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WESTERN MARYLAND HEALTH SYSTEM Provider Orders Reminder: ALL MEDICATION ORDERS REQUIRE DOSE, ROUTE, FREQUENCY DO NOT USE ABBREVIATIONS Page 1 of 3 Gastrointestinal Bleeding Medications Antibacterial Prophylactic Agents: Cephalosporins, 3rdGeneration cefTRIAXone 1 gram intravenously every 24 hours Antiulcer Agents: Proton Pump Inhibitors pantoprazole loading dose 80 milligram intravenously once pantoprazole drip 80 milligram 8 milligram/hour intravenously CONTINUOUS Gastrointestinal Prokinetic Agents erythromycin 250 milligram intravenously once Stress Ulcer Prophylaxis Agents: Histamine2 Receptor Antagonists famotidine 20 milligram intravenously every 12 hours Vasoactive Agents octreotide acetate loading dose 25 microgram intravenously once octreotide acetate drip 25 microgram/hour intravenously CONTINUOUS Antibacterial Agents ciprofloxacin 400 milligram intravenously every 12 hours metroNIDAZOLE 500 milligram intravenously every 8 hours Corticosteroids methylPREDNISolone 40 milligram intravenously every 8 hours Other Respiratory Blood gas, arterial Blood gas, venous Other Laboratory Blood Bank TYPE AND SCREEN TYPE/XMATCH RBC UNITS , _____ units FRESH FROZEN PLASMA , _____ units and reason wanted: Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart Original: 10/2013 Revised: Reviewed: Fax to Pharmacy Form #: 16.1001 WESTERN MARYLAND HEALTH SYSTEM Provider Orders Reminder: ALL MEDICATION ORDERS REQUIRE DOSE, ROUTE, FREQUENCY DO NOT USE ABBREVIATIONS Page 2 of 3 Hematology Complete blood cell count with automated white blood cell differential , if not already obtained Hemoglobin and hematocrit every 4 hours every 6 hours every 8 hours every 12 hours one hour after last unit of PRBCs infused Occult blood, stool, guaiac Partial thromboplastin time (PTT), activated , if not already obtained Prothrombin time (PT) and international normalized ratio (INR) , if not already obtained Panels Basic metabolic panel Hepatic function panel Renal function panel Serology Helicobacter pylori antibody Hepatitis panel, acute Stool Studies CLOSTRIDIUM DIFFICILE TOXIN Culture, stool CRYPTOSPORIDIUM/GIARDIA Other Radiology Computed Tomography CT angiography, abdomen CT,ABDOMEN PELVIS W/WO CONT IV and oral contrast CT,ABDOMEN PELVIS W/O CONT Oral contrast only CT,ABDOMEN PELVIS W/O CONT No oral contrast General Radiography XR,BARIUM SWALLOW/ESOPHAGUS XR,GASTROGRAPHIN SWALLOW XR,AIR CONTRAST UPPER GI W/KUB XR,UPPER GI SERIES W/SM BOWEL XR,GASTROGRAPHIN UPPER GI XR,SMALL BOWEL SERIES ONLY XR,BARIUM ENEMA XR,AIR CONTRAST BARIUM ENEMA Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart Original: 10/2013 Revised: Reviewed: Fax to Pharmacy Form #: 16.1001 WESTERN MARYLAND HEALTH SYSTEM Provider Orders Reminder: ALL MEDICATION ORDERS REQUIRE DOSE, ROUTE, FREQUENCY DO NOT USE ABBREVIATIONS Page 3 of 3 XR,ABD FLAT W/ERECT OR DECUB XR,ABD FLAT/ERECT W/CHEST 1VW Nuclear Medicine Nuclear medicine, gastrointestinal blood loss imaging tagged red blood cell scan Ultrasonography Ultrasound, abdomen Other Diagnostic Tests Cardiology 12lead ECG Other Consults Consult to gastroenterology Consult to general surgery Consult to interventional radiology Visceral angiogram, selective Other Nursing Orders Assessments Cardiac monitor Contingency Notify provider if stool for occult blood is positive if INR is greater than 2 Oxygen saturations less than 90% Change in mental status for systolic blood pressure less than 90 or greater than 170 Chest pain Hemoglobin drops less than 7.0 or more than 1 grams from last recorded value urine output is less than 30 ml/hr Interventions Elevate head of bed 30 degrees 45 degrees Nasogastric/orogastric tube insertion/management to low intermittent suction to gravity Other Physician/Date/Time: _________________________ Nurse/Date/Time: _______________________ Secretary/Date/Time: ________________________ Full page of orders requires only one physician, one nurse and one clerical signature Original to Patient's Chart Original: 10/2013 Revised: Reviewed: Fax to Pharmacy Form #: 16.1001