Download BIDMC Provider Order Entry - Order Sets

BIDMC Provider Order Entry - Order Sets
General Design
Order sets are a list of suggested orders for a particular patient event (e.g. admit) or disease
condition (heart failure). Most order sets fit one of the two basic templates listed below and are
not designed as custom screens but run through a central screen driver. Each order on a set
must be orderable as an individual order via the main POE system, although some parameters
may be left blank on the set. The end user must click each order on a set to order it; there is
no signoff on a group of orders with one click. When clicked on from the set, orders may
branch to the main POE order screen with parameters from the set pre-filled. The user can
add/edit/confirm data and also may see warnings that are specific to the patient/time of order.
This design (reuse of main ordering screens) helps keep the order sets from falling out of sync
with the evolving POE system.
Basic Templates

Procedure, Miscellaneous
o One time orders around a particular event that add to existing active order profile for the
patient
o Sequence of orders specific to each set

Admit, Transfer, Postoperative
o Complete set of orders that will become the active order profile when signed
o Sequence of order categories is defined but some categories may be omitted

Service based (Cardiac Surgery, Psychiatry, OB/GYN etc)

Diagnosis/Procedure based (Heart Failure, Sepsis, Kidney Transplant, BMT,
etc)
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Procedure/Miscellaneous Sets
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Admit/Transfer/Postoperative Sets
Heart Failure
Heart Failure (cont)
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Admit/Transfer/Postoperative Sets
Popup for ARB meds:
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Admit/Transfer/Postoperative Sets
Heart Failure (cont)
Sample Med Pop-up Screen
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Admit/Transfer/Postoperative Sets
Sample weight-based heparin order screen
Sepsis
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Admit/Transfer/Postoperative Sets
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Admit/Transfer/Postoperative Sets
Cardiac Medicine Interventional Service Admission
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Admit/Transfer/Postoperative Sets
Psychiatry Admission
Page 23 of 59
Admit/Transfer/Postoperative Sets
Whipple Resection Postop Orders
Allergies
Edit
Delete
Postop orders: Admit to Surgery - Gold; Attending: SGP YETT,HARRIS; Condition:
Good;
Vitals/Monitoring
Vital signs: per routine
I & O: Yes
click to
Incentive spirometry: 10x per hr
Order
Call HO if: T>101.5 ; HR <60 or >110 ; SBP <80 or >160 ; DBP <60 or >90 ; RR <10
or >24 ; U/O <20 cc/hr ; GLU <80 or >500 ; O2 <91% ;
click to
o2 Sats: AM POD 1 and POD 2
Order
Activity
click to
Order
Bedrest tonight. OOB to chair POD 1.
Ambulate starting POD 2.
Tubes/Drains
click to
Closed suction drain
Order
Reconstitute and Record q Shift
click to
NGT low continuous suction
Order
Flush q shift with 10 cc NS
click to
Foley to gravity
Order
Oxygen Therapy
click to
Oxygen Therapy: Nasal cannula 4 L/min D/C when sats > 91% by pulse oximetry
Order
Nutrition
click to
Order
click to
Order
Diet: NPO
Nutrition consult: Postop Whipple Resection
General Xray
click to
Portable CXR to be done in PACU
Order
Radiology General Xray
Other
click to
Order
click to
Order
click to
Order
click to
Accucheck on arrival to PACU - then QID
Thigh-high TED hose on at all times
Calf pneumatic boots on while in bed. D/C when ambulating.
Pain control via Epidural or PCA as per APS.
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Admit/Transfer/Postoperative Sets
Order
click to
Order
IV access
click to
Order
Social Work consult for discharge planning on POD 1.
IV access: Central Line
IV fluids
click to
Order
Medication
click to
Order
click to
Order
click to
Order
click to
Order
click to
Order
click to
Order
click to
Order
click to
Order
Lab
click to
Order
click to
Order
click to
Order
1000 ml D5 1/2NS
Continuous at 125 ml/hr
for 24 hrs postop. Then run at 75 ml/hr until D/C'd.
Med Order Set
Insulin
Pantoprazole 40 mg IV Q24H
Heparin 5000 UNIT SC Q12H
If necessary
Octreotide Acetate 100 mcg SC Q8H
Acetaminophen 650 mg PO Q4-6H:PRN
Diphenhydramine HCl 25 mg PO/IV HS:PRN
Metoclopramide 10 mg PO QID Start: POD 5
Dolasetron Mesylate 12.5 mg IV Q8H:PRN
Blood, To be collected , in PACU: CBC; Sodium; Potassium; Chloride; Bicarbonate;
Glucose; BUN; PT; Creatinine
Blood, To be collected , IN AM POD 1: CBC; Sodium; Potassium; Chloride;
Bicarbonate; Glucose; BUN; PT; Creatinine
Blood, To be collected , IN AM POD 4: CBC; Sodium; Potassium; Chloride;
Bicarbonate; Glucose; BUN; Creatinine
Done
Page 25 of 59
Admit/Transfer/Postoperative Sets
Laparoscopic Gastric Bypass Orders
Allergies
Edit
Delete
Postop orders: Admit to Surgery - Purple; Attending: SGP YETT,HARRIS; Condition:
Good;
Vitals/Monitoring
Vital signs: per routine
click to
o2 Sats: with vitals
Order
I & O: Yes
Incentive spirometry: 10x per hr
Activity
click to
Order
click to
Order
Pneumatic boots
Activity: Ambulate tid
Wound Care
Therapeutic devices/DVT/Prophylaxis
Tubes/Drains
click to
Foley to gravity
Order
click to
G-tube to gravity
Order
click to
NGT low continuous suction
Order
click to
Other
Order
JP drain to bulb suction
Nutrition
click to
Order
Diet: NPO
General Xray
click to
UGIS/SBFT in AM
Order
Radiology General Xray
Other
click to
Order
click to
Order
Patient has a gallbladder.
Patient does not have a gallbladder.
IV access
IV fluids
click to
Order
1000 ml LR
Continuous at 200 ml/hr
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Admit/Transfer/Postoperative Sets
Medication
click to
Order
click to
Order
click to
Order
click to
Order
click to
Order
click to
Order
click to
Order
Lab
click to
Order
click to
Order
Med Order Set
Cefazolin 2 gm IV Q8H Duration: 24 Hours
Heparin 5000 UNIT SC Q8H
Famotidine 20 mg IV Q12H
Morphine Sulfate 1 mg IVPCA Lockout Interval: 6 minutes Basal Rate: 0 mg(s)/hour 1hr Max Limit: 10 mg(s)
Methylene Blue 1% 3 ml PO ONCE Duration: 1 Doses Start: @1800 on POD 0
Please dilute 3 ml in 27 ml water (30 ml total). Check JP output 1 hour later & contact
HO ASAP if any blue is present.
