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201704102

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ED - CLINICAL DECISION UNIT - PNEUMONIA - ADULT [6082]

ED - CLINICAL DECISION UNIT - PNEUMONIA - ADULT [6082] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Clinical Decision - Pneumonia - Adult [6082]
Criteria for this Order Set:Inclusion
pneumoniaRay consistent with acute -History, exam, and Chest X1.
antigens, and/or blood cultures,If you plan to obtain sputum cultures, legionella & pneumococcal urine 2.
administrationplease do so prior to antibiotic
(ED)Initial dose of antibiotics given in Emergency Department 3.
Exclusion Criteria for this Order Set:
1. Suspected severe sepsis
2. Abnormal vital signs after ED treatment (Systolic
Blood Pressure < 90, Heart Rate > 120, Oxygen Saturation < 92% on room air)
3. Mental status change
4. Immunosuppressed patient
5. Multi-lobar pneumonia
6. Pneumonia Severity Index Score of class 4 or greater
Admission Status
Admission Status [210513]
Admit to CDU (ED Observation) [ADT0019] Patient Class: Observation
Accommodation Code, if IMC request, please enter
Comments in field to the right: OSS/OBS
Will the patient require special placement due to
ISOLATION Precautions?
Could this patient have ACS/MI?
Does the patient require CARDIAC MONITORING for
transport?
Admitting Provider?
Attending Provider?
CDU Protocol: Pneumonia
Family History:
Expected Treatment/Procedures:
Intravenous Therapy
IV Fluids [211113]
sodium chloride 0.9 % infusion [64367] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.9% infusion [51641] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
[44910]
Intravenous, CONTINUOUS
Medications
Analgesics - Acetaminophen PRN [212885]
acetaMINOPHEN (TYLENOL) tab [34149] 325-650 mg, Oral, EVERY 4 HOURS PRN, pain, Mild to
Moderate Pain
Analgesics - NSAIDS PRN [212887]
ibuprofen (MOTRIN) tab [38353] 200-400 mg, Oral, EVERY 6 HOURS PRN, pain, Mild to
Moderate Pain
Analgesics - Opioids - Oral PRN (Single Response) [212888]
hydrocodone-acetaMINOPHEN (NORCO) 5-325 MG
per tab [71425]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
oxycodone tab [45976] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain, Severe Pain
Analgesics - Opioids - Injection PRN (Single Response) [212890]
MORPHine PF injection [800122] 1-2 mg, Intravenous, EVERY 2 HOURS PRN, pain
For severe pain if unable to tolerate oral medications.
HYDROmorphone PF (DILAUDID) injection [800120] 0.2-0.4 mg, Intravenous, EVERY 2 HOURS PRN
For severe pain if unable to tolerate oral medications.
Antibiotics [212896]
patients with a history of data suggests a lower incidence of Clostridium difficile infection in Preliminary
based regimenusing a doxycycline -C.difficile infection
Infectious
Diseases Society
of
URL: http://workspaces.uconnect.wisc.edu/download/attachments/10327345/CAP+Guidelines+-+IDSA%
2C+2007.pdf?version=1&modificationDate=1297119316363
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 4/11/2017 3:01:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

America/American
Thoracic Society
Guidelines
Cefpodoxime and Doxycycline [222119] "And" Linked Panel
cefpodoxime (VANTIN) tab [44562] 200 mg, Oral, 2 X DAILY (AT MEALTIME) For 7 Days
doxycycline hyclate tab [67296] 100 mg, Oral, 2 X DAILY (AT MEALTIME) For 7 Days
Cefpodoxime and Azithromycin [222120] "And" Linked Panel
cefpodoxime (VANTIN) tab [44562] 200 mg, Oral, 2 X DAILY (AT MEALTIME) For 7 Days
azithromycin (ZITHROMAX) tab [57023] 500 mg, Oral, ONCE For 1 Doses
azithromycin (ZITHROMAX) tab [57023] 250 mg, Oral, 1 X DAILY Starting tomorrow For 4 Days
clindamycin (CLEOCIN) cap [44723] 300 mg, Oral, 4 X DAILY For 7 Days
Severe Ig-E Mediated Penicillin Allergy [222123]
patients with a history of data suggests a lower incidence of Clostridium difficile infection in Preliminary
based regimenusing a doxycycline -C.difficile infection
Infectious
Diseases Society
of
America/American
Thoracic Society
Guidelines
URL: http://workspaces.uconnect.wisc.edu/download/attachments/10327345/CAP+Guidelines+-+IDSA%
2C+2007.pdf?version=1&modificationDate=1297119316363
levofloxacin (LEVAQUIN) tab [54885] 500 mg, Oral, 1 X DAILY For 7 Days
Patient Care Orders
Vital Signs [211114]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
EVERY 1 HOUR x 2, then EVERY 2 hours X 2, then
EVERY 4 HOURS
Activity [212530]
Activity [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Nutrition [211116]
Diet - Custom [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Room Service Class:
Diet Type: Diet Modifications
Diet Modifications:
Bedside Meal Instructions:
Diet - General [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 4/11/2017 3:01:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org

