Pneumonia
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PHYSICIAN'S ORDER SHEET Pneumonia CAP Adult Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated.
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patient imprint
Allergies: _______________ Admission Status g Admit to inpatient to Dr. ______service. c d e f c Admit to observation to Dr. _________ service. d e f g Admit Location c Admit to location __________________ d e f g
Code Status g Resuscitation status Full Code c d e f c Resuscitation status Do Not Resuscitate / Do Not d e f g Intubate (allow natural death) c Resuscitation status Partial Code d e f g Vital Signs c Vitals per unit protocol d e f g c Vital signs every_______ and then _____________ d e f g c Measure and document intake and output Total for d e f g every 8 hours c Measure height d e f g b Measure weight c d e f g
Contingency c Notify provider for Temp >101 F, HR >120, HR<60, RR d e f g < 8 or >30, SBP <90 or >180, Urine Output < 120ml for 4 hrs, Pulse Ox <90% Interventions c Elevate head of bed d e f g c Foley catheter d e f g c Please notify primary care of admission and status. d e f g Respiratory c Oxygen via ______ at _______ to maintain O2 sat > or d e f g = to 90% via pulse oximetry*** c Pulse Ox spot every shift and PRN Evidence d e f g
Diet g NPO c d e f c Clear liquids d e f g c Therapeutic diet ______________. d e f g c Regular diet d e f g
IV Fluids c Dextrose 5% with 0.9% NaCl @ _____mL/hr for 24 d e f g Consider the use of a pulmonary infection score with hours. Pneumonia Severity Score Index Calculator. (PORT score) c Dextrose 5% with 0.45% NaCl @ _____mL/hr for 24 d e f g Source hours. Consider the use of CURB65 to assess severity. (Confusion, Urea > 7 mmol/L, Respiratory rate = 30/min, c Sodium Chloride 0.9% @ ______mL/hr for 24 hours. d e f g systolic blood pressure = 90 mm Hg, and diastolic blood c Additives ______________________ d e f g pressure = 60 mm Hg, and age 65 years or older). When c Saline lock. d e f g calculating the 30day mortality rate, if the CURB65 score Medications is greater or equal to 3, the site of care should be the Antibiotics intensive care unit (ICU). If the score is 2, admission to a Reminders hospital is sufficient. Outpatient management is warranted Administer antimicrobial therapy within 4 hours of when the CURB65 score is 0 or 1. presentation Evidence Mobilize patients hospitalized with communityacquired Consider discharging patients from the hospital on pneumonia as early as possible Evidence the day of conversion from intravenous to oral Ambulate with Assistance every 8 hours c d e f g antibiotics (ie, without an inhospital observation c Up ad lib d e f g period after the switch from intravenous to oral c Bed rest. d e f g antibiotics) Evidence Nursing Orders Consider early switch from parenteral to oral Assessments antimicrobial therapy followed by discharge for Consider calculating Body Mass Index for assessment of eligible patients Evidence disease severity Select appropriate empiric antimicrobial therapy Calculator for BMI Source consistent with current guidelines Evidence Mental status should be assessed Evidence BetaLactam (3rdGeneration Cephalosporin, c Glucose, blood, fingerstick. _______ One Time. Other d e f g Penicillin) + Macrolide Frequency _______________ Cephalosporins, 3rdGeneration Evidence c cefTRIAXone /ROCEPHIN 1 gram intravenously d e f g c Assess neurologic status Evidence d e f g every 24 hours b Assess smoking status c d e f g Activity
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET
patient imprint
Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. Antidotes and Rescue Agents Macrolides Evidence c naloxone /NARCAN ___ (0.42) milligram d e f g c azithromycin /ZITHROMAX 500 milligram d e f g intravenously every ____min. (23) as needed for intravenously every 24 hours opiate reversal to improve mentation and RR > 10 c azithromycin /ZITHROMAX 500 milligram orally d e f g and notify physician STAT once a day DVT Prophylaxis Quinolones Evidence Mechanical methods of prophylaxis should be used c levofloxacin /LEVAQUIN 750 milligram orally or d e f g primarily in patients who are at high risk of bleeding or intravenously every 24 hours as an adjunct to anticoagulantbased prophylaxis. Antipyretics Consider renal impairment when deciding on doses of c acetaminophen /TYLENOL 650 milligram orally or d e f g LMWH, the direct thrombin inhibitors, and other rectally every 4 hours as needed for fever >100.4 antithrombotic drugs that are cleared by the kidneys, c acetaminophen /TYLENOL 650 milligram orally or d e f g particularly in elderly patients and those who are at high rectally every 6 hours as needed for fever greater risk for bleeding. than 100.4 In