Unique Plan Description: COPD
Plan Selection Display: COPD
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 12:48:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-06-06 12:47:01
Available at all facilities: Yes

COPD
Vital Signs
	Vital Signs
		T;N, Per protocol
		Q1H, 4, hr
			Comment: Acute Respiratory Distress monitor vital signs Q1h x 4 hours, then Q2h x 10 for a total of 24 hours.  Then continue to monitor per patient condition. If BiPAP newly initiated or if patient requires > 5 L or > 40% FIO2 or Bipap, monitor vital signs and respiratory assessments hourly x 4 hours, then q2h x 24 hours. Continue to monitor per vital signs policy and procedures.
		T;N+240, Q2H-Sch, 10, Dose(s)/Time(s)
			Comment: Acute Respiratory Distress; monitor vital signs Q1h x 4 hours, then Q2h x 10 for a total of 24 hours.  Then continue to monitor per patient condition. If BiPAP newly initiated or if patient requires > 5 L or > 40% FIO2 or Bipap, monitor vital signs and respiratory assessments hourly x 4 hours, then q2h x 24 hours. Continue to monitor per vital signs policy and procedures.
Activity
	Activity-As Tolerated
		T;N
			Comment: With assistance
	Elevate head of bed
		
	Ambulate
		QID
	Up in Chair
		QID
			Comment: And with meals
	Oral Care
		BID
Laboratory
	Blood Gases Arterial (ABG) - MH/WH/JE
		Routine, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Routine, spec type = Blood
	Magnesium Level
		Routine, spec type = Blood
	Sputum Culture
		Routine, Expectorated, spec type = Sputum, Sputum
	Procalcitonin
		Routine, spec type = Blood
Diagnostic Tests
	Chest 1 View
		T+1;0400, Routine, Pneumonia
		T;N, Routine, Pneumonia
	Chest 2 View
		T+1;0400, Routine, Pneumonia
		T;N, Routine, Pneumonia
	CTA Chest
		T+1;0400, Routine
Diagnostics
	Discharge Diagnostics
		T;N, Complete pre and post PFTs. Schedule after discharge within 2-3 weeks.
	Complete pulmonary function
		
