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Immediate Orders - Pediatric - Patients Less than 18 years of Age

Immediate Orders - Pediatric - Patients Less than 18 years of Age - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols, Related


SmartSet: ED - IMMEDIATE ORDERS DELEGATION PROTOCOL - RN/ED TECH -
PEDIATRIC - PATIENTS LESS THAN 18 YEARS OF AGE (ID:4274)
General Information
Display name: ED - Immediate Orders Delegation Protocol - RN/ED Tech - Pediatric - Patients Less than
18 Years of Age
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. EMERGENCY
2. ER
3. .ED
SmartSet notes:
Description:
Web information:
Title URL
1.
Questionnaire:
Configuration
Venous Access
Orders
lidocaine (LMX) 4% topical dressing kit Topical, EVERY 1 HOUR PRN, apply 20 to 30 minutes prior
to needle insertion - see Admin Instructions
For children less than10 kg - Do NOT apply to area larger
than 100 square centimeters.
For children 10 kg or greater - Do NOT apply to area larger
than 200 square centimeters.
For patients less than 1 year old do NOT leave on longer than
1 hour.
For patients 1 year or older do NOT leave on longer than 2
hours
Insert and Maintain Peripheral IV CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Peripheral IV Location: RN Discretion
Peripheral IV Device: RN Discretion
Peripheral IV Status:
Does this need to be inserted/placed? Yes
sodium chloride 0.9% flush 10 mL injection Flush, PRN, flush/line care
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Hyperglycemia, Signs and Symptoms of
Orders
Notify Provider of Initiation of Hyperglycemia Orders Provider to Notify: Provider
Notify based on:
Turn Off Patient's Insulin Pump ONCE For 1 Occurrences
Vital Signs EVERY 1 HOUR, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Glucose, POC ONCE For 1 Occurrences, Routine, Glucose, POC should
always be ordered in conjunction with orders for
hypoglycemia management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
GLUCOSE STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ELECTROLYTES STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BUN STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CALCIUM, IONIZED STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
MAGNESIUM STAT - RN COLLECT, Starting S For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
PHOSPHATE STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
HEMOGLOBIN STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
HEMOGLOBIN A1C STAT - RN COLLECT, Starting S For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BLOOD GASES STAT - RN COLLECT, Starting S For 1 Occurrences, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


previous specimen?
If Conditional, What Condition?
Cardio-Respiratory Monitor - Pediatric - With Rhythm
Cardio-Respiratory Monitor - Pediatric - With Rhythm CONTINUOUS, Routine, Most pediatric patients do NOT
require rhythm analysis. Please complete the Notify
Provider order below, including specification for apnea >
*** seconds. If indicated, order pulse oximetry
separately.
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify Provider: Symptomatic Change in Rhythm,Serious
Arrhythmia
Notify Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds
Fever - NOT Neutropenic - Temperature Greater Than 38 C or 100.4 F
Patients LESS THAN 8 WEEKS of AGE
Infant Warmer Ohio Bed CONTINUOUS, Starting S with First Occurrence Include Now,
Routine
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension
15 mg/kg, Oral, ONCE For 1 Doses
CBC WITH DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST STAT - RN COLLECT For 1 Occurrences, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected see
Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
URINE CULTURE STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Patients 8 WEEKS or OLDER AND LESS THAN 4 MONTHS OF AGE
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension
15 mg/kg, Oral, ONCE For 1 Doses
Patients 4 MONTHS OF AGE or GREATER AND LESS THAN 60 Kg
ibuprofen (MOTRIN) susp 10 mg/kg, Oral, ONCE For 1 Doses
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension
15 mg/kg, Oral, ONCE For 1 Doses
Patients 4 MONTHS OF AGE or GREATER AND MORE THAN 60 Kg
ibuprofen (MOTRIN) tab 600 mg, Oral, ONCE For 1 Doses
acetaMINOPHEN (TYLENOL) tab 650 mg, Oral, ONCE For 1 Doses
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Neutropenic Fever - Temperature >38 C or 100.4 F actual or reported
Patients LESS THAN 6 MONTHS OF AGE
Infant Warmer Ohio Bed CONTINUOUS, Starting S with First Occurrence Include Now,
Routine
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension
15 mg/kg, Oral, ONCE For 1 Doses
CBC WITH DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST STAT - RN COLLECT For 1 Occurrences, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected see
Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Place additional orders as needed for multiple lines/lumens
URINALYSIS WITH MICROSCOPY STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Do NOT catheterize patient unless directed by provider
CULTURE, URINE STAT - RN COLLECT For 1 Occurrences, Routine
Indication:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Do NOT catheterize patient unless directed by provider
Patients 6 MONTHS or OLDER AND LESS THAN 60 Kg
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension
15 mg/kg, Oral, ONCE For 1 Doses
CBC WITH DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST STAT - RN COLLECT For 1 Occurrences, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected see
Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Place additional orders as needed for multiple lines/lumens
URINALYSIS WITH MICROSCOPY STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Do NOT catheterize patient unless directed by provider
CULTURE, URINE STAT - RN COLLECT For 1 Occurrences, Routine
Indication:
If add on test, what should lab do if unable to add test to
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