acutely ill medical patients who have been admitted Bronchodilator to the hospital with CHF or severe respiratory disease, or who are confined to bed and have one or more c albuterol/PROVENTIL ____puffs through spacer every d e f g ____hours as needed for wheezing or shortness of adtioanla risk factors, inclujding active CA, previous breath VTE, sepsis, acute neurologic disease, or inflammatory bowel disease, prophylaxis with LDUH or LMWH is c albuterol sulfate 2.5 mg/0.5 ml neb d e f g recommended. In meidcal patients with risk factors for solution /PROVENTIL via nebulizer every _____hours VTE in whom there is a contraindication to anticoagulant as needed for wheezing or shortness of breath prophylaxis, GCS or IPC is recommended. Analgesics Mild Pain (13) Evidence c Early and persistant mobilization d e f g c acetaminophen /TYLENOL ____650 mg ____650 mg d e f g c Graded compression stockings (1530 mm Hg of d e f g orally or rectally _____every 4 hours ____every 6 pressure at the ankle) hours as needed for pain c Sequential Compression Device d e f g c ibuprofen /MOTRIN 400 milligram orally every 4 d e f g c CBC every other day starting on day 4 of heparin d e f g hours as needed for pain therapy thru day 14 or until Unfractionated (Contraindicated in pregnant women and children < 6 heparin/LMWH is discontinued. mos. of age) LowDose Unfractionated Heparin Moderate Pain (46) c heparin 5,000 unit subcutaneously every 8 hours d e f g c hydrocodone/APAP/LORTAB d e f g LowMolecularWeight Heparins ____5/500_____7.5/500 ______10/500 tablet orally c enoxaparin /LOVENOX 40 milligram subcutaneously d e f g every ____4 hr._____6 hr. as needed for pain once a day c oxycodoneAPAP/PERCOCET d e f g ____5/325______7.5/325_____10/325 tablet orally Sedatives Evidence c LORazepam /ATIVAN 1 milligram intravenously every d e f g every _____4hr._____6hr. as needed for pain 6 hours as needed for sedation c oxycodone _____mg tablet orally every d e f g LORazepam /ATIVAN 1 milligram orally 2 times a day c d e f g _____4hr._____6hr. as needed for pain as needed for sedation Severe Pain (710) Evidence c zolpidem /AMBIEN 5 milligram orally once a day, at d e f g Consider the use of an opioid analgesic; morphine at bedtime as needed for insomnia a dose of 0.1 mg/kg body weight has limited effectiveness Evidence c zolpidem /AMBIEN 10 milligram orally once a day, at d e f g bedtime as needed for insomnia c HYDROmorphone /DILAUDID 1 milligram SC/IV d e f g Smoking Cessation Medications Evidence every __ 4 hrs. __ 6 hours as needed for pain c nicotine 7 mg/24 hr transdermal film, extended d e f g c morphine ____ milligram intravenously every d e f g release 1 patch transdermally once a day ____hours as needed for pain c nicotine 14 mg/24 hr transdermal film, extended d e f g c morphine ____mg intravenously every 5 minutes to d e f g release 1 patch transdermally once a day a maximum of 10 mg/hr. c nicotine 21 mg/24 hr transdermal film, extended d e f g release 1 patch transdermally once a day Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. Laxatives c magnesium hydroxide /MILK OF MAGNESIA 30 d e f g milliliter orally once a day as needed for constipation c docusate sodium /COLACE 100 milligram orally 2 d e f g times a day c bisacodyl /DULCOLAX 5 milligram orally once a day as d e f g needed for constipation c bisacodyl /DULCOLAX 10 milligram suppository d e f g rectally once a day as needed for constipation Laboratory c Complete blood cell count with automated white blood d e f g cell differential c Complete blood cell count with automated white blood d e f g cell differential every ______ . c Complete blood cell count with manual white blood cell d e f g differential c Blood gas, arterial Evidence d e f g
patient imprint
g Blood gas, venous Source c d e f c Basic metabolic panel d e f g c Comprehensive metabolic panel d e f g c Culture, blood times 2 from 2 separate sites (IDSA does d e f g not recommend routine blood cultures unless ICU
admission) Evidence g Culture, sputum Evidence c d e f c Gram stain, sputum Evidence d e f g c UA d e f g c Pregnancy test, urine, pointofcare measurement d e f g Diagnostic Tests c 12lead ECG d e f g c Radiograph, chest, 2 views Evidence d e f g c Radiograph, chest Portable d e f g
Physician Consults c Consult to MD d e f g _______________________________________ Other Consults c Consult to palliative care d e f g c Consult to Respiratory Therapy d e f g c Consult to Physical Therapy d e f g c Consult to Speech Therapy d e f g
Other: ________________________________
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
Print Only Selected Items
Print All
PHYSICIAN'S ORDER SHEET Pneumonia CAP Adult Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated.
Print All
patient imprint
Allergies: _______________ Admission Status g Admit to inpatient to Dr. ______service. c d e f c Admit to observation to Dr. _________ service. d e f g Admit Location c Admit to location __________________ d e f g
Code Status g Resuscitation status Full Code c d e f c Resuscitation status Do Not Resuscitate / Do Not d e f g Intubate (allow natural death) c Resuscitation status Partial Code d e f g Vital Signs c Vitals per unit protocol d e f g c Vital signs every_______ and then _____________ d e f g c Measure and document intake and output Total for d e f g every 8 hours c Measure height d e f g b Measure weight c d e f g
Contingency c Notify provider for Temp >101 F, HR >120, HR<60, RR d e f g < 8 or >30, SBP <90 or >180, Urine Output < 120ml for 4 hrs, Pulse Ox <90% Interventions c Elevate head of bed d e f g c Foley catheter d e f g c Please notify primary care of admission and status. d e f g Respiratory c Oxygen via ______ at _______ to maintain O2 sat > or d e f g = to 90% via pulse oximetry*** c Pulse Ox spot every shift and PRN Evidence d e f g
Diet g NPO c d e f c Clear liquids d e f g c Therapeutic diet ______________. d e f g c Regular diet d e f g
IV Fluids c Dextrose 5% with 0.9% NaCl @ _____mL/hr for 24 d e f g Consider the use of a pulmonary infection score with hours. Pneumonia Severity Score Index Calculator. (PORT score) c Dextrose 5% with 0.45% NaCl @ _____mL/hr for 24 d e f g Source hours. Consider the use of CURB65 to assess severity. (Confusion, Urea > 7 mmol/L, Respiratory rate = 30/min, c Sodium Chloride 0.9% @ ______mL/hr for 24 hours. d e f g systolic blood pressure = 90 mm Hg, and diastolic blood c Additives ______________________ d e f g pressure = 60 mm Hg, and age 65 years or older). When c Saline lock. d e f g calculating the 30day mortality rate, if the CURB65 score Medications is greater or equal to 3, the site of care should be the Antibiotics intensive care unit (ICU). If the score is 2, admission to a Reminders hospital is sufficient. Outpatient management is warranted Administer antimicrobial therapy within 4 hours of when the CURB65 score is 0 or 1. presentation Evidence Mobilize patients hospitalized with communityacquired Consider discharging patients from the hospital on pneumonia as early as possible Evidence the day of conversion from intravenous to oral Ambulate with Assistance every 8 hours c d e f g antibiotics (ie, without an inhospital observation c Up ad lib d e f g period after the switch from intravenous to oral c Bed rest. d e f g antibiotics) Evidence Nursing Orders Consider early switch from parenteral to oral Assessments antimicrobial therapy followed by discharge for Consider calculating Body Mass Index for assessment of eligible patients Evidence disease severity Select appropriate empiric antimicrobial therapy Calculator for BMI Source consistent with current guidelines Evidence Mental status should be assessed Evidence BetaLactam (3rdGeneration Cephalosporin, c Glucose, blood, fingerstick. _______ One Time. Other d e f g Penicillin) + Macrolide Frequency _______________ Cephalosporins, 3rdGeneration Evidence c cefTRIAXone /ROCEPHIN 1 gram intravenously d e f g c Assess neurologic status Evidence d e f g every 24 hours b Assess smoking status c d e f g Activity
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET
patient imprint
Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. Antidotes and Rescue Agents Macrolides Evidence c naloxone /NARCAN ___ (0.42) milligram d e f g c azithromycin /ZITHROMAX 500 milligram d e f g intravenously every ____min. (23) as needed for intravenously every 24 hours opiate reversal to improve mentation and RR > 10 c azithromycin /ZITHROMAX 500 milligram orally d e f g and notify physician STAT once a day DVT Prophylaxis Quinolones Evidence Mechanical methods of prophylaxis should be used c levofloxacin /LEVAQUIN 750 milligram orally or d e f g primarily in patients who are at high risk of bleeding or intravenously every 24 hours as an adjunct to anticoagulantbased prophylaxis. Antipyretics Consider renal impairment when deciding on doses of c acetaminophen /TYLENOL 650 milligram orally or d e f g LMWH, the direct thrombin inhibitors, and other rectally every 4 hours as needed for fever >100.4 antithrombotic drugs that are cleared by the kidneys, c acetaminophen /TYLENOL 650 milligram orally or d e f g particularly in elderly patients and those who are at high rectally every 6 hours as needed for fever greater risk for bleeding. than 100.4 In acutely ill medical patients who have been admitted Bronchodilator to the hospital with CHF or severe respiratory disease, or who are confined to bed and have one or more c albuterol/PROVENTIL ____puffs through spacer every d e f g ____hours