Diet - NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Diet - Adult Renal [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Renal
Sodium:
Potassium:
Phosphorus:
Fluid Restriction Total mLs/24H (IV/PO):
Protein:
Bedside Meal Instructions:
Room Service Class:
Respiratory [210514]
Respiratory Therapy per Protocol [RT0035] CONTINUOUS, Routine
Protocol Type:
Oxygen Therapy [RT0032] CONTINUOUS, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen?
Respiratory Therapy per Protocol [RT0035] CONTINUOUS, Routine
Protocol Type:
CPAP Overnight and Nap [RT0063] OVERNIGHT AND NAP, Routine
Therapy Settings: Per RT
CPAP Level (cm H2O):
Oxygen (LPM or %):
Self Administered (Only RT may document in this box after
patient assessment): RT Approval Required
Incentive Spirometry [NURTRT0018] CONTINUOUS, Routine
Cough And Deep Breathe [NURTRT0019] EVERY 4 HOURS, Routine
Contingency Parameters [211118]
Notify Provider [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 95
If diastolic blood pressure < (mmHg): 60
If temperature > (C): 38
If temperature < (C): 36
If heart rate > (bpm): 120
If heart rate < (bpm): 50
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 300
If blood glucose < (mg/dL): 80
If pain score >:
Pulse Oximetry < (%): 92
If urine output < (mL):
Other:
Laboratory
Laboratory [222095]
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 4/11/2017 3:01:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org

INFLUENZA A AND B AND RSV DETECTION
[HCFLURSV]
STAT - RN COLLECT For 1 Occurrences, Routine,
Includes Influenza A and B by PCR and RSV by PCR.
Collect Nasopharyngeal Minitip swab (flocked swab) and
place in UTM. Refrigerated M4 viral media and room
temperature M4 (M4RT) are not acceptable.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
PROCALCITONIN [HCPRCTON] STAT - RN COLLECT For 1 Occurrences, Routine,
Accepted uses:
1. Diagnosis of community acquired pneumonia
2. Antibiotic de-escalation/discontinuation in patients
improving from bacterial pneumonia or culture-negative
sepsis
It should NOT be ordered in the following conditions:
1. Evaluation of aspiration as it cannot differentiate
chemical from bacterial pneumonitis
2. Immunosuppressed patients
3. Culture-positive septicemia
4. Decompensated heart failure
5. Infectious disease syndromes other than pneumonia or
sepsis
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
MRSA BY PCR for SSTI/Cellulitis (Nares and Pooled
Axilla/Groin) [HCMRSA]
STAT - RN COLLECT For 1 Occurrences, Routine, There
is no need to obtain repeated surveillance tests to clear
patients from MRSA isolation. Once a patient is flagged as
MRSA positive it will remain in the HealthLink header
indefinitely.
For NICU patients: left and right nares only.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Disposition Criteria
Home [210515]
Disposition Criteria - Home [NURCOM0022] CONTINUOUS, 1. Subjective and clinical improvement
2. Stable, acceptable vital signs during observation period
3. Patient able to tolerate oral medications
Hospital [210516]
Disposition Criteria - Hospital [NURCOM0022] CONTINUOUS, 1. Lack of clinical progress or improvement
2. Worsening clinical status
3. Worsening, unstable vital signs
4. Physician discretion
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 4/11/2017 3:01:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org