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Continuation of Medications Administered During Critical Care Transport – Adult/Pediatric/Neonatal – Inpatient [80]

Continuation of Medications Administered During Critical Care Transport – Adult/Pediatric/Neonatal – Inpatient [80] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols



Protocol Number: 80

Delegation Protocol Title:
Continuation of Medications Administered During Critical Care Transport – Adult/Pediatric/Neonatal –
Inpatient

Delegation Protocol Applies To:
Patients receiving medication during Critical Care transport requiring continuation of therapy before
admission orders are written.

Target Patient Population:
All patients transported to University Hospital or American Family Children’s Hospital (AFCH) through
Critical Care Transport

Delegation Protocol Champions:
Jeff Wells, MD – Medicine‐Pulmonary, Director of Critical Care
Ryan Wubben, MD – Emergency Medicine‐ MedFlight, Medical Director MedFlight
Tom Brazelton, MD – Pediatrics‐ICU, Medical Director CHETA
Michael Wilhelm, MD – Pediatrics‐ICU, Director of Pediatric Intensive Care Unit
Jamie Limjoco, MD – Pediatrics‐Neonatology

Delegation Protocol Reviewers:
Kris Hornung, RN – Trauma Life Support Center
Anna Krupp, RN, CCNS – Trauma Life Support Center
Anne Moseley, MSN, MBA, RN – Director Pediatric Nursing and Patient Care Services AFCH
Sarah Larson, RN – Helicopter Critical Care Service
Pete Rankin, RN ‐ Helicopter Critical Care Service
Laura Konkol, CNS – Neonatal ICU
Jeff Fish, PharmD – Pharmacy
Aaron Steffenhagen, PharmD – Pharmacy
Meghann Voegeli, PharmD ‐ Pharmacy

Responsible Department:
Department of Pharmacy

Purpose Statement:
This protocol delegates authority from UW Health emergency and critical care physicians to clinical
pharmacists and Registered Nurses (RNS) to order continuation of medications administered during
emergency transport until orders are written by the admitting service. The protocol defines the process
of identifying patients and required medications, documentation in the medical record, ordering and
ensuring delivery to the patient unit.

Who May Carry Out This Protocol:
University Hospital and AFCH inpatient clinical pharmacists and registered nurses trained in the use of
this protocol.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


Guidelines for Implementation:
1. Outside facility contacts the Access Center with request for patient transport to University
Hospital or AFCH.
2. Access Center communicates request to University Hospital or AFCH attending physician.
3. Attending physician accepts patient and receives a patient report and notifies Access Center
personnel that patient must be entered into the electronic medical record system as soon as
possible.
4. Prior to departing from the referring facility, Critical Care Transport staff calls the receiving
nurse or unit charge nurse and notifies them of medication(s) required upon arrival.
4.1. The following information will be communicated:
4.1.1.Patient name and medical record number (if possible)
4.1.2.Patient weight
4.1.3. Critical Care Transport physician caring for the patient (accepting physician if no
transport physician is involved)
4.1.4. Estimated time of arrival
4.1.5. Medications required upon arrival, including dose, rate, route, and concentration
as applicable
4.2. The receiving nurse documents this communication and identifies the medications in a
progress note in the patient’s chart.
4.2.1. If patient is not assigned to a unit bed, locate patient in the Health Link folder
“Pre‐admit Patients”.
4.2.2. If the patient is not entered in the electronic medical record system, call Access
Center (263‐3260) and request patient be entered.
5. If additional medications are identified as needed upon patient arrival after the initial call,
Critical Care Transport staff will call the University Hospital or AFCH unit RN and notify them
to order additional medication(s).
6. The unit nurse communicates with the unit pharmacist indicating a medication is required
for a Critical Care Transport patient, along with the patient name and medical record
number for the pharmacist to reference the progress note written.
7. Unit nurse ensures availability of infusion pump(s).
8. Pharmacist orders medication in electronic medical record based on the written progress
note.
8.1. Enter a dose range in the “dose field”.
8.2. Frequency is entered as “ONCE” (instead of continuous)
8.3. Indicate “initiate at current rate” in ordering instructions.
8.4. Enter the Critical Care Transport physician caring for the patient as the “ordering
provider”.
8.5. Enter the Critical Care Transport physician as the “authorizing provider”. If the Critical
Care Transport physician is not listed as an authorizing provider, or if no transport
physician is involved, then the name of the attending physician on the inpatient service
is entered as the “authorizing provider”.
9. Pharmacist calls sterile products area (SPA) and notifies them of patient unit if not identified
in the medical record.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


Lee Vermeulen, CCKM@uwhealth.org
10. Pharmacist ensures delivery of medication to unit and notifies the nurse that the medication
is available.
11. If the medication is continued on an inpatient basis, then the admitting team orders the
medication in the admission orders.
11.1. Orders from the admitting team will take precedence over all orders written through
this protocol.
11.2. If a medication ordered via this protocol is not included in admission orders, the
pharmacist will verify with the admitting team that the medication should no
longer be continued.

Order Mode: Meds: Protocol/Policy, Without Cosign

References: NA

Collateral Documents/Tools:
UWHC Administrative Policy 8.16 Patient Care Orders

Approved By:
UWHC Critical Care Committee – May 2013, *September 2015; *February 2017
UWHC Pharmacy and Therapeutics Committee – May 2013, *September 2015; *February 2017
UWHC Medical Board – June 2013, *September 2015; *February 2017

Effective Date: March 2017

Scheduled for Review: March 2020
‘* Expedited Review Process
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org