Prochlorperazine 10 mg IV Q6H:PRN nausea
Dolasetron Mesylate 12.5 mg IV ONCE for nausea not responsive to
compazine Duration: 1 Doses
Blood, To be collected NEXT ROUNDS: Hematocrit
Blood, To be collected MORNING OF : Hematocrit
Done
Page 27 of 59
Admit/Transfer/Postoperative Sets
Transplant Service
Hepatobiliary Post-op Orders
Kidney Transplant Post-op Orders
Orthotopic Liver Transplant Post-op Orders
Pancreas and Simultaneous Kidney/Pancreas Transplant Post-op Order
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Admit/Transfer/Postoperative Sets
Hepatobiliary Post-op Orders
Allergies
Edit
Delete
Postop orders: Admit to Surgery - Blue; Attending: SGP YETT,HARRIS; Condition:
Good;
Vitals/Monitoring
Vital signs: per routine
I & O: Yes
Monitor urine output: q2h
click to
Incentive spirometry: q2h while awake; turn side to side and cough q2h
Order
Call HO if: T>100.5 ; HR <60 or >110 ; SBP <100 or >160 ; DBP <50 or >100 ; RR <10
or >22 ; U/O <50 /hr ; O2 <93 ;
Post-procedure vitals: q 1 hr for 2 hrs; q 2 hrs for 8 hrs; then: q4h
Activity
click to
Order
Activity: Out of bed to chair qid
Ambulate qid with assistance until independent
Wound Care
click to
Order
click to
Order
Wound care:
Site: Incision
Type: Surgical
Wound care:
Site: drain site
Change dressing: qd
Therapeutic devices/DVT/Prophylaxis
Tubes/Drains
click to
Foley to gravity
Order
Tape foley to anterior thigh
click to
NGT low continuous suction
Order
Irrigate w/ 10-20 ml normal saline PRN. Empty and record output q4h.
click to
T tube
Order
to gravity drain. Empty and record output q2h.
Closed suction drain bulb suction
click to
strip q1-2h and PRN. Empty and record output q2h and PRN if necessary to maintain
Order
adequate suction.
Oxygen Therapy
click to
Oxygen Therapy: Nasal cannula
Order
Nutrition
Other
IV access
click to
Order
IV access: Central Line
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Admit/Transfer/Postoperative Sets
click to
Order
IV fluids
click to
Order
Medication
click to
Order
click to
Order
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Order
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Order
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Order
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Order
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Order
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Order
IV access: Peripheral saline lock
20 mEq KCL / 1000 mL D5 1/2NS
Continuous
Med Order Set
Unasyn 3 gm IV Q6H
Morphine Sulfate 2-6 mg IV Q4H:PRN pain
Promethazine HCl 12.5 mg IV Q6H:PRN nausea
Promethazine HCl 12.5-25 mg PO Q6H:PRN nausea
Acetaminophen 325-650 mg PO/PR Q4-6H:PRN Temp above 101F
Heparin 5000 UNIT SC Q8H
Famotidine (IV) 20 mg IV Q12H
Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea
Lab
Done
Page 30 of 59
Admit/Transfer/Postoperative Sets
Kidney Transplant Post-op Orders
Allergies
Edit
Delete
Flomax
Postop orders: Admit to Surgery - Transplant; Attending: SGP YETT,HARRIS;
Condition: Good;
Vitals/Monitoring
Vital signs: per routine
Weight: qd
I & O: Yes
click to
Monitor urine output: q1h
Order
Incentive spirometry: with teaching
Call HO if: HR <50 or >120 ; SBP <110 or >190 ; DBP <60 or >90 ; RR <10 or >22 ;
U/O <1 ml/kg/hr ; GLU <70 or >200 ; O2 <93 ;
Post-procedure vitals: q 15 min for 1 hrs; q 30 min for 2 hrs; q 1 hr for 4 hrs; then: q2h
Activity
click to
Order
Activity: Out of bed to chair
Pneumatic boots
Tubes/Drains
click to
Closed suction drain JP drains bulb suction
Order
Empty and record PRN.
click to
Foley to gravity
Order
Nutrition
click to
Order
Diet: Clear liquids
Central TPN
General Xray
click to
Chest PORTABLE AP; schedule as STAT
Order
Radiology General Xray
IV access
click to
Order
IV access: Central Line
IV fluids
click to
Order
click to
Order
Medication
click to
1000 ml D5 1/2NS
Continuous, Replacement Fluid: ml/ml replacement of urine output, not less than 50
ml/hr
1000 ml 1/2NS
Continuous, Replacement Fluid: ml/ml replacement of urine output, not less than 50
ml/hr
Med Order Set
Pamidronate 30 mg IV ONCE Duration: 1 Doses Start: POD #1
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Admit/Transfer/Postoperative Sets
Order
click to
Order
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Order
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Order
click to
Order
click to
Order
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Order
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Order
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Order
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Order
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Order
Lab
click to
Order
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Order
Sulfameth/Trimethoprim SS 1 TAB PO DAILY
* Drug-Allergy Warning *
Valganciclovir HCl 450 mg PO DAILY
Pantoprazole 40 mg PO Q24H Start: When patient taking PO
Nystatin Oral Susp. 5 ml PO BID Start: When tolerating PO
Docusate Sodium 100 mg PO BID
Morphine Sulfate 1 mg IVPCA Lockout Interval: 15 minutes Basal Rate: 0 mg(s)/hour 1hr Max Limit: 4 mg(s)
Acetaminophen 650 mg PO Q6H:PRN
Diphenhydramine HCl 25-50 mg PO Q12H OR QHS PRN sleep
Heparin 5000 UNIT SC Q8H
Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea
Blood, To be collected NEXT ROUNDS: CBC; Sodium; Potassium; Chloride;
Bicarbonate; Plt Count; Glucose; BUN; Creatinine; Phosphate; Magnesium
Blood, To be collected MORNING OF : CBC; Sodium; Potassium; Chloride;
Bicarbonate; Plt Count; Glucose; BUN; Creatinine; Phosphate; Magnesium;
Cyclosporin; Tacrolimus
Done
Page 32 of 59
Admit/Transfer/Postoperative Sets
Orthotopic Liver Transplant Post-op Orders
Allergies
Edit Delete
Postop orders: Admit to Surgery - Transplant; Attending: SGP YETT,HARRIS;
Condition: Good;
Vitals/Monitoring
Vital signs: per routine
Weight: qd
I & O: Yes
Monitor urine output: q1h
click to Order Incentive spirometry: TCDB and incentive spirometer q2h after extubation, while
awake
Call HO if: T>100.5 ; HR <60 or >120 ; SBP <100 or >180 ; DBP <50 or >100 ; RR
<10 or >22 ; O2 <93 ;
Post-procedure vitals: q 15 min for 1/2 hr; q 30 min for 4 hrs; then: q1h
Hemodynamic monitoring
PA line: in place, transduce Wedge: q4h Hemodynamic profile (CO,CI,SVR,PVR):
click to Order q4h Cardiac output method: Thermodilution Flush w/: heparinized saline Other
instructions CVP, PAP q1h
A line: in place,transduce Flush w/: heparinized saline Other instructions continuous
click to Order
SVO2 monitoring
click to Order CVL: tranduce CVP Other instructions Call HO for CVP > or CVP <
Activity
click to Order
Activity: Bedrest with bed position Head of bed <30
Pneumatic boots
Wound Care
Wound care:
Site: JP and T-tube
click to Order
Dressing: Gauze - dry
Comment: Change dressing QD and PRN
Wound care:
Site: Incision
click to Order Type: Surgical
Dressing: Gauze - dry
Comment: Change dressing prn
Tubes/Drains
click to Order
click to Order
click to Order
click to Order
Foley to gravity
Do not irrigate unless plugged
NGT low continuous suction
Output q4h
T tube
to gravity, output q1h
Closed suction drain
Strip tubing q1-2h and PRN;
Output q1h and PRN to maintain adequate suction;
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Admit/Transfer/Postoperative Sets
Clean connection with betadine before opening and closing
Mechanical Ventilation
Nutrition
click to Order
Diet: NPO
Central TPN
General Xray
click to Order
Chest Portable AP, schedule as STAT
Radiology General Xray
Other
click to Order
IV access
click to Order
If temp greater than 38 deg C (100.5F) orally, obtain blood cultures for aerobes,
anaerobes and fungus if not sent in the last 24 hours. Check with MD whether sputum,
urine and drain cultures are required.
