Unique Plan Description: Cards Admission
Plan Selection Display: Cards Admission
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-11-22 11:10:01
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 09:40:57
Available at all facilities: Yes

Cards Admission
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
		T;N, To Inpatient Status
	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		T;N
			Comment: per floor routine
		T;N, Q4H-Sch minus Q12 Start of Shift
		T;N, Q2H
		T;N, Q4H
		T;N, Q15MIN, 4, Dose(s)/Time(s)
			Comment: until stable then routine
Activity
	Activity-Up as Tolerated
		T;N
	Up in Chair
		T;N, TIDWM
	Ambulate
		T;N, In hall, TID
		T;N, In hall, QID
Diet
	Cardiac Diet
		T;N
	Diabetic Diet
		T;N
	Low Cholesterol/No Added Salt Diet
		T;N
Laboratory
	CBC with Diff
		Routine, spec type = Blood
	Comprehensive Metabolic Panel
		Routine, spec type = Blood
	ProBNP
		Routine, spec type = Blood
	B-Type Natriuretic Peptide - FH
		Routine, spec type = Blood
	hs Troponin I - FH
		Timed, Q6H, 2 Dose(s)/Time(s), spec type = Blood
		Timed, Q6H, 3 Dose(s)/Time(s), spec type = Blood
	Myoglobin
		Timed, Q6H, 2 Dose(s)/Time(s), spec type = Blood
		Timed, Q6H, 3 Dose(s)/Time(s), spec type = Blood
Diagnostic Tests
	Chest 1 View
		T;N, Stat, Chest Pain, Portable
			Comment: if not done in ED
	ECG
		T;N, Stat, Indication: Chest Pain of Uncertain Etiology
			Comment: if not done in ED
	Echo w Doppler resting
		T;N, Indication: Chest pain
IV Solutions
Medications
	Ambien
		5 mg, Tab, BY MOUTH, QHS, PRN, insomnia
	Tylenol
		650 mg, Tab, BY MOUTH, Q4H, PRN, pain-mild
			Comment: and/or fever
	aluminum hydroxide/magnesium hydroxide/simethicone 200 mg-200 mg-20 mg/5 mL oral susp
		15 mL, Suspension-Oral, BY MOUTH, Q4H, PRN for indigestion
	morphine  IV
		2 mg, Syringe, IV PUSH, Q1H, PRN, chest pain
		1 mg, Syringe, IV PUSH, Q1H, PRN, chest pain
	Nitrostat
		0.4 mg, Tab, SUBLINGUAL, Q5MIN, PRN, chest pain
			Comment: may repeat three times.
	Xanax
		0.125 mg, Tab, BY MOUTH, Q6H, PRN, anxiety
		0.25 mg, Tab, BY MOUTH, TID, PRN, anxiety
			Comment: Do NOT administer if > 80 years of age.
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Notify MD
		T;N, if patient has chest pain; abnormal lab
	Smoking Cessation Education
		T;N, teaching, prior to discharge
	Smoking Cessation Education RT (FH)
		T;N
	Cardiac Telemetry Monitoring
		T;N
			Comment: continuously
Therapies
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID
	Pulse Oximetry Spot Check RT
		T;N, BID-RT
	Consult Social Work
		T;N, Evaluation

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

Peripheral Lock - Access
Medications

	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

VTE Prophylaxis
Medications
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N+480
			Comment: (CrCl>30) Start 8 hours after admission. Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T+1;0900
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N
			Comment: VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N+480
			Comment: Start 8 hours after admission. VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T+1;0600
			Comment: VTE Prophylaxis
Patient Care
		Sequential Compression Device and Anti Embolism Device orders will not suppress the VTE Advisor(NOTE)*
	Sequential Compression Device
		T;N, Apply, Once
	Anti Embolism Stockings
		T;N, Apply, Once
			Comment: knee high
	VTE Prophylaxis Contraindication
		High Risk of Bleeding
		Procedure Planned
		ASA order meets prophylaxis requirement
		If patient is low risk or further evaluation needed, complete advisor:(NOTE)*
	VTE Advisor
		Medical

DVT VTE Prophylaxis (FH)
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
		T+1;0500, Routine, EVERY OTHER DAY, spec type = Blood
		T+1;0500, Routine, Q24H 3 Day(s), spec type = Blood
		T+1;0500, Routine, Q24H, spec type = Blood
	BMP
		T;N, Routine, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Routine, spec type = Diagnostic Blood
		T+1;0500, Q24H, spec type = Therapeutic Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Routine, spec type = Diagnostic Blood
Medications
		See VTE Risk Assessment for patient risk score(NOTE)*
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
		30 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		For CrCl < 30 mL/min(NOTE)*
		30 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000. D/C lovenox if INR > 1.8
		For Patients > 150 kg(NOTE)*
		40 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
Anticoagulants
		Baseline INR required for Coumadin(NOTE)*
	warfarin
		5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		ORTHO ONLY(NOTE)*
	Xarelto
		10 mg, Tab, By Mouth, DAILY
	dabigatran
		150 mg, Capsule, By Mouth, BID
			Comment: Check renal function
	Eliquis
		2.5 mg, Tab, By Mouth, BID
			Comment: Hip Replacement: Duration of therapy 35 days  Knee Replacement: 12 days
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Syringe, SUBCUTANEOUS, TID
		5,000 units, Syringe, SUBCUTANEOUS, BID
Patient Care

	Impulse Foot Pumps
		To be worn at all time while patient is not bearing weight
	Sequential Compression Device
		T;N, Wear, Both legs
			Comment: To be worn at all times while patient is not bearing weight
	Anti Embolism Stockings
		TED hose, knee high, Both legs
		TED hose, knee high, Left leg
		TED hose, knee high, Right leg
		TED hose, thigh high, Both legs
		TED hose, thigh high, Left leg
		TED hose, thigh high, Right leg
	Notify MD
		Contact Physician if INR < 1.8 on Day of Dismissal
Therapies
	Consult Physical Therapy, Evaluate and Treat
		
Consults/Follow-up
	Pharmacy Consult
		D/C Lovenox if INR > 1.8
		D/C Lovenox if INR > 2.0
		Contact MD and Hold Coumadin if INR > 2.5
		Contact MD and Hold Coumadin if INR > 3.0
		Contact MD and Hold Coumadin if INR > 3.5

hs Troponin T - MH/WH/JE
Laboratory
	hs Troponin T - MH/WH/JE
		Stat, spec type = Blood
		T;N+120, Timed, spec type = Blood
		T;N+360, Timed, spec type = Blood

*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