/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/,

/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98214-en.cckm

201708223

page

100

UWHC,UWMF,

Tools,

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

IP – Infliximab (REMICADE) Infusion – Adult – Supplemental [1824]

IP – Infliximab (REMICADE) Infusion – Adult – Supplemental [1824] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Infliximab (REMICADE) Infusion - Adult - Supplemental [1824]
for Adult Patients OnlyIntended
Evaluate Prior to Prescribing Infliximab
TB Evaluation [190749]
A TB evaluation with a negative result must be completed within 6 months prior to initiation of
biologic therapy.
TB Evaluation Results [NURCOM0022] ONCE, Confirm patient has a negative TB evaluation prior to
initiation of biologic therapy.
@BRIEFLAB
(QUGOLDQUL,QUGOLDMG,QFERONNIL,QUGOLDNONIL)
@
PPD Induration (last result): @BRIEFLAB(PPD)@
QUANTIFERON-TB GOLD [GM8455] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Hepatitis B Evaluation [190751]
Consider evaluation for hepatitis B prior to initiation of biologic therapy.
Hepatitis B Evaluation Results [NURCOM0022] ONCE, Confirm patient has a negative Hepatitis B
evaluation prior to initiation of biologic therapy.
Hepatitis B surface antigen (last result): @BRIEFLAB
(HBSAG)@
Antibody to hepatitis B core antigen (last result):
@BRIEFLAB(HBSAB)@
HEPATITIS B SURFACE AG [HBSAG] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HEPATITIS B CORE AB, TOTAL [HBCAB] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Patient Care Orders
Vital Signs [26596]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Obtain prior to infusion, 30 minutes after infusion is
started, and at the completion of infusion.
Non-Categorized Patient Care Orders [26597]
Measure Weight [NURMON0015] ONCE, Starting today For 1 Occurrences, Routine
Weigh With?
Weigh when?
On each visit.
Contingency Parameters [191659]
Page 1 of 3
Printed by WILLIAMS, HEATHER R [HRS0] at 8/9/2017 11:51:48 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Other
Other: Patient develops signs of an infusion reaction
(flushing, hives, dyspnea, wheezing),Heart rate
changes by plus or minus 20 beats/minute from
baseline,Blood pressure changes by plus or minus 20
mmHg from baseline
Notify [NURCOM0001] Provider to Notify: Other (Comment)
Notify based on: Other
Other: Notify GI Fellow if infusion reaction occurs in GI
patient.
Medications - Pre-infusion
Analgesics [27242]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, ONCE For 1 Doses
Administer 30 minutes prior to infliximab
Antihistamines (Single Response) [27286]
diphenhydramine (BENADRYL) cap [36791] 25 mg, Oral, ONCE For 1 Doses
Administer 30 minutes prior to infliximab
diphenhydramine (BENADRYL) cap [36791] 50 mg, Oral, ONCE For 1 Doses
Administer 30 minutes prior to infliximab
diphenhydramine (BENADRYL) injection
[800106]
25 mg, Intravenous, ONCE For 1 Doses
Administer 30 minutes prior to infliximab
diphenhydramine (BENADRYL) injection
[800106]
50 mg, Intravenous, ONCE For 1 Doses
Administer 30 minutes prior to infliximab
Steroids (Single Response) [27288]
dexamethasone (DECADRON) intraVENOUS
[800037]
4 mg, Intravenous, ONCE For 1 Doses
Administer 30 minutes prior to infliximab
dexamethasone (DECADRON) intraVENOUS
[800037]
8 mg, Intravenous, ONCE For 1 Doses
Give 30 minutes prior to infliximab
Medications - Infusion Agent
Infusion Agent [27291]
infliximab (REMICADE) intraVENOUS [800268] Intravenous, ONCE
Administer with 0.2 or 0.22 micron filter
Doses 1000 mg or less are prepared in 250 ml normal
saline and titrated using- Administer at 10 mL/hr for 15
minutes, then 20 mL/hr for 15 minutes, then 40 mL/hr
for 15 minutes, then 80 mL/hr for 15 minutes, then 150
mL/hr for 30 minutes, then 250 mL/hr until completed.
Doses greater than 1000 mg are prepared in 500 ml
normal saline and titrated using- Administer at 20
mL/hr for 15 minutes, then 40 mL/hr for 15 minutes,
then 80 mL/hr for 15 minutes, then 160 mL/hr for 15
minutes, then 300 mL/hr for 30 minutes, then 500
mL/hr until completed.
For adverse reactions, stop infusion. When symptoms
resolve, resume infusion at 10 mL/hr and follow same
titration schedule.
Pharmacy to round dose to nearest 100 milligram vial
size.
Bronchodilators [228228]
albuterol neb soln (3 mL) [800248] 2.5 mg, Nebulization, PRN - NOTIFY PHARMACY
WHEN NEEDED, dyspnea, infusion reaction with
wheezing, shortness of breath
Medications - Adverse Reaction
Analgesics [27293]
Page 2 of 3
Printed by WILLIAMS, HEATHER R [HRS0] at 8/9/2017 11:51:48 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, PRN For 1 Doses, pain/fever, For pain
or temperature greater than 38.5 degrees C. May give
if not given in the previous 4 hours
Antihistamines (Single Response) [27292]
diphenhydramine (BENADRYL) injection RANGE
[750044]
25-50 mg, Intravenous, PRN For 1 Doses, infusion
reaction, for 1 Minutes
Steroids (Single Response) [27294]
dexamethasone (DECADRON) intraVENOUS
[800037]
4 mg, Intravenous, PRN For 1 Doses
dexamethasone (DECADRON) intraVENOUS
[800037]
8 mg, Intravenous, PRN For 1 Doses
Page 3 of 3
Printed by WILLIAMS, HEATHER R [HRS0] at 8/9/2017 11:51:48 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org