IV access: Central Line
IV fluids
1000 ml D5 1/2NS
Continuous at 125 ml/hr
Medication Med Order Set
click to Order Valganciclovir HCl 450 mg PO DAILY
click to Order Famotidine (IV) 20 mg IV Q12H
click to Order Fluconazole 400 mg PO/NG Q24H
For Serum creatinine <3 mg/dL
click to Order Sulfameth/Trimethoprim DS 1 TAB PO/NG DAILY
* Drug-Allergy Warning *
For Serum creatinine >3 mg/dL
click to Order Sulfameth/Trimethoprim DS 0.5 TAB PO DAILY
* Drug-Allergy Warning *
click to Order Morphine Sulfate 2 mg IV Q1-2H:PRN
click to Order Heparin 5000 UNIT SC Q8H
click to Order Unasyn 1.5 gm IV Q6H Duration: 8 Doses
click to Order
Lab
click to Order
click to Order
click to Order
click to Order
click to Order
click to Order
Blood Gases - Arterial, To be collected 03/10/03, on admission to SICU and q8h x
24hrs, process STAT: ABG (1 of 4)
Blood Gases - Arterial, To be collected , second draw, process STAT: ABG (2 of 4)
Blood Gases - Arterial, To be collected , third draw, process STAT: ABG (3 of 4)
Blood Gases - Arterial, To be collected , fourth draw, process STAT: ABG (4 of 4)
Blood, To be collected , on admission to SICU: CBC; Sodium; ALT; Potassium; AST;
Chloride; Alk Phos; Bicarbonate; Total Bili; Glucose; BUN; PT; Creatinine; Amylase;
PTT; Calcium; Phosphate; Fibrinogen; Magnesium; Bilirubin, Direct
Blood, To be collected , 8 hrs after SICU admission labs: CBC; Sodium; ALT;
Potassium; AST; Chloride; Alk Phos; Bicarbonate; Total Bili; Glucose; BUN; PT;
Creatinine; PTT; Fibrinogen; Bilirubin, Direct
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Admit/Transfer/Postoperative Sets
click to Order
Blood, To be collected , 8 hrs after 2nd draw: CBC; Sodium; ALT; Potassium; AST;
Chloride; Alk Phos; Bicarbonate; Total Bili; Glucose; BUN; PT; Creatinine; PTT;
Fibrinogen; Bilirubin, Direct
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Admit/Transfer/Postoperative Sets
Pancreas and Simultaneous Kidney/Pancreas and Transplant Post-op Orders
Allergies
Edit
Delete
Postop orders: Admit to Surgery - Transplant; Attending: SGP YETT,HARRIS;
Condition: Good;
Vitals/Monitoring
Vital signs: per routine
o2 Sats: continuous
Weight: qd
click to
I & O: Yes
Order
Fingerstick: q 1hr X4, then q 2hrs while in SICU
Call HO if: HR <50 or >120 ; SBP <110 or >190 ; GLU <70 or >200 ; O2 <93 ; CVP <4
or >20; HCT <24 ;
Hemodynamic monitoring
click to
CVL: tranduce CVP
Order
Activity
click to
Order
Activity: Out of bed to chair
Tubes/Drains
click to
Foley to gravity
Order
click to
NGT low continuous suction
Order
Absolutely nothing per NG tube
click to
Closed suction drain bulb suction
Order
empty and record PRN
Nutrition
click to
Order
Diet: NPO Absolutely nothing by mouth
Central TPN
General Xray
click to
Chest Portable AP; schedule as STAT
Order
Radiology General Xray
IV access
IV fluids
click to
Order
click to
Order
1000 ml D5 1/2NS
Continuous, Replacement Fluid: ml/ml of urine output, not less than 125 ml/hr
Simultaneous kidney/pancreas transplant
1000 ml D5 1/2NS
Continuous at 50 ml/hr
Pancreas transplant
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Admit/Transfer/Postoperative Sets
Medication
click to
Order
click to
Order
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Order
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Order
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Order
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Order
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Order
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Order
Lab
click to
Order
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Order
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Order
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Order
Med Order Set
Pamidronate 30 mg IV ONCE Duration: 1 Doses Start: POD #1
Heparin IV Start: 4 - 6 hrs post-operatively
No Initial Bolus
Initial Infusion Rate: 200 units/hr
Unasyn 3 gm IV Q8H Duration: 6 Doses
Fluconazole 400 mg IV Q24H
Valganciclovir HCl 450 mg PO DAILY Start: POD #5
Famotidine (IV) 20 mg IV Q12H
until tolerating PO, then DC
Pantoprazole 40 mg PO Q24H Start: when tolerating PO
Octreotide Acetate 100 mcg SC Q8H
Blood, To be collected , on arrival to SICU: CBC; Sodium; Potassium; Chloride;
Hematocrit; Bicarbonate; Plt Count; Glucose; BUN; Creatinine; Amylase; Lipase
Blood, To be collected , 6 hrs after first draw: Hematocrit
Blood, To be collected , 12 hrs after first draw : CBC; Sodium; Potassium; Chloride;
Hematocrit; Bicarbonate; Plt Count; BUN; Creatinine; Amylase; Lipase
Blood, To be collected , 18 hrs after first draw: Hematocrit
Done
Page 37 of 59
Admit/Transfer/Postoperative Sets
Labor and Delivery Orders
Allergies
Edit
Delete
Admit to Obstetrics - L & D; Attending: SGP YETT,HARRIS; Condition: Good;
Vitals/Monitoring
Vital signs: BP, HR: q2h; Temp q4h
click to
I & O: Yes
Order
Call HO if: T>100.4 ; HR <60 or >130 ; SBP <90 or >160 ; DBP <60 or >90 ; RR <10 or
>22 ; U/O <30 cc/hr ; O2 <93% RA ;
click to
Vital signs: per Preeclampsia Magnesium Protocol
Order
click to
Vital signs: per Preterm Magnesium Protocol
Order
OB
click to
Order
Activity
click to
Order
Nutrition
click to
Order
click to
Order
Other
click to
Order
IV access
click to
Order
OB Fetal monitoring
Activity: Activity as tolerated
Diet: Clear liquids, low fat 40 gm until active labor established
Diet: NPO , may take ice chips
Foley to gravity.