	Complete pre and post PFT's
		
Medications
Steroids
	predniSONE
		40 mg, Tab, By Mouth, DAILY, 5 Day(s)
		60 mg, Tab, By Mouth, DAILY, 48 hr
		40 mg, Tab, By Mouth, DAILY, 3 Day(s)
	SOLU-Medrol
		60 mg, Injection, IV Push, DAILY, 48 hr
	predniSONE
		40 mg, Tab, By Mouth, DAILY, 5 Day(s)
			Comment: start after 48hrs of IV solumedrol
	SOLU-Medrol
		40 mg, Injection, IV Push, Q6H, 48 hr
	predniSONE
		40 mg, Tab, By Mouth, DAILY, 5 Day(s)
			Comment: start after 48hrs of IV solumedrol
	SOLU-Medrol
		60 mg, Injection, IV PUSH, Q6H, duration: 5 Day(s)
		60 mg, Injection, IV PUSH, Q8H, duration: 5 Day(s)
		80 mg, Injection, IV PUSH, Q8H, duration: 5 Day(s)
		60 mg, Injection, IV PUSH, Q12H, duration: 5 Day(s)
		80 mg, Injection, IV PUSH, Q12H, duration: 5 Day(s)
Antibiotics
		Recommend 3-5 days antibiotic therapy. If IV antibiotic course recommended, review in 48-72 hours, and transition to oral.(NOTE)*
		Mild Exacerbation: select one from this section(NOTE)*
	doxycycline
		100 mg, Capsule, By Mouth, Q12H, COPD, 5 Day(s)
	Zithromax
		500 mg, Tab, By Mouth, DAILY, Other- type in, COPD, 5 Day(s)
	cefuroxime
		500 mg, Tab, By Mouth, BID, Other- type in, COPD, 5 Day(s)
		Moderate Exacerbation without Pseudomonas Risk Factors: select one from this section(NOTE)*
		Pseudomonas Risk Factors: 1. Recent hospitalization in past 90 days. 2. Frequent antibiotic courses in past year. 3. Severe COPD (FEV, <50%), 4. Previous isolation of pseudomonas.(NOTE)*
	amoxicillin-clavulanate  875 mg-125 mg oral tablet
		1 TAB, Tab, By Mouth, BID, Other- type in, COPD, 7 Day(s)
	Rocephin IVPB
		1,000 mg, Injection-Premix, IVPB, Q24H, Other- type in, COPD, 7 Day(s)
	Rocephin IVPB (FH)
		1,000 mg, INT, IVPB, Q24H, Other- type in, COPD, 7 Day(s)
	levoFLOXacin
		750 mg, Tab, By Mouth, DAILY, COPD, 7 Day(s)
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, Q24H, COPD, 7 Day(s)
		Moderate Exacerbation with Pseudomonas Risk Factors or severe exacerbation:NOTE: select one from this section(NOTE)*
		Severe exacerbation: requiring ventilation support, invasive or non invasive (BiPap/Vent)		Pseudomonas Risk Factors: 1. Recent hospitalization in past 90 days. 2. Frequent antibiotic courses in past year. 3. Severe COPD (FEV, <50%), 4. Previous isolatio(NOTE)*
	cefepime
		1,000 mg, Injection-Premix, IVPB, Q8H, Other- type in, COPD, 7 Day(s)
	cefepime IVPB (FH)
		1,000 mg, INT, IVPB, Q24H, Other- type in, COPD, 7 Day(s)
	Zosyn IVPB
		4.5 gm, Injection-Premix, IVPB, Q8H, Other- type in, COPD, STAT
	Zosyn IVPB (FH)
		4.5 gm, INT, IVPB, Q8H, Other- type in, COPD, STAT
		Severe beta lactam allergy:(NOTE)*
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, Q24H, COPD, 7 Day(s)
	levoFLOXacin
		750 mg, Tab, By Mouth, DAILY, COPD, 7 Day(s)
	aztreonam
		2,000 mg, INT, IVPB, Q8H, COPD, 7 Day(s)
		2,000 mg, INT, IVPB, Q8H, COPD, 7 Day(s)
	Zithromax IVPB
		500 mg, INT, IVPB, Q24H, Other- type in, COPD, T;N, 5 Day(s)
	doxycycline IVPB
		100 mg, INT, IVPB, Q12H, COPD, COPD, 5 Day(s)
		200 mg, INT, IVPB, Q12H, COPD, COPD, 5 Day(s)
		The U.S. Food and Drug Administration today approved safety labeling changes for a class of antibiotics, called fluoroquinolones, to enhance warnings about their association with disabling and potentially permanent side effects and to limit their use in p(NOTE)*
Nebulizers
	albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, QID
		3 mL, Solution-Nebulization, NEBULIZED, Q2H, PRN, shortness of breath
	albuterol 2.5 mg/3 mL (0.083%) inh soln
		3 mL, Solution-Nebulization, NEBULIZED, QID
		3 mL, Solution-Nebulization, NEBULIZED, Q4H
		3 mL, Solution-Nebulization, NEBULIZED, Q2H, PRN, wheezing and/or shortness of breath
		For use in tachycardic arrhythmia that has been exacerbated by albuterol(NOTE)*
	levalbuterol 1.25 mg/3 ml inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Q8H
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Q8H
	Pulmicort Respules
		0.5 mg, Solution-Nebulization, NEBULIZED, BID
Inhalers
	Breo Ellipta 100 mcg-25 mcg/inh inhalation powder
		1 puff, Powder, Inhalation, DAILY
	Anoro Ellipta 62.5 mcg-25 mcg/inh inhalation powder
		1 puff, Powder, Inhalation, DAILY
	Anoro Ellipta
		1 puff, Powder, Inhalation, DAILY
	Incruse Ellipta 62.5 mcg/inh inhalation powder
		1 puff, Powder-Inhalation, Inhalation, DAILY
Symptom Medications
	Daliresp
		500 mcg, Tab, By Mouth, DAILY, T+1;0900
	Mucinex
		600 mg, Tablet-Extended-Release, By Mouth, BID
		1,200 mg, Tablet-Extended-Release, By Mouth, BID
	dextromethorphan-guaifenesin 20 mg-200 mg/10 mL oral liquid
		10 mL, Liquid, By Mouth, QHS, PRN, cough
Patient Care

