Unique Plan Description: Blood Conservation Program (BCP) Inpatient (MHWH)
Plan Selection Display: Blood Conservation Program (BCP) Inpatient (MHWH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-12-13 14:06:02
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-05-02 15:26:51
Available at all facilities: Yes

Blood Conservation Program (BCP) Inpatient (MHWH)
Laboratory
	Vitamin B12 Level
		Routine, spec type = Blood, Q3D-Lab
	Iron Panel - MH/WH/JE
		Stat, spec type = Blood
	Ferritin
		Stat, spec type = Blood
	Folate
		Routine, spec type = Blood, Q3D-Lab
	CBC with Diff
		T+1;0400, Routine, Q3D-Lab, spec type = Blood
	Reticulocyte Count
		T+1;0400, Routine, spec type = Blood, Q3D-Lab
Medications
		Critically Ill patients:(NOTE)*
	Procrit
		10,000 units, Solution, SUBCUTANEOUS, MonWedFri, T;N
			Comment: Expected CCU stay > 7 days and HGB <12 and high risk patient (if one of the following apply: history of heart failure, unstable angina, recent MI (<3 months), age >65. Discontinue when patient discharged from ICU> Epoetin Alfa (Procrit) Dosing (Monitor blood pressure during this treatment procedure. Never give IM
		Acute blood loss or potential for acute blood loss:(NOTE)*
		10,000 units, Solution, SUBCUTANEOUS, MonWedFri, T;N
			Comment: Hgb <10 or substantial blood loss(>500ml of blood) or potential for future blood loss due to surgery, invasive procedure etc. Epoetin Alfa (Procrit) Dosing (Monitor blood pressure during this treatment procedure. Never give IM
		Reduction of blood transfusion in surgery patient:(NOTE)*
		10,000 units, Solution, SUBCUTANEOUS, MonWedFri, T;N
			Comment: Hgb <12 AND future surgical blood loss is expected >500mlEpoetin Alfa (Procrit) Dosing (Monitor blood pressure during this treatment procedure. Never give IM
		Iron Dosing (choose one if blood loss has occurred or if giving epoetin alfa)(NOTE)*
	Venofer IVPB
		300 mg, Injection, IVPB, Once, 167 ml/hr
			Comment: In NS 250ml. To be given over 90 minutes. Watch patient due to risk of anaphylaxis. Vital Signs every 30 minutes.
	sodium ferric gluconate complex
		125 mg, INT, IVPB, Once, infuse over 1 hr, T;N
		250 mg, INT, IVPB, Once, infuse over 2 hr, T;N
	Reglan
		10 mg, Injection, IV PUSH, Once, NOW, T;N
			Comment: Give prior to IV Iron Sucrose
		10 mg, Tab, BY MOUTH, Once, NOW, T;N
			Comment: Give prior to IV Iron Sucrose
	Benadryl
		25 mg, Injection, IV PUSH, ONCE AT, NOW, T;N
			Comment: Give prior to IV Iron Sucrose
		25 mg, Tab, By Mouth, Once, NOW, T;N
			Comment: Give prior to IV Iron Sucrose
	iron polysaccharide
		150 mg, Capsule, BY MOUTH, BID, T;N
	ferrous sulfate
		325 mg, Tab, BY MOUTH, BID, T;N
	Vitamin B-12
		1,000 mcg, Injection, IM-IntraMUSCULAR, Once
	folic acid
		1 mg, Tab, BY MOUTH, BID, T;N
	Vitamin C
		250 mg, Tab, BY MOUTH, DAILY, T;N
	Theragran-M
		1 TAB, Tab, By Mouth, DAILY
	Colace
		100 mg, Capsule, BY MOUTH, DAILY, PRN, constipation, T;N
Patient Care
	Notify BC Program Coordinator of patient
		T;N, Office 354-3981  Cell: 315-0568 (24 Hr)
	Notify MD
		T;N, Contact physician AND BCP Coordinator of signs and symptoms of blood loss >300ml per 24 hour period or blood loss >250ml/8 hours
	Minimum blood draw requirement
		T;N, Limit and consolidate blood draws and perform blood sampling per IBC lab policy - consider microtainer
	Notify MD
		T;N, If on Epoetin Alfa (Procrit): Call ordering physician if symptomatic hypertension or systolic BP >/= 160 or diastolic BP >/=100.
		T;N, If on IV Iron Therapy: Call ordering physician if symptomatic hypotension or systolic BP </= 110 or diastolic BP </=50
Consults/Follow-up
	Pharmacy Consult
		Procrit dose adjustment for patient with chronic renal failure.
	Consult Hematologist/Oncologist
		Reason for Referral: chronic renal failure
	Consult Nephrologist
		Reason for Referral: chronic renal failure

Oxygen Protocol
Therapies
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

Allergy Reaction Protocol
Activity

	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in trendelenberg
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, Routine, Bolus
		1,000 mL, IV, Routine, 30 ml/hr
Medications
	Benadryl
		50 mg, Injection, IV Push, Once, PRN, allergic reaction, NOW
		25 mg, Injection, IV Push, Once, PRN, allergic reaction, NOW
	Decadron (MH/WH)
		20 mg, Injection, IV PUSH, Once, PRN, allergic reaction
	SOLU-Medrol
		125 mg, Injection, IV Push, Once
	EPINEPHrine
		0.5 mg, Injection, SUBCUTANEOUS, Once
		0.5 mg, Injection, IM-Intramuscular, Once
		0.5 mg, Injection, SUBCUTANEOUS, Q10MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.5 mg, Injection, IM-Intramuscular, Q10MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		For infants and children up to age 12 < 30kg(NOTE)*
		0.01 mg/kg, Injection, SUBCUTANEOUS, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.01 mg/kg, Injection, IM-Intramuscular, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		For infants and children up to age 12 > or equal to 30kg(NOTE)*
		0.3 mg, Injection, SUBCUTANEOUS, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.3 mg, Injection, IM-Intramuscular, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
Patient Care
	Pharmacy Consult
		T;N, Allergy Reaction Protocol was entered on this patient, please verify allergy, and add allergen to patient allergies in medical record
	Discontinue Medication
		T;N, Discontinue IV medication or infusion and remove tubing
	Notify MD
		T;N, Contact PCP for additional orders

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase