Unique Plan Description: COVID - 19
Plan Selection Display: COVID - 19
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-07-16 12:12:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-06-25 09:38:44
Available at all facilities: Yes

COVID - 19
Vital Signs
	Vital Signs
		T;N, Q1H, If on >6L of NC oxygen
		T;N, Q1H, 4, Dose(s)/Time(s)
			Comment: Acute respiratory distress monitor vital signs Q1h x 4 hours, then Q2h x 10 for total 24h. Then continue to monitor 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 24h.
		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 total 24h. Then continue to monitor 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 24h.
Activity
	Activity-Position
		Prone
			Comment: as much as possible
Laboratory
STAT Lab
	COVID-19 (2019 Novel Coronavirus) by PCR
		T;N, Stat, spec type = Nasopharynx
	Type and Screen (No Product on hold)
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	CK
		T;N, Stat, spec type = Blood
	hsCRP
		T;N, Stat, spec type = Blood
	Ferritin
		T;N, Stat, spec type = Blood
	PT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Timed, spec type = Therapeutic Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Fibrinogen Level - MH/WH/JE
		T;N, Stat, spec type = Blood
	Fibrinogen Level - FH
		T;N, Stat, spec type = Blood
	D-Dimer - MH/WH/JE
		Stat, spec type = Blood
	D-Dimer Level - FH
		Stat, spec type = Blood
	Procalcitonin
		T;N, Stat, spec type = Blood
	LDH
		T;N, Stat, spec type = Blood
	hs Troponin T
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	ProBNP
		T;N, Stat, spec type = Blood
		Future Lab Monitoring(NOTE)*
	CBC with Diff
		T+1;0400, Routine, Q24H 7 Dose(s)/Time(s), spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H 7 Dose(s)/Time(s), spec type = Blood
	hsCRP
		T+1;0400, Routine, Q24H 7 Dose(s)/Time(s), spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T+1;0400, Routine, Q24H 7 Dose(s)/Time(s), spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T+1;0400, Routine, Q24H 7 Dose(s)/Time(s), spec type = Blood
		Critically ill patient-needs SOFA score daily(NOTE)*
	CBC with Diff
		T+1;0400, Routine, Q24H 7 Dose(s)/Time(s), spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H 7 Dose(s)/Time(s), spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T+1;0400, Routine, Q24H 7 Dose(s)/Time(s), spec type = Blood
	Heparin Anti-Xa LMWH Lovenox
		T+1;0400, Routine, spec type = Blood
			Comment: Notify provider if anti Xa greater than 0.8
Diagnostic Tests

	CTA Chest Pulmonary Arteries
		Stat, Pulmonary Emboli
	Chest 1 View
		T;N, Stat, Fever
Medications
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		ALL patients with COVID19 recommended to have at least prophylactic dose Lovenox(NOTE)*
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: COVID 19 - prophylactic dose Pharmacy to adjust dose based on weight
		Non Critically ill patients with an elevated DDimer, may benefit from therapeutic anticoagulation.(NOTE)*
		1 mg/kg, Syringe, SUBCUTANEOUS, Q12H, STAT
		For any patient requiring oxygen or ventilatory support, consider addition of dexamethasone(NOTE)*
	dexAMETHasone
		6 mg, Tab, By Mouth, DAILY, duration: 10 Dose(s)/Time(s)
			Comment: Switch to IV Push if patient unable to take oral - pharmacy to update doses/times of remaining administrations.
	dexamethasone Injectable
		6 mg, Injection, IV Push, DAILY, duration: 10 Dose(s)/Time(s)
			Comment: Switch to BY MOUTH if patient able to take oral- pharmacy to update doses/times of remaining administrations.
	benzonatate
		100 mg, Capsule, By Mouth, TID, PRN for cough
		200 mg, Capsule, By Mouth, TID, PRN for cough
	codeine-guaifenesin 10 mg-100 mg/5 mL oral syrup
		5 mL, Syrup, By Mouth, Q4H, PRN for cough
Patient Care
	Isolation Precautions
		T;N, Special Droplet/Contact Isolation, Reason for Isolation: Covid-19
	Respiratory Assessment-Focused
		T;N, Q1H, 4, Dose(s)/Time(s)
			Comment: Acute respiratory distress monitor vital signs Q1h x 4 hours, then Q2h x 10 for total 24h. Then continue to monitor 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 24h.
		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 total 24h. Then continue to monitor 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 24h.
	Notify MD
		T;N, if anti Xa greater than 0.8
	Cardiac Telemetry Monitoring
		T;N
Therapies
	Consult Respiratory Therapy-Assess and Treat
		
Consults/Follow-up
	Pharmacy Consult
		Please exchange all nebulized medication to inhaler per formulary interchange

Care Directives
Patient Care
	Care Directive Resp Intubate
		Intubate as medically appropriate
		Short-term intubation only
		Do not intubate
		When extubated, do not reintubate
		Post op intubation of only __ days
	Care Directive Resp BiPAP
		Bipap as medically appropriate
		Short-term Bipap
		Do not use bipap
	Care Directive Resp Oxygen
		Oxygen as medically appropriate
		Do not use oxygen
		Do not increase oxygen
	Care Directive Resp Tracheostomy
		Tracheostomy as medically appropriate
		No tracheostomy
	Care Directive Transfer
		To ICU/higher Appropriate level of care
		Do not transfer to ICU
	Care Directive BP Vasopressors
		Use Medically Appropriate vasopressors
		Do not add additional vasopressors
		Do not increase rate of vasopressor(s)
		No vasopressors
	Care Directive Nutrition/Hydration Fluids
		Use IV fluids as medically appropriate
		Use TPN as medically appropriate
		Use enteral feedings as appropriate
		Use NG tube as medically appropriate
		Use PEG tube as medically appropriate
	Care Directive BP Parenteral Fluids
		IV  bolus or increased IV as appropriate
		No IV bolus to treat low blood pressure
	Care Directive Nutrition/Hydration TPN
		Use TPN as medically appropriate
		Limit TPN
		No TPN use
	Care Directive Nutrition/Hydration Enteral Feeding
		Use enteral feedings as appropriate
		Limit enteral feedings
		No enteral feedings
	Care Directive Nutrition/Hydration NG Tube
		Use NG tube as medically appropriate
		Limit NG tube
		No NG tube use regardless
	Care Directive Nutrition/Hydration PEG Tube
		Use PEG tube as medically appropriate
		Limit PEG tube
		No PEG tube
	Care Directive Dialysis
		Use dialysis as medically appropriate
		Limit dialysis
		No dialysis
	Care Directive Blood Products
		Use blood products medically appropriate
		Limit blood products
		No blood products
	Care Directive Antibiotics
		Use antibiotics as medically appropriate
		Limit antibiotics
		No antibiotics
	Care Directive Additional Individualized Decisions
		Full aggressive care
		Other

*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