IV access: Peripheral
IV fluids
click to
Order
Medication
click to
Order
click to
Order
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Order
click to
1000 ml LR
Continuous at 125 ml/hr
Adjust rate as needed
Med Order Set
Penicillin G Potassium 4 MU IV ONCE Duration: 1 Doses
LOADING DOSE
Penicillin G Potassium 2 MU IV Q4H
Clindamycin 600 mg IV Q8H
Ampicillin 2 gm IV Q6H
Page 38 of 59
Admit/Transfer/Postoperative Sets
Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
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Order
Lab
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Order
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Order
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Order
Gentamicin 120 mg IV ONCE Duration: 1 Doses
LOADING DOSE
Gentamicin 80 mg IV Q8H
Misoprostol 25 mcg VG Q4-6H:PRN Duration: 3 Doses
For induction of labor as per protocol.
Magnesium Sulfate (L&D) 4 gm IV BOLUS ONCE Duration: 1 Doses
Bolus: 4 gm over 20 minutes
Magnesium Sulfate (L&D) 2 gm/hr IV DRIP INFUSION Start: After completion of
bolus dose
Terbutaline Sulfate 0.25 mg SC MR Q20MIN X3
Hold for MHR>120
Terbutaline Sulfate 5 mg PO TID
Hold for MHR>120
Hydralazine HCl 5 mg IV ONCE Duration: 1 Doses
Methylergonovine Maleate 0.2 mg IM ONCE Duration: 1 Doses
Nalbuphine HCl 10 mg IM ONCE Duration: 1 Doses
Nalbuphine HCl 10 mg IV ONCE Duration: 1 Doses
IV dose must follow IM dose
Oxytocin 2 MILLI UNITS/MIN IV DRIP INFUSION
Increase by ___ mu/min every ___ min until contractions are q2-3min apart or to a
maximum of ___ mu/min. Discontinue for hyperstimulation and/or a non-reassuring
FHR pattern.
Betamethasone Sodium Phos/Acet 12 mg IM Q24H Duration: 2 Doses
Erythromycin 250 mg PO Q6H Duration: 7 Days
Labetalol HCl 100 mg PO BID
Hold for Maternal SBP <100 and/or MHR <50
Labetalol HCl 10 mg IV ONCE Duration: 1 Doses
Hold for Maternal SBP <100 and/or MHR <50
Dexamethasone 6 mg IM Q12H Duration: 4 Doses
Sodium Citrate 30 ml PO ONCE:PRN epidural or c-section
Administer within 15 minutes of procedure
Blood, To be collected STAT: CBC
Urine, To be collected STAT: UA dipstick only
LABS for patients with preeclampsia
Blood, To be collected STAT: CBC; ALT; Plt Count; Creatinine; Uric Acid
Blood tests
Page 39 of 59
Admit/Transfer/Postoperative Sets
Antepartum Orders
Allergies
Edit
Delete
Admit to Obstetrics - Antepartum; Attending: SGP YETT,HARRIS; Condition: Good;
Vitals/Monitoring
Vital signs: BP, T, P, R qshift
click to
Weight: weekly
Order
Call HO if: T>100.4 ; HR <60 or >130 ; SBP <90 or >160 ; DBP <60 or >90 ; RR <10 or
>22 ; U/O <30 cc/hr ; O2 <93% RA ;
click to
Fingerstick: 2 hrs after every meal
Order
click to
DTR/Clonus: q4
Order
click to
Vital signs: per Preeclampsia Magnesium Protocol
Order
click to
Vital signs: per Preterm Magnesium Protocol
Order
OB
click to
Order
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Order
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Order
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Order
Activity
click to
Order
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Order
Nutrition
click to
Order
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Order
Consults
click to
Order
Other
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OB Fetal monitoring
OB ATU
Check FHR Qshift;
Check Active Fetal Movement Qshift;
Activity: Activity as tolerated
Activity: Bedrest with bathroom privileges
Nutrition consult: Initial patient assessment
Diet: House diet
Consults Physical Therapy
NICU Consult - MD must call to arrange.
Page 40 of 59
Admit/Transfer/Postoperative Sets
Order
click to
Order
click to
Order
UA dipstick only Q Tuesday.
Joslin Consult. MD must call to arrange.
IV access
IV fluids
Medication
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Order
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Lab
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Order
Med Order Set
Docusate Sodium 100 mg PO BID:PRN
Acetaminophen 650 mg PO Q6H:PRN
Oxazepam 15-30 mg PO HS:PRN insomnia
Calcium Carbonate 500 mg PO QID:PRN
Milk of Magnesia 15-30 ml PO Q6H:PRN
Nephrocaps 1 CAP PO DAILY
Clindamycin 600 mg IV Q8H
Ampicillin 2 gm IV Q6H
Gentamicin 120 mg IV ONCE Duration: 1 Doses
LOADING DOSE
Gentamicin 80 mg IV Q8H
Magnesium Sulfate (L&D) 4 gm IV BOLUS ONCE Duration: 1 Doses
Bolus: 4 gm over 20 minutes
Magnesium Sulfate (L&D) 2 gm/hr IV DRIP INFUSION Start: After completion of
bolus dose
Hydralazine HCl 5 mg IV ONCE Duration: 1 Doses
Methylergonovine Maleate 0.2 mg IM ONCE Duration: 1 Doses
Erythromycin 250 mg PO Q6H Duration: 7 Days
Labetalol HCl 100 mg PO BID
Hold for Maternal SBP <100 and/or MHR <50
Labetalol HCl 10 mg IV ONCE Duration: 1 Doses
Hold for Maternal SBP <100 and/or MHR <50
Bisacodyl 10 mg PR DAILY:PRN
Blood, To be collected NEXT ROUNDS: CBC; ALT; Creatinine; Uric Acid
Page 41 of 59
Admit/Transfer/Postoperative Sets
click to
Order
Urine, To be collected ROUTINE: Protein, total; Creatinine
Blood tests
Done
Page 42 of 59
Admit/Transfer/Postoperative Sets
]
Postpartum Orders
Allergies
Edit
Delete
Transfer to Obstetrics - Postpartum; Attending: SGP YETT,HARRIS; Condition: Good;
Vitals/Monitoring
Vital signs: BP, T, P, R qshift
click to
Call HO if: T>100.4 ; HR <60 or >130 ; SBP <90 or >160 ; DBP <60 or >90 ; RR <10
Order
or >22 ; U/O <30 cc/hr ; O2 <93% RA ;
OB
Activity
click to
Order
Nutrition
click to
Order
Other
click to
Order
click to
Order
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Order
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Order
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Order
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Order
Activity: Ambulate
Diet: House diet
RhoGAM if indicated.
