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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98201-en.cckm

201711317

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP/OP - Drug Reaction - Infusion Center - Adult - Supplemental [3054]

IP/OP - Drug Reaction - Infusion Center - Adult - Supplemental [3054] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP/OP - Drug Reaction - Infusion Center - Adult - Supplemental [3054]
Intended for Adult Patients Only
PatientsNot Use This Order Set for General Clinical Research Center Do
Patient Care Orders
Respiratory [95337]
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
While in Infusion Center
Respiratory [223731]
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
While in Infusion Center, Pre-Op Day Of Procedure
Non-Categorized Patient Care Orders [95336]
Page Consult Hospitalist [NURCOM0022] CONTINUOUS, Starting today, If ordering provider is
unreachable, page Consult Hospitalist at #6699 with
an FYI that the Infusion Center Drug Reaction
Protocol is initiated. Then send a follow up page -
either a STAT page if the patient does NOT respond
to the protocol, OR an FYI page that the patient has
responded to the protocol.
Non-Categorized Patient Care Orders [223732]
Page Consult Hospitalist [NURCOM0022] CONTINUOUS, Starting today, If ordering provider is
unreachable, page Consult Hospitalist at #6699 with
an FYI that the Infusion Center Drug Reaction
Protocol is initiated. Then send a follow up page -
either a STAT page if the patient does NOT respond
to the protocol, OR an FYI page that the patient has
responded to the protocol., Pre-Op Day Of Procedure
Prescriber Contact Information [128247]
If the patient has an acute reaction to the infusion, the infusion will be stopped and -NOTE
started until you (the -treatment for the acute reaction will be given. The infusion WILL NOT be re
challenge, or provide -original prescriber) or your designee can be reached to authorize the re
further instructions. If you cannot be reached, the medication will not be restarted and the patient
ordered -up with you, and future doses will not be administered until re-will be sent home to follow
by you. We will page/call you 3 times in 30 minutes. If we have not received a response from
you at the end of 30 minutes, the patient will be discharged.
Notify Provider - Infusion Reaction
[NURCOM0001]
Location:
Notify based on:
During business hours, I can be reached at this
number: ***
After hours, I can be reached at this number: ***
If unable to reach me, please contact the following
physician: *** at this number: ***
Prescriber Contact Information [223733]
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:29:31 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

If the patient has an acute reaction to the infusion, the infusion will be stopped and -NOTE
started until you (the -treatment for the acute reaction will be given. The infusion WILL NOT be re
challenge, or provide -original prescriber) or your designee can be reached to authorize the re
further instructions. If you cannot be reached, the medication will not be restarted and the patient
ordered -up with you, and future doses will not be administered until re-will be sent home to follow
by you. We will page/call you 3 times in 30 minutes. If we have not received a response from
you at the end of 30 minutes, the patient will be discharged.
Notify Provider - Infusion Reaction
[NURCOM0001]
Location:
Notify based on:
During business hours, I can be reached at this
number: ***
After hours, I can be reached at this number: ***
If unable to reach me, please contact the following
physician: *** at this number: ***, Pre-Op Day Of
Procedure
Intravenous Therapy
IV Fluids [95345]
sodium chloride 0.9% BOLUS [730003] 250 mL, Intravenous, PRN - NOTIFY PHARMACY
WHEN NEEDED For 2 Doses, Give if patient has
inadequate response to termination of the infusion or
develops hypotension.
For infusion reaction while in the Infusion Center.
Administer first dose if patient has inadequate respone
to termination of the infusion or develops hypotension.
Administer second dose if drug reaction symptoms do
not improve in 15 minutes after initial dose or if patient
develops hypotension.
IV Fluids [223734]
sodium chloride 0.9% BOLUS [730003] 250 mL, Intravenous, PRN For 1 Doses, Give if patient
has inadequate response to termination of the infusion
or develops hypotension.
While in Infusion Center
Pre-Op Day Of Procedure
sodium chloride 0.9% BOLUS [730003] 250 mL, Intravenous, PRN For 1 Doses, Give if drug
reaction symptoms do not improve in 15 minutes after
initial dose or if patient develops hypotension.
While in Infusion Center
Pre-Op Day Of Procedure
Medications
Drug Reaction [95347]
diphenhydramine (BENADRYL) injection [800106] 25 mg, Intravenous, PRN - NOTIFY PHARMACY
WHEN NEEDED For 2 Doses, Give if patient has
inadequate response to termination of the infusion.
While in Infusion Center. Administer first dose if
patient has inadequate response to termination of the
infusion. Administer second dose if drug reaction
symptoms do not improve in 15 minutes after initial
dose.
dexamethasone (DECADRON) intraVENOUS
[800037]
4 mg, Intravenous, PRN For 1 Doses, Give if patient
has inadequate response to termination of the
infusion.
While in the Infusion Center
Drug Reaction [223735]
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:29:31 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

diphenhydramine (BENADRYL) injection [800106] 25 mg, Intravenous, PRN For 1 Doses, Give if patient
has inadequate response to termination of the
infusion.
While in Infusion Center
Pre-Op Day Of Procedure
diphenhydramine (BENADRYL) injection [800106] 25 mg, Intravenous, PRN For 1 Doses, Give if drug
reaction symptoms do not improve in 15 minutes after
initial dose.
While in Infusion Center
Pre-Op Day Of Procedure
dexamethasone (DECADRON) intraVENOUS
[800037]
4 mg, Intravenous, PRN For 1 Doses, Give if patient
has inadequate response to termination of the
infusion.
While in the Infusion Center
Pre-Op Day Of Procedure
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 10/23/2017 5:29:31 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org