Unique Plan Description: ED OB Delivery
Plan Selection Display: ED OB Delivery
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2019-12-03 10:41:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-11-26 09:24:31
Available at all facilities: Yes

ED OB Delivery
Vital Signs
	Vital Signs
		T;N
			Comment: every 15 minutes until stable, then every hour for the first 4 hours, then every 2 hours if clinically stable
Activity
	Position Patient
		T;N
			Comment: position on either side with a wedge behind her hip for support
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Glucose POC - RN
		T;N
	Tissue Request Placenta
		T;N, Placenta
IV Solutions
	oxytocin 30 units/500mL Premix IV
		500 mL, IV, Routine, T;N
			Comment: Infuse 15 units over 15 minutes (999mL/hr) immediately post partum Followed by 15 units over 3 hours (83.3mL/hr) immediately after first bolus dose is completed - The Initial postpartum infusion rate may be decreased prior to 15 minutes based on patient's clinical status and communication between the surgeon and anesthesia provider. - RN will be responsible to adjust IV rate.
		30 units, EVERY BAG, 59.94 units/hr
	Lactated Ringers Injection
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 999 ml/hr
	Sodium Chloride 0.9%
		500 mL, IV, STAT, 1 Dose(s)/Time(s), 999 ml/hr
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 999 ml/hr
Medications
	Pitocin
		10 units, Injection, IV Push, Once, STAT
	Cytotec
		800 mcg, Tab, RECTALLY, Once, STAT
	Methergine
		0.2 mg, Injection, IM-Intramuscular, Once, STAT
	Hemabate
		250 mcg, Injection, IM-Intramuscular, Q15MIN, PRN uterine relaxation, duration: 8 Dose(s)/Time(s)
			Comment: Avoid in asthmatic patients.  Relative contraindication if hepatic, renal and cardiac disease
	terbutaline
		0.25 mg, Injection, SUBCUTANEOUS, Once, STAT
			Comment: Do not give if pulse is > 120
Patient Care
	Peripheral Lock-Insert
		T;N, Once
	Notify MD
		If SBP >160 mmHg and/or DBP >110 mmHg, P: >120 or <50, O2 Sat: <90%, RR: <10 or >30, Oliguria: <60 mL in 2 hours, Single Temp > 39.0C (102.2F), OR 2 temps between 38.0C (100.4F) and 39C (102.2F), at least 30 min apart
	Pulse Ox, Continuous
		T;N
			Comment: CONTINUOUSLY
	Fetal Monitoring
		T;N
			Comment: Obtain baseline fetal monitoring for 30 minutes.  Comment: L&D RN to complete
	Oxygen Therapy, Nurse to Administer
		Via Non-rebreathing Mask, O2 @ 10-15L/min, Continuous
	External Toco Monitoring
		T;N
			Comment: L&D RN to come from WH L&D department for assessment to assess labor status
	Non-stress test
		T;N
			Comment: L&D RN to come from WH L&D department for assessment to assess labor status
Consults/Follow-up
	Consult OB/GYN
		Reason for Referral: Pending delivery
	Consult Neonatologist
		Reason for Referral: NNP for pending delivery

ED Lab Rainbow
Laboratory
	Extra Drk Grn Tube
		T;N, Stat, spec type = Blood
	Extra EDTA Tube
		T;N, Stat, spec type = Blood
	Extra NaCit Tube
		T;N, Stat, spec type = Blood
	Extra PST Tube
		T;N, Stat, spec type = Blood
		T;N, Stat, spec type = Blood
	Extra SST Tube
		T;N, Stat, spec type = Blood
	Extra NaFlor Tube
		T;N, Stat, spec type = Blood

ED Newborn Delivery
IV Solutions
	Dextrose 10% intravenous soln (Bolus)
		5 mL/kg, Solution, IV Push, Once, NOW
			Comment: Max of 250mL/dose
		10 mL/kg, Solution, IV Push, Once, NOW
			Comment: Max of 250mL/dose

OB GBS Prophylaxis Protocol
Medications
	penicillin G potassium
		6 millionunits, Injection-Premix, IVPB, Once, GBS prophylaxis, STAT
		3 millionunits, Injection-Premix, IVPB, Q4H, GBS prophylaxis
		Low Risk penicillin Allergy--If patient has a penicillin allergy and is at low risk for anaphylaxis, select the 2 ceFAZolin (Ancef) orders below:(NOTE)*
	Ancef IVPB
		2,000 mg, Injection-Premix, IVPB, Once, Other- type in, GBS prophylaxis, STAT, 100 ml/hr
		1,000 mg, Injection-Premix, IVPB, Q8H, Other- type in, GBS prophylaxis, 100 ml/hr
	Ancef IVPB (FH)
		2,000 mg, Injection-Premix, IVPB, Once, Other- type in, GBS Prophylaxis, STAT, 100 ml/hr
		1,000 mg, INT, IVPB, Q8H, Other- type in, GBS Prophylaxis, 100 ml/hr
		High Risk Penicillin Allergy  WITH documented sensitivity--If patient has a high risk Penicillin allergy AND there is documented GBS sensitivity to Clindamycin select order below:(NOTE)*
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, Q8H, Other- type in, GBS prophylaxis, STAT
		High Risk Penicillin Allergy with resistance OR no sensitivity testing--If patient has a high risk Penicillin allergy AND there is documented Clindamycin resistance OR no sensitivity testing completed, select the vancomycin order below:(NOTE)*
	vancomycin IVPB
		20 mg/kg, Injection-Premix, IVPB, Q8H, Indication: Other- type in, GBS prophylaxis, STAT
			Comment: Maximum single dose is 2000mg; please ensure doses greater than 1000mg are infused no faster than 500mg/30 min to prevent infusion related reactions.
	vancomycin IVPB (FH)
		20 mg/kg, Injection-Premix, IVPB, Q8H, Indication: Other- type in, GBS Prophylaxis, STAT
			Comment: Comment: Maximum single dose is 2000mg; please ensure doses greater than 1000mg are infused no faster than 500mg/30 min to prevent infusion related reactions

*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