 Intravenous
 1000 mg IV STAT
 500 mg every 12 hours
 Oral
 3000 mg IV STAT
 1000 mg every 12 hours
 1500 mg every 12 hours
 phenytoin (Dilantin)
 Bolus dose: 15 mg/kg intravenously x 1 (infuse over 1 hour)
 Maintenance doses: 100 mg intravenously every 8 hours
 lorazepam (Ativan) 2 mg intravenously, as needed for every seizure and immediately notify Neuro team
ANALGESIA/ANTIPYRETICS
 morphine sulfate 2 mg intravenously every 2 hours as needed for pain (pain severity score 7/10 to 10/10)
 morphine sulfate 1 mg intravenously every 2 hours as needed for pain (pain severity score 4/10 to 6/10)
 morphine sulfate 0.5 mg intravenously every 2 hours as needed for pain (pain severity score 1/10 to 3/10)
 hydrocodone/acetaminophen (Vicodin) (5/500) 2 tablets orally every 6 hours as needed for pain (pain severity score 7/10 to 10/10)
 hydrocodone/acetaminophen (Vicodin) (5/500) 1 tablet orally every 4 hours as needed for pain (pain severity score 4/10 to 6/10)
 acetaminophen (Tylenol) 650 mg orally every 4 hours PRN for Temp. above 99 degrees Fahrenheit OR pain (pain severity score 1/10 to 3/10)
 acetaminophen (Tylenol) 650 mg elixir per gastric tube every 4 hours PRN for Temp. above 99 degree Fahrenheit OR pain (pain severity
score 1/10 to 3/10)
 acetaminophen (Tylenol) 650 mg suppository rectally every 4 hours PRN for Temp. above 99 degree Fahrenheit OR pain (pain severity score
1/10 to 3/10)
BOWEL MANAGEMENT
 docusate sodium (Colace) 100 mg orally every eight hours
 polyethylene glycol (Miralax) one packet orally daily at 10:00 in the morning every AM
 psyllium (Metamucil) one packet orally daily every PM
WOUND HEALING PROMOTION
 Vitamin A 20,000 International Units orally daily
 Telephone order from: ____________________________________MD / NP / PA _____________________________ Date________ Time_______  RB&C
(circle one)
Provider Signature______________________________________________________________ ID #______________________ Date_______ Time _______
RN Signature___________________________________ Date_________ Time_______
USC Signature_______________________ Date________ Time________
Patient Identification
PILOT
NEUROSURGERY ICU ORDERS
WAH ###-### (3/09)
page 2 of 3
The licensed independent practitioner must check () the desired boxes. All order sheets must be signed with date/time by the licensed independent practitioner
with ID #. A generic or therapeutically equivalent drug as approved by the P&T Committee may be dispensed unless other wise specifically stated.
ANTIBIOTIC PROPHYLAXIS
 cefazolin (Ancef)
Dose and frequency of therapy
 1 gram intravenously every 8 hours
 2 grams intravenously every 8 hours
Duration of therapy
 Times 2 doses, then discontinue
 Continue until after all drain(s)/ventriculostomy is removed, then give one additional dose, then notify the pharmacy to discontinue the
medication
Alternative antibiotic prophylaxis (use if Cefazolin (Ancef) is contraindicated)
 vancomycin 1 gram intravenously every 12 hours
 Times 2 doses, then discontinue
 Continue until after all drain(s)/ventriculostomy is removed, then give one additional dose, then notify the pharmacy to discontinue the
medication
AUTOMATIC STOP ORDERS INCLUDE: Narcotics – 7 days (Demerol 48 hrs) Antibiotics – 7 days
SEDATION
 propofol (Diprivan) 10 mg/mL IV at 20 mcg/kg/min. to maintain Ramsey of ________ . Titrate by 5-10 mcg/kg/min every 10 min. prn
SEDATION --- DO NOT USE LORAZEPAM (ATIVAN) FOR SEDATION
 haloperidol (Haldol) 1 mg intravenously every 6 hours PRN severe agitation/ delirium, if this dose is ineffective, increase to 2 mg intravenously
every 6 hours PRN severe agitation/delirium
BLOOD PRESSURE MANAGEMENT:
Desired SBP
mmHg
Desired DBP
mmHg
Desired MAP
mmHg
Desired CPP
mmHg
 labetalol (Normodyne)
10 mg intravenously every 15 minutes as needed to keep within above stated range(s), if this dose is not effective, increase to
20 mg intravenously every 15 minutes as needed to keep within above stated range(s), if this dose is not effective, increase to
40 mg intravenously every 15 minutes as needed to keep within above stated range(s), if this dose is not effective, notify Neuro
 nicardipine (Cardene) 20 mg/ 200 mL intravenous infusion as needed to keep within above stated range(s)
(Initial drip at 5 mg/hour. Titrate every 30 minutes by 2.5 mg/hour. Max dose = 15 mg/hour.)
 phenylephrine (Neo-Synephrine) 20 mg / 250 mL intravenous infusion as needed to keep within above stated range(s) (Initial drip at 50
mcg/min. Titrate by 10 – 25 mcg/min. every 5 minutes. Max dose = 300 mcg/min.)
 norepinephrine (Levophed) 4 mg / 250 mL intravenous infusion as needed to keep within above stated range(s)
(Initial Drip at 1 mcg/min. Titrate by 0.5 – 1 mcg/min every 5 minutes. Max dose = 30 mcg/min.)
 dopamine (Intropin) 200 mg / 250 mL intravenous infusion as needed to keep within above stated range(s)
(Initial Drip at 3 mcg/kg/min. Titrate by 1 – 4 mcg/kg/min every 10 minutes. Max dose = 20 mcg/kg/min.)
FLUID AND NUTRITION MANAGEMENT:
Intravenous Fluids
 Normal Saline (0.9%) at
ml/hour
 Lactated Ringers at
ml/hour
 Other:
ml/hour
DIET:
 NPO
 Diet as tolerated
 Other:
 See Enteral Nutrition Orders. Notify Neuro service if enteral feeding held for more than 4 hours
 Telephone order from: ____________________________________MD / NP / PA _____________________________ Date________ Time_______  RB&C
(circle one)
Provider Signature______________________________________________________________ ID #______________________ Date_______ Time _______
RN Signature___________________________________ Date_________ Time_______
USC Signature_______________________ Date________ Time________
Patient Identification
PILOT
NEUROSURGERY ICU ORDERS
WAH ###-### (3/09)
page 3 of 3