D/C IV fluids when tolerating adequate POs.
D/C Foley in 12-24 hours if u/o >30 cc per hour
Ice to perineum first 12-24hours prn.
Sitz baths prn.
May shower.
Heating pad prn.
If unable to void, follow protocol for management of postpartum bladder distention.
If patient on WIC, obtain HCT first postpartum day.
IV access
IV fluids
Medication
click to
Order
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Order
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Order
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Order
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Order
Med Order Set
Docusate Sodium 100 mg PO BID:PRN
Oxycodone-Acetaminophen 1-2 TAB PO Q4-6H:PRN
Ibuprofen 600 mg PO Q6H:PRN
Codeine Sulfate 30-60 mg PO Q4-6H:PRN
Acetaminophen 500-1000 mg PO Q4-6H:PRN
Page 43 of 59
Admit/Transfer/Postoperative Sets
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Lab
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Order
Bisacodyl 10 mg PR DAILY:PRN
Milk of Magnesia 30 ml PO HS:PRN
Dibucaine 1 Appl TP PRN
to perineum
Simethicone 80 mg PO QID:PRN
Calcium Carbonate 500 mg PO QID:PRN
LABS for patients with preeclampsia
Blood, To be collected , routine: CBC; ALT; Plt Count; Creatinine; Uric Acid
Blood tests
Done
Page 44 of 59
Admit/Transfer/Postoperative Sets
GYN Postop Orders
Allergies
Edit
Delete
Postop orders: Admit to GYN; Attending: SGP YETT,HARRIS; Condition: Good;
Vitals/Monitoring
Vital signs: q4
click to
o2 Sats: with vitals
Order
Incentive spirometry: 10x per hr
Call HO if: T>100.4 ; U/O <30cc x 2h ;
Activity
click to
Order
Activity: Ambulate tid
Pneumatic boots
Wound Care
Tubes/Drains
click to
Foley to gravity
Order
DC in am
Nutrition
click to
Order
Other
click to
Order
IV access
click to
Order
Diet: House diet Advance diet as tolerated
RhoGAM if indicated.
IV access: Peripheral
IV fluids
click to
Order
Medication
click to
Order
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Order
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Order
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Order
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Order
1000 ml LR
Continuous at 125 ml/hr
Change to peripheral lock when taking POs
Med Order Set
Meperidine 50-100 mg IM Q3-4H:PRN Duration: 2 Days
Ibuprofen 600 mg PO Q6H:PRN
Oxycodone-Acetaminophen 1-2 TAB PO Q4-6H:PRN
Ketorolac 15-30 mg IV Q6H:PRN Duration: 3 Days
Hydroxyzine HCl 25 mg IM Q3-4H:PRN
Lab
Page 45 of 59
Admit/Transfer/Postoperative Sets
Cardiac Surgery Post-op Orders
Allergies
Edit
Delete
Postop orders: Admit to Surgery - Cardiac; Attending: SGP YETT,HARRIS; Condition:
Good;
Vitals/Monitoring
Vital signs: per protocol
click to
I & O: Yes
Order
Monitor urine output: q1h
Hemodynamic monitoring
click to
PA line: in place, transduce Other instructions cardiac output/index q1hr until C.I.>2.0,
Order
then q4hr
Cardiac monitoring
Activity
click to
Order
Activity: Activity as tolerated
Advance per cardiac rehabilitation
Wound Care
click to
Order
Wound care:
Site: operative leg
Type: Surgical
Comment: keep ace wraps on from ankle to thigh x 72 hrs. May change prn.
Therapeutic devices/DVT/Prophylaxis
Tubes/Drains
click to
Chest tube to suction 20 cm
Order
Record chest tube output hourly.
click to
NGT low continuous suction
Order
Remove when extubated.
Oxygen Therapy
click to
Oxygen Therapy: After extubation, titrate O2 to keep saturation >92%
Order
Mechanical Ventilation
Mechanical Ventilation: SIMV (Volume Targeted) w/ PS & w/o PS
click to
Tidal volume (mechanical): 700 cc Respiratory rate: 10 Pressure support level: 5 cm/h2o
Order
PEEP: 5 cm/h2o FIO2: 100 % Wean per Cardiac Surgery Fast Track Protocol.
Weaning
Nutrition
click to
Order
Cardiology
click to
Diet: Start: when extubated Clear liquids
Cardiology ECG
Page 46 of 59
Admit/Transfer/Postoperative Sets
Order
General Xray
click to
CXR upon admission to CSRU
Order
Radiology General Xray
Consults
click to
Order
Other
click to
Order
click to
Order
click to
Order
Consults Physical Therapy
Soft protective devices on wrists as needed per protocol.
Please D/C CVL prior to transfer to floor after peripheral IV access established.
D/C Foley catheter on POD #2
IV access
IV fluids
click to
Order
Medication
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Order
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Order
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Order
click to
1000ml LR
Continuous for 1000 ml
Up to 1 liter to maintain C.I. >2.0, then call HO.
Med Order Set
Propofol 20-50 mcg/kg/min IV DRIP TITRATE TO sedation
DC prior to extubation Patient must have adequate airway support prior to administration
of dose.
Nitroglycerin 0.25-0.6 MCG/KG/MIN IV DRIP TITRATE TO to keep MAP < 90, or at
0.5 mcg/kg/min if radial artery graft
Nitroprusside Sodium 0.25-1 MCG/KG/MIN IV DRIP TITRATE TO maintain MAP <
90
Phenylephrine HCl 0.5-5 MCG/KG/MIN IV DRIP TITRATE TO to keep MAP > 60
Glycopyrrolate 0.6 mg IV ONCE:PRN
to reverse neuromuscular blockade, if T >36C. May combine with neostigmine in
syringe
Neostigmine 3 mg IV ONCE:PRN
to reverse neuromuscular blockade, if T>36C. May combine with glycopyrrolate in
syringe.
Potassium Chloride 20 mEq / 50 ml SW IV PRN K<4.4 and CR<2.0
** Concentrated KCL must be given via central line only **
Calcium Gluconate 2 gm / 100 ml D5W IV PRN Free Cal <1.12
to run over 1 hr.