	Patient Education
		Regarding pneumonia and COPD
		DAILY, Instructions: Review My COPD Action Plan. Coordinate with CAT tool completion on day of discharge with RT.
	Obtain Medical Records
		Obtain outside PFTs if available and notify MD when received.
	Respiratory Assessment-Focused
		Q1H, 4, hr
			Comment: Acute Respiratory Distress monitor vital signs Q1h x 4 hours, then Q2h x 10 for a total of 24 hours.  Then continue to monitor per patient condition. If BiPAP newly initiated or if patient requires > 5 L or > 40% FIO2 or Bipap, monitor vital signs and respiratory assessments hourly x 4 hours, then q2h x 24 hours. Continue to monitor per vital signs policy and procedures.
		T;N+240, Q2H-Sch, 10, Dose(s)/Time(s)
			Comment: Acute Respiratory Distress; monitor vital signs Q1h x 4 hours, then Q2h x 10 for a total of 24 hours.  Then continue to monitor per patient condition. If BiPAP newly initiated or if patient requires > 5 L or > 40% FIO2 or Bipap, monitor vital signs and respiratory assessments hourly x 4 hours, then q2h x 24 hours. Continue to monitor per vital signs policy and procedures.
	Incentive Spirometer
		
	Notify MD
		T;N
			Comment: Temperature <36.1 C or >38.0 C, SBPressure <90 or >180     DBPressure >110     Heart rate < 50 or > 110     Respiratory rate <10 or >24     O2 sat <93%new onset rhythm changeblood glucose > 180 mg/dL (x 2 consecutive measurements)     urine output < 60 ml in 4 hours
Therapies
	NIV (BiPAP)
		T;N
			Comment: If newly initiated or if patient requires > 5 L or > 40% FIO2 or Bipap, monitor vital signs and respiratory assessments Q1H x 4 hours, then q2h x 10 hours for total of 24 hours. Continue to monitor per vital signs policy and procedures.
	Bronchodilator Therapy per Respiratory Protocol (FH)
		T;N
Consults/Follow-up
	Consult Pulmonary Rehab: Inpatient
		T;N, COPD
			Comment: Evaluate and treat inpatient
	Consult Pulmonary Rehab: Outpatient
		T;N, COPD
	Consult Respiratory Therapy-Assess and Treat
		T;N
			Comment: COPD patient. Obtain records from previous pulmonary function tests.
	Smoking Cessation Education
		T;N
			Comment: Patient to be seen prior to discharge
	Smoking Cessation Education RT (FH)
		T;N
	Consult Pulmonologist
		Reason for Referral: COPD, Refer to/Consult with: patient's pulmonologist
		Reason for Referral: COPD, Refer to/Consult with: Pulmonary Medicine Institute
		Reason for Referral: COPD, Refer to/Consult with: Pulmonary Medicine Specialists MPC
	Consult Inpatient Palliative Care
		Reason for Referral: COPD establish goals of care, Refer to/Consult with: Provider on call
	Consult Care Navigator
		Education
			Comment: COPD, MPC patients only
	Pharmacy Consult
		Pharmacy to determine if home inhalers are available to bring/use while in hospital
		Pharmacy to assess inhaler therapy based on admission information and contact MD if necessary.
		T;N+2880, Pharmacy and nursing to assess patient in 48 hours for IV to oral conversion

*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