PLACE LABEL HERE

CRITICAL CARE ADMISSION

ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

1.Diagnosis

Status:Admit asInpatient ______(reason for admission)

2.Unit: ICU  IMCU/PCU  Neuro ICU Neuro IMCU

3.Consult with: ______call back number: ______

Consult with: ______call back number: ______

4.Diagnostics:  Portable chest x-ray ECG (______to read)

 Nutritional profile Other: ______

Serum hCG for females 10-60 years of age, if no pregnancy test done in ED

5.Vital sign frequency:  Per unit routine Other:______

 Neuro checks q ______hrs

6. May be off monitor for tests

7. Mechanical Ventilation Orders (form# 18389)

8.O2 per Respiratory Care Protocol (# 7500-10-01-03) or to maintain sat ______%

  • Adjust O2 to maintain SpO2 90% or 88% in COPD. Call physician for O2 usage 4 L/min or 40%.
  • Reassess daily, wean O2 to maintain SpO2 > 90% or 88% in COPD. Wean to room air if SpO2 is acceptable and patient has no known exclusions per 7504-10-01-03. May restart O2 as needed.
  • Post op patients will be weaned to room air the morning following surgery unless SpO2 is < 90% (88% for COPD) or patient has other exclusions.

9. Respiratory Care Evaluate and Treat per protocol (# 7504-10-07-01)

10.DVT prophylaxis:  Plexi-pulse  Sequential compression device  TED hose

11. Daily weight

12. Foley catheter to bedside drainage

13. Insert arterial line

14. Diet: ______ NPO  Enteral feeding (see order sheet)

15.Activity:  Bedrest  Ad lib  Bed to chair position  OOB to chair

16. Initiate PT/OT order set (form #32655) if patient has a substantial decrease from base line function
(that is unlikely to resolve within 48 hours), or needs placement and disposition.

SCHEDULED MEDICATIONS:

17.IVF: ______IV at ______ml/hr

18.DVT prophylaxis: Lovenox (enoxaparin) 40 mg SQ q 24 hrs at 1700; if CrCl < 30, give 30 mg SQ q 24 hrs

19. Stress ulcer prophylaxis:  Pepcid (famotidine) 20 mg bid  po  IV

DC famotidine if PPI (i.e. pantoprazole, omeprazole) is ordered

20.Bowel Management: Sennakot-S (docusate/senna), 2 tablets po/per NGT at bedtime nightly

PRN MEDICATIONS(See policy # 520-06 for range orders and pain intensity guidelines)

21.Initiate Critical Care Insulin Orders (form # 21386)

  1. Severe pain: Morphine 1-4 mg IV q 3 hrs prn

or  DC Morphine. Dilaudid (HYDROmorphone) 0.5-1 mg IV q 3 hrs prn

23.Mild pain/temp>100.5F/HA: Tylenol (acetaminophen) 650 mg po q 4 hrs prn

24.Nausea/Vomiting: Zofran (ondansetron) 4 mg IV or po q 6 hrs prn

 If N/V persists, add Phenergan (promethazine) 12.5-25 mg po or per rectum q 4 hrs prn

25.Constipation: Dulcolax 10 mg per rectum per day prn

26.Anxiety/Sedation:  Ativan(lorazepam)0.5 - 1 mg po q 8 hrs prn. DC Xanax if ordered.

or

Xanax (alprazolam) 0.25 - 0.5 mg po q 6 hrs prn. DC Ativan if ordered.

 Critical Care Mechanical Ventilation Sedation Orders (form # 15395)

 Neuromuscular Blocking Agent Orders (form # 15396)

______

Date Time Physician SignaturePID Number

Send copy to pharmacy

*1-14115*FORM 1-14115 REV. 12/2012 Page 1 of 1