Magnesium Sulfate 2 gm / 100 ml D5W IV PRN mg <2.0
Meperidine 12.5 mg IV PRN shivering
May repeat X1.
Morphine Sulfate 0.5-4 mg IV Q2H:PRN pain
Page 47 of 59
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Lab
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Metoclopramide 10 mg IV Q6H:PRN nausea/vomiting
Cefazolin 2 gm IV Q8H Duration: 4 Doses
if patient is POA
Vancomycin HCl 1000 mg IV Q12H Duration: 4 Doses
if patient was in hospital pre-operatively
Ketorolac 30 mg IM ONCE Duration: 1 Doses
hold if Creat>1.2 or >70 years of age
Ketorolac 15 mg IM Q6H Duration: 4 Doses
Hold if creat >1.2 or >70 years of age
Oxycodone-Acetaminophen 1-2 TAB PO Q4H:PRN pain
Sucralfate 1 gm NG Q6H Duration: 4 Doses
DC after 4 doses or removal of GT
Acetaminophen 650 mg PO/PR Q4H:PRN temperature >38.0
Clopidogrel Bisulfate 300 MG PO/NG ONCE Duration: 1 Doses Start: 4 hrs postop
for off-pump CABG if CT output <200 ml over 4 hrs.
Clopidogrel Bisulfate 75 MG PO/NG DAILY Duration: 3 Months Start: POD #1
for off-pump CABG
Isosorbide Mononitrate 60 mg PO DAILY Start: POD #1
for patients with radial artery graft if NGT discontinued.
Aspirin EC 81 mg PO DAILY Start: POD #1
if extubated
Aspirin 81 mg NG DAILY Start: POD #1
if intubated. DC when NGT removed.
Ranitidine 150 mg PO BID
Ranitidine 150 mg NG BID
DC when NGT removed.
Docusate Sodium 100 mg PO BID
Docusate Sodium (Liquid) 100 mg NG BID
DC when NGT removed.
Insulin
Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
Blood, To be collected , upon arrival to CSRU, process STAT: Chloride; Bicarbonate;
BUN; Creatinine
Blood Gases, To be collected , upon arrival to CSRU
, process STAT: ABG; Sodium, Whole Blood; Potassium, Whole Blood; Glucose,
Whole Blood; Ionized Calcium
Blood, To be collected MORNING OF : CBC; Sodium; Potassium; Chloride;
Bicarbonate; Glucose; BUN; Creatinine; to be done morning of postop day #1
Page 48 of 59
Admit/Transfer/Postoperative Sets
Cardiac Surgery Transfer Orders
Allergies
Edit
Delete
Flomax
Transfer to Surgery - Cardiac; Attending: SGP YETT,HARRIS; Condition: Good;
Vitals/Monitoring
Vital signs: Q 4 hours X 24 hours then Q 8 hours if stable
o2 Sats: Daily and PRN
Telemetry: Yes
click to
Weight: qd
Order
I & O: Yes
Fingerstick: Q AC and QHS
Incentive spirometry: Q 2 hours while awake
Activity
click to
Order
Progress activity per cardiac rehabilitation guidelines.
Wound Care
Therapeutic devices/DVT/Prophylaxis
Tubes/Drains
click to
Chest tube to suction 20 cm
Order
Oxygen Therapy
click to
Oxygen Therapy: Wean o2 keeping saturation >92%
Order
Nutrition
click to
Order
Consults
click to
Order
Diet: Diabetic/Consistent Carbohydrate, Cardiac/Heart healthy (3-4 gm NA)
Consults Physical Therapy
Other
click to
Order
click to
Order
click to
Order
Temporary Cardiac Pacing:
Electronically isolate pacing wires when not in use.
Patient to remain in bed for 1 hr after wires removed.
Document BP after wire removal.
Observe for a minimum of 2 hrs prior to discharge.
DC Central venous line on POD #2.
DC Foley catheter on POD #2.
IV access
Page 49 of 59
Admit/Transfer/Postoperative Sets
IV fluids
Medication
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Lab
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Med Order Set
Metoprolol 25 mg PO BID
Furosemide 20 mg PO Q12H
* Drug-Allergy Warning *
Furosemide 20 mg IV Q12H
* Drug-Allergy Warning *
Potassium Chloride 20 mEq PO Q12H
Docusate Sodium 100 mg PO BID
Ranitidine 150 mg PO BID
Aspirin EC 81 mg PO DAILY
Warfarin MD to order daily dose PO DAILY
Insulin
Acetaminophen 650 mg PO Q4H:PRN
Oxycodone-Acetaminophen 1-2 TAB PO Q4H:PRN pain
Morphine Sulfate 1-5 mg SC/IM Q3-4H:PRN pain
Milk Of Magnesia 30 ml PO HS:PRN constipation
Bisacodyl 10 mg PR DAILY:PRN constipation
Clopidogrel Bisulfate 75 MG PO DAILY
for off-pump CABG patients x 3 mos. total
Isosorbide Mononitrate 60 mg PO DAILY
for patients with radial artery graft
Cefazolin 2 gm IV Q8H Duration: 4 Doses
if patient is POA. 4 doses total Postop - check MAR for dose given in ICU.
Vancomycin HCl 1000 mg IV Q12H Duration: 4 Doses
if patient inhouse preop. 4 doses total Postop - check MAR for dose given in ICU.
Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
Atorvastatin 10 mg PO DAILY
Blood, To be collected MORNING OF , process STAT: CBC; Sodium; Potassium;
Chloride; Bicarbonate; Glucose; BUN; Creatinine
Daily PT/INR if on Warfarin
Blood, To be collected MORNING OF : PT
Page 50 of 59
Admit/Transfer/Postoperative Sets
Biologics/Oncology Sample
Concurrent biochemotherapy in melanoma (off study)
High Dose IL-2 Off Protocol
*Low Dose IL-2 Off Protocol
Maintenance Biotherapy for Metastatic Melanoma
Page 51 of 59
Admit/Transfer/Postoperative Sets
Low Dose IL-2 Off Protocol
Allergies
Edit
Delete
Admit to Medicine - Biologics/Oncology; Attending: SGP YETT,HARRIS; Condition:
Good;
Vitals/Monitoring
Vital signs: q4
click to
I & O: Yes
Order
Call HO if: T>104 ; severe N/V/D, Dyspnea, confusion, or chest pain ;
Activity
click to
Order
Nutrition
click to
Order
Activity: Activity as tolerated
Diet: House diet
General Xray
Consults
Other
click to
Order
click to
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Order
Target SBP >= ___________.
Weigh Q AM.
BC x 2 for T >101.5 after Day 3.
PIV x 2 upon admission.
NO STEROIDS.
Cardiac monitor for all patients while on vasopressors.
Patients should D/C all antihypertensive meds at least 24 hours before admission unless
otherwise specified.