previous specimen?
If Conditional, What Condition?
Do NOT catheterize patient unless directed by provider
Patients 6 MONTHS OR OLDER AND 60 Kg or GREATER
acetaMINOPHEN (TYLENOL) tab 650 mg, Oral, ONCE For 1 Doses
CBC WITH DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST STAT - RN COLLECT For 1 Occurrences, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected see
Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Place additional orders as needed for multiple lines/lumens
URINALYSIS WITH MICROSCOPY STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Do NOT catheterize patient unless directed by provider
CULTURE, URINE STAT - RN COLLECT For 1 Occurrences, Routine
Indication:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Do NOT catheterize patient unless directed by provider
Lacerations - Less Than 5 Centimeters
Orders
lidocaine-tetracaine-epinephrine 4%-0.5%-1:2000 gel Topical, ONCE For 1 Doses
To laceration
Nausea and Vomiting
Orders
ondansetron (ZOFRAN) injection 0.15 mg/kg, Intravenous, ONCE For 1 Doses
ondansetron (ZOFRAN) soln 0.15 mg/kg, Oral, ONCE For 1 Doses
ondansetron (ZOFRAN ODT) disintegrating tab -
NOTE: Order for patients 25 kg or greater
4 mg, Oral, ONCE For 1 Doses
Pain
Patients LESS THAN 4 MONTHS OF AGE
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension
15 mg/kg, Oral, ONCE For 1 Doses
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


sucrose (SWEET-EASE) 24% buccal soln Oral, ONCE For 1 Doses
Mild to Moderate Pain- Patients 4 MONTHS OF AGE OR GREATER AND LESS THAN 60 Kg
ibuprofen (MOTRIN) susp 10 mg/kg, Oral, ONCE For 1 Doses
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension
15 mg/kg, Oral, ONCE For 1 Doses
Mild to Moderate Pain- Patients 4 MONTHS OF AGE AND 60 Kg or GREATER
ibuprofen (MOTRIN) tab 600 mg, Oral, ONCE For 1 Doses
acetaMINOPHEN (TYLENOL) tab 650 mg, Oral, ONCE For 1 Doses
Severe Pain- Patients 4 MONTHS of AGE or GREATER
FENTanyl (SUBLIMAZE) 0.05 MG/ML intraNASAL soln 1.5 mcg/kg, Nasal, ONCE For 1 Doses
Sickle Cell Crisis
Patients LESS THAN 60 Kg
Pulse Oximetry CONTINUOUS, Routine
Oxygen Therapy CONTINUOUS, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen?
FENTanyl (SUBLIMAZE) 0.05 MG/ML intraNASAL soln 1 mcg/kg, Nasal, ONCE PRN For 1 Doses
CBC WITH DIFFERENTIAL STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST CONDITIONAL - RN COLLECT, Starting S, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected see
Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Temperature greater than 38
C or 100.4 F
URINALYSIS WITH MICROSCOPY STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
RETICULOCYTE COUNT STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Patients 60 Kg or GREATER
Pulse Oximetry CONTINUOUS, Routine
Oxygen Therapy CONTINUOUS, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen?
FENTanyl (SUBLIMAZE) 0.05 MG/ML intraNASAL soln 1 mcg/kg, Nasal, ONCE PRN For 1 Doses
CBC WITH DIFFERENTIAL STAT - RN COLLECT For 1 Occurrences, Routine
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST CONDITIONAL - RN COLLECT, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida and
Cryptococcus. If filamentous fungi are suspected see Culture,
Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Temperature greater than 38
C or 100.4 F
URINALYSIS WITH MICROSCOPY STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
RETICULOCYTE COUNT STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Suicide Precautions
Orders
Constant Supervision by Staff - FOR ED USE ONLY CONTINUOUS, Routine
Patient placed in a hospital gown ONCE
Belongings removed ONCE
If gown and removal of belongings are refused, patient
will be screened by Security
ONCE
Wheezing
Patients LESS THAN 20 Kg
Notify Provider of Wheezing ONCE
Pulse Oximetry CONTINUOUS, Starting S, Routine, If <94% apply
supplemental O2
Oxygen Therapy CONTINUOUS, Starting S For Until specified, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 94
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen?
albuterol neb soln (3 mL) 2.5 mg, Nebulization, ONCE For 1 Doses
Patients 20 Kg or GREATER
Notify Provider of Wheezing ONCE
Pulse Oximetry CONTINUOUS, Routine, If <94% apply supplemental O2
Oxygen Therapy CONTINUOUS, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 94
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen?
albuterol neb soln (3 mL) 5 mg, Nebulization, ONCE For 1 Doses
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