as needed for wheezing or shortness of adtioanla risk factors, inclujding active CA, previous breath VTE, sepsis, acute neurologic disease, or inflammatory bowel disease, prophylaxis with LDUH or LMWH is c albuterol sulfate 2.5 mg/0.5 ml neb d e f g recommended. In meidcal patients with risk factors for solution /PROVENTIL via nebulizer every _____hours VTE in whom there is a contraindication to anticoagulant as needed for wheezing or shortness of breath prophylaxis, GCS or IPC is recommended. Analgesics Mild Pain (13) Evidence c Early and persistant mobilization d e f g c acetaminophen /TYLENOL ____650 mg ____650 mg d e f g c Graded compression stockings (1530 mm Hg of d e f g orally or rectally _____every 4 hours ____every 6 pressure at the ankle) hours as needed for pain c Sequential Compression Device d e f g c ibuprofen /MOTRIN 400 milligram orally every 4 d e f g c CBC every other day starting on day 4 of heparin d e f g hours as needed for pain therapy thru day 14 or until Unfractionated (Contraindicated in pregnant women and children < 6 heparin/LMWH is discontinued. mos. of age) LowDose Unfractionated Heparin Moderate Pain (46) c heparin 5,000 unit subcutaneously every 8 hours d e f g c hydrocodone/APAP/LORTAB d e f g LowMolecularWeight Heparins ____5/500_____7.5/500 ______10/500 tablet orally c enoxaparin /LOVENOX 40 milligram subcutaneously d e f g every ____4 hr._____6 hr. as needed for pain once a day c oxycodoneAPAP/PERCOCET d e f g ____5/325______7.5/325_____10/325 tablet orally Sedatives Evidence c LORazepam /ATIVAN 1 milligram intravenously every d e f g every _____4hr._____6hr. as needed for pain 6 hours as needed for sedation c oxycodone _____mg tablet orally every d e f g LORazepam /ATIVAN 1 milligram orally 2 times a day c d e f g _____4hr._____6hr. as needed for pain as needed for sedation Severe Pain (710) Evidence c zolpidem /AMBIEN 5 milligram orally once a day, at d e f g Consider the use of an opioid analgesic; morphine at bedtime as needed for insomnia a dose of 0.1 mg/kg body weight has limited effectiveness Evidence c zolpidem /AMBIEN 10 milligram orally once a day, at d e f g bedtime as needed for insomnia c HYDROmorphone /DILAUDID 1 milligram SC/IV d e f g Smoking Cessation Medications Evidence every __ 4 hrs. __ 6 hours as needed for pain c nicotine 7 mg/24 hr transdermal film, extended d e f g c morphine ____ milligram intravenously every d e f g release 1 patch transdermally once a day ____hours as needed for pain c nicotine 14 mg/24 hr transdermal film, extended d e f g c morphine ____mg intravenously every 5 minutes to d e f g release 1 patch transdermally once a day a maximum of 10 mg/hr. c nicotine 21 mg/24 hr transdermal film, extended d e f g release 1 patch transdermally once a day Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
PHYSICIAN'S ORDER SHEET Another brand of a generically equivalent product identical in dosage form and content of active ingredient may be administered unless indicated. Laxatives c magnesium hydroxide /MILK OF MAGNESIA 30 d e f g milliliter orally once a day as needed for constipation c docusate sodium /COLACE 100 milligram orally 2 d e f g times a day c bisacodyl /DULCOLAX 5 milligram orally once a day as d e f g needed for constipation c bisacodyl /DULCOLAX 10 milligram suppository d e f g rectally once a day as needed for constipation Laboratory c Complete blood cell count with automated white blood d e f g cell differential c Complete blood cell count with automated white blood d e f g cell differential every ______ . c Complete blood cell count with manual white blood cell d e f g differential c Blood gas, arterial Evidence d e f g
patient imprint
g Blood gas, venous Source c d e f c Basic metabolic panel d e f g c Comprehensive metabolic panel d e f g c Culture, blood times 2 from 2 separate sites (IDSA does d e f g not recommend routine blood cultures unless ICU
admission) Evidence g Culture, sputum Evidence c d e f c Gram stain, sputum Evidence d e f g c UA d e f g c Pregnancy test, urine, pointofcare measurement d e f g Diagnostic Tests c 12lead ECG d e f g c Radiograph, chest, 2 views Evidence d e f g c Radiograph, chest Portable d e f g
Physician Consults c Consult to MD d e f g _______________________________________ Other Consults c Consult to palliative care d e f g c Consult to Respiratory Therapy d e f g c Consult to Physical Therapy d e f g c Consult to Speech Therapy d e f g
Other: ________________________________
Order Initiated By: _________________________ Date/Time: _______________ Physician Signature: ________________________ Date/Time: _______________ Telephone/Verbal Orders: g c Read Back g d e f c Confirmed d e f
Released: April 2, 2009 Page &p of &P
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