Transfuse 1-2 units PRBC's over 1-3 hrs each unit for hgb<9.
Transfuse 1 bag plts over 30 min for plt ct<10K.
Labs:
Day 1,3,5: CBC with platelets, NA, K, CL, CO2, Ca, Mg, Phos, Glucose, BUN/Creat,
ALT, AST, Alk Phos, Total Bili, LD
Day 2,4,6: NA, K, CL, C02, BUN/Creat, CK
Hold IL-2 for bicarb < 18; see toxicity management/lytes replacement guidelines.
Hypotension Guidelines:
If SBP < target:
1) Give 250cc NS IV over 15 min, may repeat x 2 (total 3 boluses)*.
2) If SBP remains < target, start Dopamine at 4 mcg/kg/min, ** then call covering
NP/MD for further instructions.
3) Adjust dopamine and/or add Neosynephrine per Biologics dosing chart.
4) D/C fluid bolus order for weight gain > 5% over baseline.
See Toxicity Management Guidelines
*Fluid bolus order may be repeated at each hypotensive episode until weight gain
Page 52 of 59
Admit/Transfer/Postoperative Sets
exceeds guideline above.
** Use admission weight to calculate dosage.
IV access
IV fluids
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Medication
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250 ml NS Bolus 250 ml Over 15 mins
For SBP < target. May repeat x2 for a total of 3 boluses. D/C this order for weight gain >
5% over baseline.
50 mEq Sodium Bicarbonate/1000 ml D5 1/2 NS
Continuous at 75 ml/hr
Bicarb replacement: If serum bicarb >=18 and <=20, change IVF to this solution. Once
serum bicarb >=21, discontinue IVF. If bicarb <18 and >=16, give 100 mEq IVB and
recheck in 1 hr and if < 16, call HO.
Med Order Set
Indomethacin 25 mg PO Q6H
Acetaminophen 650 mg PO Q4H
Start at 1pm on Day 1
Ranitidine 150 mg PO BID
Lorazepam 1-2 mg PO/IV Q4-6H:PRN nausea or anxiety
Meperidine 25-50 mg IV Q2H:PRN rigors
in 50 ml D5W over 15 min
Diphenhydramine HCl 25-50 mg PO/IV Q6H:PRN pruritis
Oxazepam 15-30 mg PO HS:PRN insomnia
May repeat X1.
Prochlorperazine 10 mg PO/IV Q6H:PRN nausea
Diphenoxylate-Atropine 1 TAB PO PRN diarrhea
One tab after each loose stool. Max 8 tabs per day.
DopAmine 4 mcg/kg/min IV DRIP TITRATE TO keep SBP >= target
PRN hypotension that is refractory to fluid boluses. Cardiac monitor while on
medication.
Phenylephrine HCl 1 mcg/kg/min IV DRIP TITRATE TO keep SBP >= target.
PRN if target SBP not met while pt on maximum dopamine dose. Cardiac monitor while
on medication.
Potassium Chloride PO Sliding Scale
Notify HO if K < 3.0
Potassium Chloride IV Sliding Scale
Notify HO if K < 3.0
Calcium Replacement (Oncology) IV Sliding Scale
Notify HO if Corrected Calcium < = 7.0
Magnesium Sulfate IV Sliding Scale
Notify HO if Magnesium <1.2
Potassium Phosphate 15 mmol / 250 ml NS IV PRN for serum phosphate >= 1.5 and
<2.4
Infuse over 5 hours If serum phosphate <1.5, call HO.
Page 53 of 59
Admit/Transfer/Postoperative Sets
Lab
Blood tests
Done
Page 54 of 59
Admit/Transfer/Postoperative Sets
Oncology Bone Marrow Transplant
Auto Acute Leuk BMT
*Conventional Allo: Busulfan/Cytoxan
Conventional Allo: Cytoxan/TBI
General Auto BMT Orders
Non-ECOG Multiple Myeloma
Page 55 of 59
Admit/Transfer/Postoperative Sets
Conventional Allo: Busulfan/Cytoxan
Allergies
Admit to Medicine - Hematology/ BMT; Attending: SGP YETT,HARRIS; Condition:
Edit Delete Good;
BMT protocol: prot name
General Orders
click to Order Diet: Low bacteria TPN when caloric intake decreases
Vital signs: q4
click to Order I & O: Yes
Call HO if: SBP <100 or >150 ; DBP>90 ;
Record height on admission.
click to Order
Weigh (kg) daily by 7 AM.
Private room, door closed, required due to prolonged neutropenia.
Before entering room: Put on mask, wash hands, wear gloves.
click to Order
Equipment in room for patient only.
Incentive spirometer in room.
click to Order Consults Physical Therapy
click to Order Nutrition consult: BMT admission
Labs
Blood, To be collected , on afternoon of admission: Sodium; ALT; CBC/DIFF;
Potassium; AST; Chloride; Alk Phos; Bicarbonate; Total Bili; Plt Count; Glucose; LD;
click to Order
BUN; Albumin; PT; Creatinine; PTT; Calcium; Phosphate; Magnesium; Bilirubin,
Direct; Protein, Total
click to Order To be collected NEXT ROUNDS: Hold Specimen
click to Order Urine, To be collected , on afternoon of admission: UA complete w/reflex
click to Order Radiology General Xray
click to Order EKG to be done on afternoon of admission
Ongoing labs:
1. Q day: CBC, diff, plts, BUN, creatinine, electrolytes, Ca, phos, Mg
2. Q Mon, Wed, Fri: AST, bili T/D, uric acid, glucose, albumin, LD, alk phos
3. Q Tues: PT, reticulocyte count, albumin, total protein
4. Q weekly, beginning Day +14 through Day +100: Cytomegalovirus (CMV) Viral
Load testing if patient or donor CMV positive.
5. Day 0, then Mon Wed, Fri: Cyclosporine levels from peripheral blood draw.
click to Order 6. Additional labs
Clot to blood bank q3d.
For 1st T >100.5 per day, culture blood from all central line & from a peripheral stick.
Call HO.
Day -3,-2,-1, then PRN: EKG
Day -4 through Day 0: Urine Complete w/ reflex.
7.Before Discharge Obtain:
CBC, diff, plts, BUN, creat, electroytes, Mg, Ca, phos, PFT's if plt> 50,000
RBC and Platelet Transfusions
Irradiate, WBC-poor at collection or by filtration all blood products (except marrow or
stem cells) before administration.
click to Order
Packed RBC’S for HCT <25
Platelets: If a.m. (or any other) plt count: <20,000/ul: Recheck plts at 5 PM
Page 56 of 59
Admit/Transfer/Postoperative Sets
<10,000/ul: give one bag plt product. Check post platelet count. If <10,000, repeat
procedure above until plts >10,000
Acetaminophen 650 mg PO PRN Premedicate before all blood products
click to Order
No acetaminophen during chemotherapy.
Diphenhydramine HCl 25-50 mg PO/IV PRN only if history of hives with all blood
click to Order
products
Meperidine 25-50 mg IV PRN rigors after blood products
click to Order
Hold if SBP <90
Bone Marrow and Peripheral Blood Stem Cell Reinfusion
Bone Marrow and/or Peripheral Blood Stem Cell Reinfusions:
Call transplant nurse to arrange time when marrow/ stem cells will be available
Please send STAT type & screen in morning before reinfusion.
click to Order
Do not radiate or filter marrow or stem cells.
Reinfuse stored marrow and/or peripheral blood stem cells
EKG, crash cart on floor.
click to Order Acetaminophen 650 mg PO PRN premedicate before BM/PBPC reinfusions
Diphenhydramine HCl 25-50 mg PO/IV PRN premedicate before BM/PBPC
click to Order
reinfusions
Lorazepam 0.5-1 mg PO/IV PRN premedicate before BM/PBPC reinfusions
click to Order
PRN and then q3-4h PRN with BM/PBPC reinfusions
50 mEq Sodium Bicarb + 20 mEq Potassium Chl / 1000 mL D5 1/2 NS
click to Order Continuous at 350 ml/hr for 1000 ml
for 2-3 hrs prior to BM/PBPC reinfusion
50 mEq Sodium Bicarb + 20 mEq Potassium Chl / 1000 mL D5 1/2 NS
click to Order Continuous at 200 ml/hr
between BM/PBPC reinfusions
50 mEq Sodium Bicarb + 20 mEq Potassium Chl / 1000 mL D5 1/2 NS
Continuous at 350 ml/hr for 1000 ml
click to Order
over 2-3 hours after last BM/PBPC reinfusion. Then revert back to pre-infusion
hydration order.
Antiemetics
Dolasetron Mesylate 100 mg IV PRN
click to Order
30 mins prior to chemotherapy then QD for 3 days.
click to Order Lorazepam 1 mg IV PRN prior to each dose of busulfan
click to Order Lorazepam 1-2 mg IV Q4-6H:PRN after busulfan
Supportive Care
click to Order Oxazepam 15-30 mg PO HS:PRN
click to Order Aluminum Hydroxide Suspension 30 ml PO Q4H:PRN
Loperamide HCl 2 mg PO PRN after each loose stool.
click to Order For 3 or more loose stools/day. Not to exceed 16 mg per day. Call HO prior to
administering for the 1st time.
click to Order Multivitamins 1 CAP PO DAILY
click to Order Folic Acid 1 mg PO DAILY
click to Order BID sitz bath for perianal irritation.
Electrolyte Replacement
When giving electrolyte replacement, repeat level approximately 2 hrs after
click to Order
supplementation.
click to Order Potassium Chloride PO Sliding Scale
Page 57 of 59
Admit/Transfer/Postoperative Sets
Call HO for K <3.0
Potassium Chloride IV Sliding Scale
click to Order
Notify MD if K < 3.0
Magnesium Sulfate IV Sliding Scale
click to Order
Call HO for MG <1.2
Potassium Phosphate 15 mmol / 250 ml NS IV PRN if serum phosphate >=1.5 and
click to Order <2.4
Infuse over 5 hours. If serum phosphate <1.5, call HO.
Calcium Replacement (Oncology) IV Sliding Scale
click to Order
Notify HO if corrected CA <7.0
Antibiotics
Except for dosage adjustment, BMT MD on call should approve all changes in
click to Order
antibiotic regimen.
Acyclovir 400 mg IV Q8H
click to Order
Day minus 2 until discharge. Hold if creatinine >1.5 (See also PO order)
Acyclovir 400 mg PO Q8H
click to Order
Day minus 2 until discharge. Hold if creatinine >1.5 (See also IV order).
Sulfameth/Trimethoprim DS 1 TAB PO BID
click to Order Start on admission and discontinue on day -3.
* Drug-Allergy Warning *
Levofloxacin 500 mg PO DAILY
click to Order
Day -2 until 1st neutropenic spike >=100.5
Fluconazole 200 mg PO BID
click to Order
Start Day -2
Nystatin Oral Suspension 10 ml PO QID
click to Order
swish and swallow
During Neutropenia (PMN<500) for first T>100.5:
Repeat T in 15 minutes.
If T >100.5 clearly unassociated with blood product or growth factor administration.
click to Order
Culture blood from each central access catheter and one peripheral stick.
Culture stool, sputum & urine.
Portable PA CXR.
click to Order Clotrimazole 1 TROC PO 5X/D
Sodium Fluoride (Dental Gel) 1 Appl TP HS
click to Order
to be brushed with toothettes HS
Bacitracin 500 mg PO TID
click to Order Give with nystatin & polymyxin Start 4 days prior to admission and continue until
engraftment.
click to Order Chlorhexidine Gluconate 15 ml PO BID
Polymyxin B Sulfate 1,000,000 UNIT PO TID
click to Order Give with nystatin and bacitracin. Start 4 days prior to admission and continue until
engraftment.
Nystatin 4 TAB PO TID
click to Order Give with polymyxin & bacitracin. Start 4 days prior to admission and continue until
engraftment.
Hydration/Chemotherapy
20 mEq Potassium Chloride / 1000 mL D5 1/2 NS
click to Order Continuous at 100 ml/hr
Begin on admission. 6 hrs prior to beginning cyclophosphamide, change rate to 200
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Admit/Transfer/Postoperative Sets
cc/hr (see additional order).
20 mEq Potassium Chloride / 1000 mL D5 1/2 NS
click to Order Continuous at 200 ml/hr Start: 6 hrs prior to beginning cyclophosphamide
Continue for 24 hours after cyclophosphamide administration.
Use oncology guideline on med screen for dose & frequency
click to Order Ursodiol PO
Day -2 until discharge
Glutamine 10 gm PO TID
click to Order
Day 0 until discharge. Mixed in a slurry of any PO liquid
CycloSPORINE (Continuous Infusion for BMT) IV DRIP INFUSION
click to Order Start Day -1 in the morning. Continuous Infusion over 24 hours. Adjust dose per blood
levels.
Cyclosporin levels:
Monitor CSA levels by peripheral blood draw.
Start Day 0, then Mon, Wed, Fri.
Target CSA level is 475-525 mg/mL.
click to Order
With any dose changes, CSA levels should be re-checked >=24 hrs following dose
change, per BMT MD.
Repeat levels when there is a change in LFTs or changing renal function, per BMT
MD.
Chemotherapy
ALL CHEMOTHERAPY MEDICATIONS ARE ON PAPER AND MUST BE
click to Order
WRITTEN OR COSIGNED BY AN ONCOLOGY ATTENDING.
Calculate BSA based on Ht and Wt at admission.
Use corrected IBW.
click to Order
See appendix on paper protocol for formula.
Call BMT MD if there is a difference of > 5% from BSA used on orders.
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